Once you memorize these ANCC-CVNC Exam Questions, you will get 100% marks.

We regarded with our acknowledgment of assisting individuals with breezing through the ANCC (RN-BC) Cardiac-Vascular Nursing assessment of their absolute first endeavor with our most recent, legitimate, and exceptional ANCC-CVNC test questions and replies. Our prosperity during the beyond two years has been totally heavenly, Thanks to our happy clients who are presently ready to get advancements in their individual associations. killexams.com is the main decision among certificate experts.

Exam Code: ANCC-CVNC Practice test 2023 by Killexams.com team
ANCC-CVNC ANCC (RN-BC) Cardiac-Vascular Nursing

The ANCC Cardiac-Vascular Nursing board certification examination is a competency based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of registered nurses in the cardiac-vascular specialty after initial RN licensure. Once you complete eligibility requirements to take the certification examination and successfully pass the exam, you are awarded the credential: Registered Nurse-Board Certified (RN-BC). This credential is valid for 5 years. You can continue to use this credential by maintaining your license to practice and meeting the renewal requirements in place at the time of your certification renewal. The Accreditation Board for Specialty Nursing Certification accredits this ANCC certification

There are 150 questions on this examination. Of these, 125 are scored questions and 25 are pretest questions that are not scored. Pretest questions are used to determine how well these questions will perform before they are used on the scored portion of the examination. The pretest questions cannot be distinguished from those that will be scored, so it is important for a candidate to answer all questions. A candidate's score, however, is based solely on the 125 scored questions. Performance on pretest questions does not affect a candidate's score.

I Assessment and Diagnosis 31 25%
II Planning and Implementation 44 35%
III Evaluation and Modification 28 22%
IV Patient and Community Education 22 18%
TOTAL 125 100%

Assessment and Diagnosis
A. Knowledge
1. Anatomy and physiology
2. Pathophysiology
B. Skill
1. Patient interview (e.g., history, chief complaint, allergies)
2. Cardiac-vascular assessment techniques and tools (e.g., Doppler, stroke scale)
3. Data collection and interpretation (e.g., diagnostic tests, laboratory results)
4. Nursing diagnosis identification and prioritization
II Planning and Implementation
A. Knowledge
1. Evidence-based practice guidelines (e.g., ACC/AHA guidelines, quality measures)
2. Scope and standards of practice (i.e., cardiovascular nursing, vascular nursing)
3. Legal and ethical considerations (e.g., informed consent, advance directives)
4. Procedures (e.g., angiogram)
5. Surgeries (e.g., coronary artery bypass, carotid endarterectomy)
6. Pharmacologic therapies
7. Non-pharmacologic and complementary therapies
8. Risk-reduction measures (e.g., venous thromboembolism prophylaxis)
B. Skill
1. Care coordination (e.g., interdisciplinary teams, discharge planning)
2. Interventions (e.g., therapeutic hypothermia)
III Evaluation and Modification
A. Knowledge
1. Expected outcomes
2. Drug interactions (e.g., drug-drug, drug-food)
B. Skill
1. Adverse reactions and events (e.g., heparin-induced thrombocytopenia, hypotension) recognition and treatment
2. Urgent condition (e.g., pseudoaneurysm) recognition and treatment
3. Emergent condition (e.g., STEMI) recognition and treatment
IV Patient and Community Education
A. Knowledge
1. Cardiac-vascular risk factors (e.g., ethnicity, smoking)
2. Chronic disease management
3. Cardiac-vascular education subjects (e.g., procedures, medications)
4. Self-management strategies (e.g., daily weights, blood pressure logs)
5. Community resources (e.g., cardiac rehabilitation, anticoagulation clinic)
B. Skill
1. Individualized education planning and implementation (e.g., addressing barriers)
2. Home monitoring (e.g., remote telemetry, point-of-care testing)
3. Health promotion (e.g., wellness counseling, health fairs)

ANCC (RN-BC) Cardiac-Vascular Nursing
Medical Cardiac-Vascular guide
Killexams : Medical Cardiac-Vascular guide - BingNews https://killexams.com/pass4sure/exam-detail/ANCC-CVNC Search results Killexams : Medical Cardiac-Vascular guide - BingNews https://killexams.com/pass4sure/exam-detail/ANCC-CVNC https://killexams.com/exam_list/Medical Killexams : Inside the Big Business of Clogged Arteries

On June 14, 2017, just before noon, a doctor made an incision near a patient’s groin. Kari Kirk, a representative for the world’s largest medical device company, Medtronic, looked on and began texting her colleague a play-by-play.

“Fixing both legs from the ankles,” she wrote.

It was a fairly common procedure at the Robert J. Dole Veterans Affairs Medical Center in Wichita, Kansas, performed to treat blockages in the leg vessels.

Within reach were an array of Medtronic products: tubes with blades attached to shave hardened deposits off of artery walls; stents to widen blood vessels; balloons coated with therapeutic drugs.

Each time a doctor puts a foreign device in someone’s body, it carries a risk of complication, which can include clots or even require amputation. So medical experts, research and even Medtronic’s own device instructions urge doctors to use as few as are necessary.

But, as revealed in Kirk’s text messages, this doctor took an aggressive approach.

“Just used 12 [drug-coated balloons]!!” Kirk texted her colleague.

“Does that mean I owe u $$,” he responded.

“Thats what I'm thinking!!!,” she said. “And now 14 balloons!?

“but only one stent so far??”

“So far!”

As the texting continued, her colleague replied, “U are going to want to start going to the VA all the time.”

The messages, recently unsealed in an ongoing whistleblower lawsuit, deliver a window into the way money and medicine mingle in the booming business of peripheral artery disease, a condition that afflicts 6.5 million Americans over age 40 and is caused when fatty plaque builds up in arteries, blocking blood flow to the legs.

Representatives from companies are often present during vascular procedures to guide doctors on how to use their complex devices. This kind of access has the potential to influence treatment plans, as companies and their representatives profit when more of their product is used.

The suit, filed in 2017 by a sales representative for a competing medical device firm, alleges an illegal kickback scheme between Medtronic and hospital employees. According to the complaint and documents released in the suit, between 2011 and 2018, VA health care workers received steakhouse dinners, Apple electronics and NASCAR tickets, and in turn, Medtronic secured a lucrative contract with the hospital. Meanwhile, the company's representatives allegedly “groomed and trained” physicians at the facility, who then deployed the company’s devices even when it was not medically indicated.

Independent from the whistleblower suit, internal investigators at the Wichita facility have also examined the treatment patterns of its vascular patients in latest years and found numerous cases where medical devices were used excessively. While it’s not uncommon to deploy several devices, a medical expert on the investigation team found that the VA doctors sometimes used more than 15 at a time — one used 33 — deviating from the standard of care.

“It is unconscionable — there can be no valid medically acceptable basis to cram so many devices into a human being,” wrote attorneys representing the whistleblower in legal filings from January 2023. “This is not medical treatment. This is abuse.”

Dr. Kim Hodgson, former president of the Society for Vascular Surgery and an expert retained by the plaintiff, said the findings of the internal review of patient data raise “a high level of concern regarding necessity of treatment provided,” according to case documents.

Medtronic declined to respond to ProPublica’s questions, citing the ongoing litigation. “These allegations are false and Medtronic is defending against these claims in court,” said Boua Xiong, a spokesperson for the company. Medtronic representative Kirk declined to respond to ProPublica’s request for comment.

The hospital investigation found that amputations increased sixfold in the same time frame as the procedures in question, according to internal emails, but made no conclusion about whether those two things were connected. ProPublica reached out to the VA to ask whether any patients had been harmed.

The VA is “conducting an extensive review of patient care” at the Kansas hospital, “including the number of devices used on patients — to make sure that Veterans were not harmed by any procedures,” press secretary Terrence Hayes said. So far, the VA’s investigation has found no “quality of care issues,” he said, and the investigation will continue “until every Veteran’s case has been reviewed.” (Read the full statement here.) Neither the department nor the hospital has taken formal action against the medical providers, Hayes said.

The medical group that had a contract with the VA for vascular interventions, Wichita Radiological Group, did not respond to ProPublica’s requests for comment, nor did the doctors named in the suit: Dr. Shaun Gonda, Dr. Bret Winblad and Dr. Kermit Rust. It is unclear from the case documents which doctors conducted which procedures. Eric Barth, an attorney for the medical group, denied the allegations in recent legal filings, calling the claims “baseless” and the lawsuit a “witch hunt.”

The lawsuit comes amid growing concern about one of these procedures — atherectomies — after researchers and doctors have uncovered patterns of excessive and inappropriate use. latest research has found that this procedure, a common but costly treatment to shave or laser plaque from blood vessels, is not more effective than cheaper alternatives and may even be associated with a higher risk of complications including amputation. In latest years, several doctors and clinics have been investigated for allegedly taking advantage of Medicare’s reimbursement rates, and one study found that many doctors are resorting to atherectomies in the earliest stages of peripheral artery disease, against best practices that urge noninvasive treatment.

“Atherectomy is important in certain settings. But it’s being used in a way that is entirely inappropriate and it’s largely driven by the incentive structure,” said Dr. Caitlin Hicks, the lead author of the study and an associate professor of surgery at Johns Hopkins University School of Medicine.

Although different payment structures govern the care of veterans, the whistleblower lawsuit alleges that outside physicians, paid hourly by the Dole VA, were motivated to conduct longer and more complex procedures that would earn them higher payment.

Under different circumstances, the patient in the procedure room on that summer day could have been done after two hours.

But, 150 minutes in, those Medtronic representatives were still texting. At that point, more than 15 of their vascular devices had been used, including stents, balloons and those for atherectomy.

“Long case!” Kirk’s colleague texted. “Is it looking ok??”

“It is,” she said. “Thought we were done a few times! Now he’s going back in to cut again!”

A little while later, she texted: “....17!”

Hospital leaders had been scrutinizing the use of these procedures at the Dole VA for years.

In 2017, shortly after Rick Ament was hired to lead the facility, he noticed something was amiss. While the longtime hospital administrator was poring over the finances, he was alarmed to discover that the relatively small Dole VA had one of the most expensive cardiac programs in the country. As Ament dug deeper, he realized vascular interventions were the reason.

“It just did not make sense that the acuity level of our patients would generate such extreme cost variances from the norm,” he testified in December, in a deposition for the whistleblower case. “It was so significant, we needed to get to the bottom of it.”

Ament, a second generation Air Force veteran, quietly assembled a task force to investigate why the facility had purchased so many medical devices for these procedures. After they examined inventory records, calculating the total number of medical devices and the cost of devices per patient, they grew concerned.

“We were more expensive than, I believe it was, the top 10 hospitals in the VA combined,” he said. “My feeling was that we either had very, very bad providers or we had product walking out the door.”

Ament enlisted experts from other VA hospitals to help his team investigate, including an administrative officer who could understand finances and a respected interventional radiologist who could examine records. The task force gathered a list of patients from 2016 to 2018, according to internal emails, and analyzed their medical charts.

According to internal VA documents released through the whistleblower suit, the review found a number of clinical failings: Evidence-based medicine had not been followed in the majority of cases reviewed. Procedures were over-aggressive, treating lesions that should have been left alone. And there was a total disregard for established best practices for treating peripheral artery disease.

One of the experts on the investigative team explained to Ament that while it was not uncommon for doctors to use a couple of devices in one intervention, the total number of devices in many of the procedures at his facility went into the double digits, sometimes five times the expected amount.

In one encounter, a doctor deployed 33 devices in one procedure — three atherectomy devices, nine stents and 21 balloons.

This use of devices was exorbitant, Ament came to understand. “I want to say the term ‘egregious’ was used,” he testified. “It was kind of like validation, but I really wish I was wrong.”

“Did it make you concerned for patient care?” a lawyer asked during the deposition.

“It did,” Ament replied.

A member of his task force pulled data for veterans who had leg amputations due to vascular disease. Over five years, the number of veterans who had amputations increased, from about six in 2013 to 38 in 2018, according to internal emails released in the suit. The VA did not respond to ProPublica’s questions about the rise in amputations or whether it was due to complications from the procedures.

Even though Ament testified in December 2022 that he became aware of the excessive use of devices during his investigation that began about five years ago, neither he nor the VA have publicly acknowledged these findings outside of the lawsuit. It is unclear whether VA representatives informed the patients whose records were reviewed about their findings. ProPublica reached out to more than half a dozen veteran community groups in the Wichita area and none were aware of the investigation nor the allegations of overuse of vascular procedures at the facility.

The VA says that if its ongoing review finds instances of substandard care, it will reach out to affected patients and inform them about possible complications and benefits they may be entitled to. The press secretary said the review will take several months. Ament declined to respond to ProPublica’s questions, citing the ongoing case.

In 2018, Ament turned over his findings to the criminal division of the VA’s Office of Inspector General. He also shut down interventional radiology procedures at the facility’s catheter lab.

Federal agents separately opened an investigation into the same unit in the facility, looking into allegations of kickbacks.

More than 40 pages of expense reports from Medtronic, revealed in the whistleblower case, show sales representatives treating Dole health care workers to hundreds of meals over several years — lunches at Dempsey’s Biscuit Co.; business meals at the Scotch & Sirloin steakhouse; dinner at Chester’s Chophouse & Wine Bar, price per attendee: $122.39.

Federal agents obtained the receipts.

“Robert J. Dole VAMC employees may have received improper gratuities, in the forms of paid lunches, dinners, etc., from sales representatives from Medtronic,” wrote Nathen Howard, a special agent in the VA OIG, in an investigation memo from February 2019.

This kind of relationship could violate VA policy, which forbids federal employees from receiving any gifts, including meals, from people who do business or seek to do business with a federal institution. For health care workers, violating this policy could have serious implications for patients. Numerous studies have shown that even modest industry-sponsored gifts, including meals, may influence prescribing or treatment behavior of health care professionals.

The agents opened their investigation into kickbacks at the Wichita facility in response to the whistleblower lawsuit, which was filed by Thomas Schroeder in 2017. The VA OIG would not confirm or deny whether it was continuing to investigate kickbacks at the facility. The VA did not directly answer ProPublica’s questions about kickbacks at the Dole VA, but it said that every employee must complete an annual ethics training, which covers gift rules.

In latest years, Medtronic has settled a handful of other cases that have alleged kickbacks between company representatives and health care professionals.

In 2018, Medtronic’s subsidiary Covidien paid $13 million to settle claims with the U.S. Department of Justice that it paid kickbacks to health care institutions that used its mechanical blood clot devices. In 2019, the same subsidiary paid $17 million to resolve allegations that it provided in-kind marketing support to doctors using its vein products. And in 2020, Medtronic paid more than $8 million to settle claims that representatives had paid kickbacks to a neurosurgeon, including scores of lavish meals at a restaurant that the doctor owned, to induce him to purchase the company’s medication pumps.

Schroeder’s lawsuit is not the first time Medtronic’s vascular devices were named in an alleged kickback scheme. In early 2015, Medtronic acquired Covidien, and shortly after the merger, its subsidiary ev3 Inc. agreed to pay $1.25 million to resolve allegations that it had paid doctors who were “high volume users” of its atherectomy devices to act as evangelists for the company, and had provided physicians with company shares to participate in clinical trials for their tools.

The whistleblower in this earlier case, a former sales representative for the company, also alleged that the subsidiary was gaming Medicare’s payment system. Hospitals were often hesitant to conduct atherectomy procedures because of the low reimbursement rates. According to the suit, sales representatives encouraged doctors to admit patients for longer stays to reap greater reimbursements and make a profit, even though such stays were often not medically indicated.

“Medical device makers that try to boost their profits by causing patients to be admitted for unnecessary and expensive inpatient hospital stays will be held accountable,” special agent Thomas O’Donnell, from the Office of Inspector General at the U.S. Department of Health and Human Services, said in a press release for the settlement. “Both patients and taxpayers deserve to have medical decisions made based on what is medically appropriate.”

Medtronic spokesperson Xiong said that in each case, the company “cooperated fully with the DOJ to resolve its concerns and, where wrongdoing was found, took appropriate remedial action.”

Seton Hall Law School professor Jacob Elberg, a former assistant U.S. attorney for the District of New Jersey who led its health care and government fraud unit, is concerned by the frequency of such settlements in the last two decades. “There are, at this point, dump questions as to whether the sanctions imposed by DOJ are sufficient to deter wrongdoing and to lead to meaningful change, especially within the medical device industry.”

Although the Department of Justice has declined to intervene in the lawsuit involving the Dole VA at this time, the case is ongoing and further depositions with Medtronic sales representatives and a former VA employee are scheduled for this month.

VA employees and doctors named in the suit declined to comment or did not respond to ProPublica’s questions about the alleged kickbacks and whether sales representatives may have influenced veterans’ treatment plans. In interviews with federal investigators, according to released transcripts, several of the employees who were questioned denied receiving frequent meals from sales representatives, contradicting Medtronic’s expense reports.

Their statements also stand in contrast to Medtronic representative Kari Kirk’s final text messages during that procedure in June 2017, which ultimately lasted more than three hours.

“Now u done??” her colleague asked.

“Just finished,” she texted. “Running to get them lunch!”

Annie Waldman is a reporter at ProPublica covering health care.

Fri, 17 Feb 2023 06:40:00 -0600 en text/html https://www.medscape.com/viewarticle/988448
Killexams : Irregular sleep may be harmful to your heart, study finds

Sign up for CNN’s Sleep, But Better newsletter series. Our seven-part guide has helpful hints to achieve better sleep.

CNN  — 

When you don’t get enough good sleep, the short-term consequences are noticeable — maybe you’re distracted at work or snappy with loved ones. But in the background, irregular and poor-quality sleeping patterns could increase your risk for developing cardiovascular disease, according to a study published this week in the Journal of the American Heart Association.

“This study is one of the first investigations to provide evidence of a connection between irregular sleep duration and irregular sleep timing and atherosclerosis,” said lead study author Kelsie Full, an assistant professor of medicine in the epidemiology division at Vanderbilt University Medical Center in Nashville.

Atherosclerosis is the buildup of plaque in arteries, according to the American Heart Association. This plaque is made up of cholesterol, fatty substances, cellular waste products, calcium and fibrin, a clotting agent in the blood. As plaque accumulates, blood vessel walls thicken, which reduces blood flow and therefore diminishes the amount of oxygen and other nutrients reaching the rest of the body. Atherosclerosis can lead to cardiovascular health conditions, including coronary heart disease, angina, heart attacks, strokes and carotid or peripheral artery disease.

Poor sleep — including poor quality, abnormal quantity and fragmented sleep — has been linked with cardiovascular disease and cardiovascular disease-related deaths before, but less had been known about the specific associations between sleep regularity and atherosclerosis.

Sleep regularity, the new study’s authors defined, is estimated by variations in sleep duration (how long someone sleeps each night) and sleep timing (the time when someone falls asleep nightly) — the fewer variations the better.

The authors set out to learn more about this relationship by analyzing the sleep of older adults — age 69 on average — who participated in the Multi-Ethnic Study of Atherosclerosis, a longitudinal cohort study designed to investigate the prevalence and progression of, and risk factors for, cardiovascular disease. More than 2,000 participants were recruited between 2000 and 2002 from Minnesota, Maryland, Illinois, North Carolina, California and New York state.

During sleep assessments conducted between 2010 and 2013, participants kept a sleep diary over seven consecutive days and wore a wristwatch that tracked their sleep and wake history. Participants also underwent an at-home sleep study to measure breathing, sleep stages, waking during the night and heart rate.

After participants’ cardiovascular health was assessed during the same time frame, the researchers found those with irregular sleep durations — those that varied by 90 minutes to more than two hours within a week — were about 1.4 times more likely to have high coronary artery calcium scores compared with those with more consistent sleep durations. (This calcium score measures the amount of calcified plaque in arteries; a higher number increases the risk of some cardiovascular conditions.) The former group was also more likely to have carotid plaque and abnormal results from a test assessing blood vessel stiffness.

“These results suggest that maintaining regular or habitual sleep durations, or sleeping close to the same total amount of time each night,” Full said, “may play an important role in preventing cardiovascular disease.”

Since sleep quality and atherosclerosis were measured at the same time, researchers weren’t able to assess or prove whether irregular sleep caused the condition — they found only an association between the two.

The findings of the study published Wednesday could be due to both a direct link between sleep and the heart, and/or other lifestyle factors.

“People with less sleep or irregular patterns do tend to have less healthy patterns in other lifestyles (like diet and physical activity),” Dr. Donald Lloyd-Jones, chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, said via email. Lloyd-Jones wasn’t involved in the study.

“Sleep is critical for the heart to be able to rest, as that is when heart rate slows and blood pressure normally dips,” he added. “Without that regular rest, the heart and vascular system are stressed over time.”

Whatever interrupts a person’s sleep could result in changes that affect the heart, said Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver. Freeman wasn’t involved in the research.

“Interrupted sleep — especially (in) those with sleep apnea — usually releases catecholamines like adrenaline, which can do all sorts of things if it’s a chronic problem,” Freeman said. Sleep interruptions can also be a sign of increased stress or anxiety, he added.

Still, the study’s findings were in participants with no history of cardiovascular disease, so everyone should take heed, Lloyd-Jones said.

“Sleep matters to all of us,” he added. “It is an important part of the Life’s Essential 8 approach to optimizing your cardiovascular health — which can also help prevent cancers, dementia and many other chronic diseases of aging.”

Life’s Essential 8 is the American Heart Association’s checklist for lifelong good health, which also includes eating healthy, being physically active, quitting tobacco, managing weight, controlling cholesterol and managing blood sugar and blood pressure.

The association recommends adults get seven to nine hours of sleep each night, which is more likely if you have sound sleep hygiene. That involves going to bed at the same time each night, waking at the same time daily, avoiding caffeine after late morning, using your bedroom for sleep and intimacy only, avoiding screen usage before bed and sleeping in a dark, quiet and cool room.

“I also recommend keeping a notebook next to the bed,” Freeman said. “Then when people wake up in the middle of the night, (they should) write down what comes to mind first. It could be they heard a bird or they had to pee or they had some stressor on their mind. And that may be a focus for when they meditate or do something mindful.”

If you have sleep apnea or persistent sleep issues, seek treatment from a sleep specialist or other clinician.

Fri, 17 Feb 2023 04:04:00 -0600 en text/html https://www.cnn.com/2023/02/17/health/irregular-sleep-heart-disease-risk-study-wellness/index.html
Killexams : Heart Month is the perfect time to address risk factors and take steps to prevent disease

Dr. Malur said up to 80% of heart disease is preventable if people adopt a healthy lifestyle. Some of the biggest risk factors for heart disease are smoking, obesity, high cholesterol and high blood sugar. However, people can address each of these.

Ochsner offers free services to help people stop smoking. Resources are available by visiting www.ochsner.org/quit or calling 888-673-0734.

Getting enough exercise, even something as simple as walking, can help people lose weight and Boost their heart function. Prescribed medications combined with a healthy diet can keep blood sugar and cholesterol in check.

“Prevention is key,” Dr. Malur said. “Once you take away or reduce those risk factors, the heart can remodel itself and perform better. It can also lessen any damage that may have already occurred.”

Interventional Cardiologist Bahij Khuri, M.D. (background), examines patient Adam MacDowell at Ochsner Health Center – O’Neal. MacDowell had two life-saving stents implanted by Dr. Khuri at Ochsner Medical Center – Baton Rouge.

Although starting an exercise regimen is often the most daunting idea for many people, Dr. Malur said even simple actions can make a big difference. Many studies show that if a person takes at least 10,000 steps each day, they can reduce their risk of heart disease, diabetes, hypertension, obesity, sleep apnea and more. For those interested in other activities, 150 minutes per week of moderate exercise such as biking, tennis, dancing, walking, swimming or other fitness activities can lead to major benefits.

“There’s a latest study from the CDC that says if someone moves around for just 21 and a half minutes a day, they can reduce their risk of death by about one-third,” Dr. Malur said. “You can spread out activity throughout the day during intervals if it’s not feasible to do it all at once. Simple things that increase your heart rate count, like yardwork, washing your car and chores around the house. It all adds up to make your heart stronger and better over time.”

Know Your Family History

Dr. Malur said many patients who experience heart disease have parents or grandparents who also had cardiac issues. Being knowledgeable about this history and discussing it with a physician can help guide treatment options.

Sat, 11 Feb 2023 15:00:00 -0600 en text/html https://www.theadvocate.com/sponsored/baton_rouge/ochsner_health/heart-month-is-the-perfect-time-to-address-risk-factors-and-take-steps-to-prevent/article_2c4093d2-a7eb-11ed-8585-179a66a34773.html
Killexams : Biggest medical device company allegedly "groomed" doctors to unnecessarily overuse their products

On June 14, 2017, just before noon, a doctor made an incision near a patient's groin. Kari Kirk, a representative for the world's largest medical device company, Medtronic, looked on and began texting her colleague a play-by-play.

"Fixing both legs from the ankles," she wrote.

It was a fairly common procedure at the Robert J. Dole Veterans Affairs Medical Center in Wichita, Kansas, performed to treat blockages in the leg vessels.

Within reach were an array of Medtronic products: tubes with blades attached to shave hardened deposits off of artery walls; stents to widen blood vessels; balloons coated with therapeutic drugs.

Each time a doctor puts a foreign device in someone's body, it carries a risk of complication, which can include clots or even require amputation. So medical experts, research and even Medtronic's own device instructions urge doctors to use as few as are necessary.

But, as revealed in Kirk's text messages, this doctor took an aggressive approach.

"Just used 12 [drug-coated balloons]!!" Kirk texted her colleague.

"Does that mean I owe u $$," he responded.

"Thats what I'm thinking!!!" she said. "And now 14 balloons!"

"-but only one stent so far??"

"So far!"

As the texting continued, her colleague replied, "U are going to want to start going to the VA all the time."

The messages, recently unsealed in an ongoing whistleblower lawsuit, deliver a window into the way money and medicine mingle in the booming business of peripheral artery disease, a condition that afflicts 6.5 million Americans over age 40 and is caused when fatty plaque builds up in arteries, blocking blood flow to the legs.

Representatives from companies are often present during vascular procedures to guide doctors on how to use their complex devices. This kind of access has the potential to influence treatment plans, as companies and their representatives profit when more of their product is used.

The suit, filed in 2017 by a sales representative for a competing medical device firm, alleges an illegal kickback scheme between Medtronic and hospital employees. According to the complaint and documents released in the suit, between 2011 and 2018, VA health care workers received steakhouse dinners, Apple electronics and NASCAR tickets, and in turn, Medtronic secured a lucrative contract with the hospital. Meanwhile, the company's representatives allegedly "groomed and trained" physicians at the facility, who then deployed the company's devices even when it was not medically indicated.

Independent from the whistleblower suit, internal investigators at the Wichita facility have also examined the treatment patterns of its vascular patients in latest years and found numerous cases where medical devices were used excessively. While it's not uncommon to deploy several devices, a medical expert on the investigation team found that the VA doctors sometimes used more than 15 at a time — one used 33 — deviating from the standard of care.

"It is unconscionable — there can be no valid medically acceptable basis to cram so many devices into a human being," wrote attorneys representing the whistleblower in legal filings from January 2023. "This is not medical treatment. This is abuse."

Dr. Kim Hodgson, former president of the Society for Vascular Surgery and an expert retained by the plaintiff, said the findings of the internal review of patient data raise "a high level of concern regarding necessity of treatment provided," according to case documents.

Medtronic declined to respond to ProPublica's questions, citing the ongoing litigation. "These allegations are false and Medtronic is defending against these claims in court," said Boua Xiong, a spokesperson for the company. Medtronic representative Kirk declined to respond to ProPublica's request for comment.

The hospital investigation found that amputations increased sixfold in the same time frame as the procedures in question, according to internal emails, but made no conclusion about whether those two things were connected. ProPublica reached out to the VA to ask whether any patients had been harmed.

The VA is "conducting an extensive review of patient care" at the Kansas hospital, "including the number of devices used on patients — to make sure that Veterans were not harmed by any procedures," press secretary Terrence Hayes said. So far, the VA's investigation has found no "quality of care issues," he said, and the investigation will continue "until every Veteran's case has been reviewed." (Read the full statement here.) Neither the department nor the hospital has taken formal action against the medical providers, Hayes said.

The medical group that had a contract with the VA for vascular interventions, Wichita Radiological Group, did not respond to ProPublica's requests for comment, nor did the doctors named in the suit: Dr. Shaun Gonda, Dr. Bret Winblad and Dr. Kermit Rust. It is unclear from the case documents which doctors conducted which procedures. Eric Barth, an attorney for the medical group, denied the allegations in latest legal filings, calling the claims "baseless" and the lawsuit a "witch hunt."

The lawsuit comes amid growing concern about one of these procedures — atherectomies — after researchers and doctors have uncovered patterns of excessive and inappropriate use. latest research has found that this procedure, a common but costly treatment to shave or laser plaque from blood vessels, is not more effective than cheaper alternatives and may even be associated with a higher risk of complications including amputation. In latest years, several doctors and clinics have been investigated for allegedly takingadvantage of Medicare's reimbursement rates, and one study found that many doctors are resorting to atherectomies in the earliest stages of peripheral artery disease, against best practices that urge noninvasive treatment.

"Atherectomy is important in certain settings. But it's being used in a way that is entirely inappropriate and it's largely driven by the incentive structure," said Dr. Caitlin Hicks, the lead author of the study and an associate professor of surgery at Johns Hopkins University School of Medicine.

Although different payment structures govern the care of veterans, the whistleblower lawsuit alleges that outside physicians, paid hourly by the Dole VA, were motivated to conduct longer and more complex procedures that would earn them higher payment.

Under different circumstances, the patient in the procedure room on that summer day could have been done after two hours.

But, 150 minutes in, those Medtronic representatives were still texting. At that point, more than 15 of their vascular devices had been used, including stents, balloons and those for atherectomy.

"Long case!" Kirk's colleague texted. "Is it looking ok??"

"It is," she said. "Thought we were done a few times! Now he's going back in to cut again!"

A little while later, she texted: "....17!"

He texted back a series of laughing emojis.

Hospital leaders had been scrutinizing the use of these procedures at the Dole VA for years.

In 2017, shortly after Rick Ament was hired to lead the facility, he noticed something was amiss. While the longtime hospital administrator was poring over the finances, he was alarmed to discover that the relatively small Dole VA had one of the most expensive cardiac programs in the country. As Ament dug deeper, he realized vascular interventions were the reason.

"It just did not make sense that the acuity level of our patients would generate such extreme cost variances from the norm," he testified in December, in a deposition for the whistleblower case. "It was so significant, we needed to get to the bottom of it."

Ament, a second generation Air Force veteran, quietly assembled a task force to investigate why the facility had purchased so many medical devices for these procedures. After they examined inventory records, calculating the total number of medical devices and the cost of devices per patient, they grew concerned.

"We were more expensive than, I believe it was, the top 10 hospitals in the VA combined," he said. "My feeling was that we either had very, very bad providers or we had product walking out the door."

Ament enlisted experts from other VA hospitals to help his team investigate, including an administrative officer who could understand finances and a respected interventional radiologist who could examine records. The task force gathered a list of patients from 2016 to 2018, according to internal emails, and analyzed their medical charts.

According to internal VA documents released through the whistleblower suit, the review found a number of clinical failings: Evidence-based medicine had not been followed in the majority of cases reviewed. Procedures were over-aggressive, treating lesions that should have been left alone. And there was a total disregard for established best practices for treating peripheral artery disease.

One of the experts on the investigative team explained to Ament that while it was not uncommon for doctors to use a couple of devices in one intervention, the total number of devices in many of the procedures at his facility went into the double digits, sometimes five times the expected amount.

In one encounter, a doctor deployed 33 devices in one procedure — three atherectomy devices, nine stents and 21 balloons.

This use of devices was exorbitant, Ament came to understand. "I want to say the term 'egregious' was used," he testified. "It was kind of like validation, but I really wish I was wrong."

"Did it make you concerned for patient care?" a lawyer asked during the deposition.

"It did," Ament replied.

A member of his task force pulled data for veterans who had leg amputations due to vascular disease. Over five years, the number of veterans who had amputations increased, from about six in 2013 to 38 in 2018, according to internal emails released in the suit. The VA did not respond to ProPublica's questions about the rise in amputations or whether it was due to complications from the procedures.

Even though Ament testified in December 2022 that he became aware of the excessive use of devices during his investigation that began about five years ago, neither he nor the VA have publicly acknowledged these findings outside of the lawsuit. It is unclear whether VA representatives informed the patients whose records were reviewed about their findings. ProPublica reached out to more than half a dozen veteran community groups in the Wichita area and none were aware of the investigation nor the allegations of overuse of vascular procedures at the facility.

The VA says that if its ongoing review finds instances of substandard care, it will reach out to affected patients and inform them about possible complications and benefits they may be entitled to. The press secretary said the review will take several months. Ament declined to respond to ProPublica's questions, citing the ongoing case.

In 2018, Ament turned over his findings to the criminal division of the VA's Office of Inspector General. He also shut down interventional radiology procedures at the facility's catheter lab.

Federal agents separately opened an investigation into the same unit in the facility, looking into allegations of kickbacks.

More than 40 pages of expense reports from Medtronic, revealed in the whistleblower case, show sales representatives treating Dole health care workers to hundreds of meals over several years — lunches at Dempsey's Biscuit Co.; business meals at the Scotch & Sirloin steakhouse; dinner at Chester's Chophouse & Wine Bar, price per attendee: $122.39.

Federal agents obtained the receipts.

"Robert J. Dole VAMC employees may have received improper gratuities, in the forms of paid lunches, dinners, etc., from sales representatives from Medtronic," wrote Nathen Howard, a special agent in the VA OIG, in an investigation memo from February 2019.

This kind of relationship could violate VA policy, which forbids federal employees from receiving any gifts, including meals, from people who do business or seek to do business with a federal institution. For health care workers, violating this policy could have serious implications for patients. Numerous studies have shown that even modest industry-sponsored gifts, including meals, may influence prescribing or treatment behavior of health care professionals.

The agents opened their investigation into kickbacks at the Wichita facility in response to the whistleblower lawsuit, which was filed by Thomas Schroeder in 2017. The VA OIG would not confirm or deny whether it was continuing to investigate kickbacks at the facility. The VA did not directly answer ProPublica's questions about kickbacks at the Dole VA, but it said that every employee must complete an annual ethics training, which covers gift rules.

In latest years, Medtronic has settled a handful of other cases that have alleged kickbacks between company representatives and health care professionals.

In 2018, Medtronic's subsidiary Covidien paid $13 million to settle claims with the U.S. Department of Justice that it paid kickbacks to health care institutions that used its mechanical blood clot devices. In 2019, the same subsidiary paid $17 million to resolve allegations that it provided in-kind marketing support to doctors using its vein products. And in 2020, Medtronic paid more than $8 million to settle claims that representatives had paid kickbacks to a neurosurgeon, including scores of lavish meals at a restaurant that the doctor owned, to induce him to purchase the company's medication pumps.

Schroeder's lawsuit is not the first time Medtronic's vascular devices were named in an alleged kickback scheme. In early 2015, Medtronic acquired Covidien, and shortly after the merger, its subsidiary ev3 Inc.agreed to pay $1.25 million to resolve allegations that it had paid doctors who were "high volume users" of its atherectomy devices to act as evangelists for the company, and had provided physicians with company shares to participate in clinical trials for their tools.

The whistleblower in this earlier case, a former sales representative for the company, also alleged that the subsidiary was gaming Medicare's payment system. Hospitals were often hesitant to conduct atherectomy procedures because of the low reimbursement rates. According to the suit, sales representatives encouraged doctors to admit patients for longer stays to reap greater reimbursements and make a profit, even though such stays were often not medically indicated.

"Medical device makers that try to boost their profits by causing patients to be admitted for unnecessary and expensive inpatient hospital stays will be held accountable," special agent Thomas O'Donnell, from the Office of Inspector General at the U.S. Department of Health and Human Services, said in a press release for the settlement. "Both patients and taxpayers deserve to have medical decisions made based on what is medically appropriate."

Medtronic spokesperson Xiong said that in each case, the company "cooperated fully with the DOJ to resolve its concerns and, where wrongdoing was found, took appropriate remedial action."

Seton Hall Law School professor Jacob Elberg, a former assistant U.S. attorney for the District of New Jersey who led its health care and government fraud unit, is concerned by the frequency of such settlements in the last two decades. "There are, at this point, dump questions as to whether the sanctions imposed by DOJ are sufficient to deter wrongdoing and to lead to meaningful change, especially within the medical device industry."

Although the Department of Justice has declined to intervene in the lawsuit involving the Dole VA at this time, the case is ongoing and further depositions with Medtronic sales representatives and a former VA employee are scheduled for this month.

VA employees and doctors named in the suit declined to comment or did not respond to ProPublica's questions about the alleged kickbacks and whether sales representatives may have influenced veterans' treatment plans. In interviews with federal investigators, according to released transcripts, several of the employees who were questioned denied receiving frequent meals from sales representatives, contradicting Medtronic's expense reports.

Their statements also stand in contrast to Medtronic representative Kari Kirk's final text messages during that procedure in June 2017, which ultimately lasted more than three hours.

"Now u done??" her colleague asked.

"Just finished," she texted. "Running to get them lunch!"

Editor's Note: A photo previously used to art this story showed a product unrelated to the allegations.

Thu, 16 Feb 2023 00:59:00 -0600 en text/html https://www.salon.com/2023/02/16/biggest-device-company-allegedly-groomed-doctors-to-unnecessarily-overuse-their-products_partner/
Killexams : Steak Dinners, Sales Reps and Risky Procedures: Inside the Big Business of Clogged Arteries

On June 14, 2017, just before noon, a doctor made an incision near a patient’s groin. Kari Kirk, a representative for the world’s largest medical device company, Medtronic, looked on and began texting her colleague a play-by-play.

“Fixing both legs from the ankles,” she wrote.

It was a fairly common procedure at the Robert J. Dole Veterans Affairs Medical Center in Wichita, Kansas, performed to treat blockages in the leg vessels.

Within reach were an array of Medtronic products: tubes with blades attached to shave hardened deposits off of artery walls; stents to widen blood vessels; balloons coated with therapeutic drugs.

Each time a doctor puts a foreign device in someone’s body, it carries a risk of complication, which can include clots or even require amputation. So medical experts, research and even Medtronic’s own device instructions urge doctors to use as few as are necessary.

But, as revealed in Kirk’s text messages, this doctor took an aggressive approach.

“Just used 12 [drug-coated balloons]!!” Kirk texted her colleague.

“Does that mean I owe u $$,” he responded.

“Thats what I'm thinking!!! 🤣,” she said. “And now 14 balloons!😳”

“😜- but only one stent so far??”

“So far!”

As the texting continued, her colleague replied, “U are going to want to start going to the VA all the time.”

The messages, recently unsealed in an ongoing whistleblower lawsuit, deliver a window into the way money and medicine mingle in the booming business of peripheral artery disease, a condition that afflicts 6.5 million Americans over age 40 and is caused when fatty plaque builds up in arteries, blocking blood flow to the legs.

Representatives from companies are often present during vascular procedures to guide doctors on how to use their complex devices. This kind of access has the potential to influence treatment plans, as companies and their representatives profit when more of their product is used.

The suit, filed in 2017 by a sales representative for a competing medical device firm, alleges an illegal kickback scheme between Medtronic and hospital employees. According to the complaint and documents released in the suit, between 2011 and 2018, VA health care workers received steakhouse dinners, Apple electronics and NASCAR tickets, and in turn, Medtronic secured a lucrative contract with the hospital. Meanwhile, the company's representatives allegedly “groomed and trained” physicians at the facility, who then deployed the company’s devices even when it was not medically indicated.

Independent from the whistleblower suit, internal investigators at the Wichita facility have also examined the treatment patterns of its vascular patients in latest years and found numerous cases where medical devices were used excessively. While it’s not uncommon to deploy several devices, a medical expert on the investigation team found that the VA doctors sometimes used more than 15 at a time — one used 33 — deviating from the standard of care.

“It is unconscionable — there can be no valid medically acceptable basis to cram so many devices into a human being,” wrote attorneys representing the whistleblower in legal filings from January 2023. “This is not medical treatment. This is abuse.”

Dr. Kim Hodgson, former president of the Society for Vascular Surgery and an expert retained by the plaintiff, said the findings of the internal review of patient data raise “a high level of concern regarding necessity of treatment provided,” according to case documents.

Medtronic declined to respond to ProPublica’s questions, citing the ongoing litigation. “These allegations are false and Medtronic is defending against these claims in court,” said Boua Xiong, a spokesperson for the company. Medtronic representative Kirk declined to respond to ProPublica’s request for comment.

The hospital investigation found that amputations increased sixfold in the same time frame as the procedures in question, according to internal emails, but made no conclusion about whether those two things were connected. ProPublica reached out to the VA to ask whether any patients had been harmed.

The VA is “conducting an extensive review of patient care” at the Kansas hospital, “including the number of devices used on patients — to make sure that Veterans were not harmed by any procedures,” press secretary Terrence Hayes said. So far, the VA’s investigation has found no “quality of care issues,” he said, and the investigation will continue “until every Veteran’s case has been reviewed.” (Read the full statement here.) Neither the department nor the hospital has taken formal action against the medical providers, Hayes said.

The Robert J. Dole Veterans Affairs Medical Center in Wichita, Kansas Credit: Jeffrey Beall/Wikipedia Commons

The medical group that had a contract with the VA for vascular interventions, Wichita Radiological Group, did not respond to ProPublica’s requests for comment, nor did the doctors named in the suit: Dr. Shaun Gonda, Dr. Bret Winblad and Dr. Kermit Rust. It is unclear from the case documents which doctors conducted which procedures. Eric Barth, an attorney for the medical group, denied the allegations in latest legal filings, calling the claims “baseless” and the lawsuit a “witch hunt.”

The lawsuit comes amid growing concern about one of these procedures — atherectomies — after researchers and doctors have uncovered patterns of excessive and inappropriate use. latest research has found that this procedure, a common but costly treatment to shave or laser plaque from blood vessels, is not more effective than cheaper alternatives and may even be associated with a higher risk of complications including amputation. In latest years, several doctors and clinics have been investigated for allegedly taking advantage of Medicare’s reimbursement rates, and one study found that many doctors are resorting to atherectomies in the earliest stages of peripheral artery disease, against best practices that urge noninvasive treatment.

“Atherectomy is important in certain settings. But it’s being used in a way that is entirely inappropriate and it’s largely driven by the incentive structure,” said Dr. Caitlin Hicks, the lead author of the study and an associate professor of surgery at Johns Hopkins University School of Medicine.

Although different payment structures govern the care of veterans, the whistleblower lawsuit alleges that outside physicians, paid hourly by the Dole VA, were motivated to conduct longer and more complex procedures that would earn them higher payment.

Under different circumstances, the patient in the procedure room on that summer day could have been done after two hours.

But, 150 minutes in, those Medtronic representatives were still texting. At that point, more than 15 of their vascular devices had been used, including stents, balloons and those for atherectomy.

“Long case!” Kirk’s colleague texted. “Is it looking ok??”

“It is,” she said. “Thought we were done a few times! Now he’s going back in to cut again!”

A little while later, she texted: “....17!”

He texted back: “😆😆😂😂”


Hospital leaders had been scrutinizing the use of these procedures at the Dole VA for years.

In 2017, shortly after Rick Ament was hired to lead the facility, he noticed something was amiss. While the longtime hospital administrator was poring over the finances, he was alarmed to discover that the relatively small Dole VA had one of the most expensive cardiac programs in the country. As Ament dug deeper, he realized vascular interventions were the reason.

Angioplasty: A compact balloon is inserted into a blood vessel and inflated to flatten plaque against its walls.

Stent: A metal mesh tube is implanted into a narrowed blood vessel to hold open its walls.

Atherectomy: A catheter, often capped with a blade or laser, is inserted into a blood vessel and removes plaque off its walls.

Credit: Illustrations by Now Medical Studios, special to ProPublica

“It just did not make sense that the acuity level of our patients would generate such extreme cost variances from the norm,” he testified in December, in a deposition for the whistleblower case. “It was so significant, we needed to get to the bottom of it.”

Ament, a second generation Air Force veteran, quietly assembled a task force to investigate why the facility had purchased so many medical devices for these procedures. After they examined inventory records, calculating the total number of medical devices and the cost of devices per patient, they grew concerned.

“We were more expensive than, I believe it was, the top 10 hospitals in the VA combined,” he said. “My feeling was that we either had very, very bad providers or we had product walking out the door.”

Ament enlisted experts from other VA hospitals to help his team investigate, including an administrative officer who could understand finances and a respected interventional radiologist who could examine records. The task force gathered a list of patients from 2016 to 2018, according to internal emails, and analyzed their medical charts.

According to internal VA documents released through the whistleblower suit, the review found a number of clinical failings: Evidence-based medicine had not been followed in the majority of cases reviewed. Procedures were over-aggressive, treating lesions that should have been left alone. And there was a total disregard for established best practices for treating peripheral artery disease.

One of the experts on the investigative team explained to Ament that while it was not uncommon for doctors to use a couple of devices in one intervention, the total number of devices in many of the procedures at his facility went into the double digits, sometimes five times the expected amount.

In one encounter, a doctor deployed 33 devices in one procedure — three atherectomy devices, nine stents and 21 balloons.

This use of devices was exorbitant, Ament came to understand. “I want to say the term ‘egregious’ was used,” he testified. “It was kind of like validation, but I really wish I was wrong.”

“Did it make you concerned for patient care?” a lawyer asked during the deposition.

“It did,” Ament replied.

A member of his task force pulled data for veterans who had leg amputations due to vascular disease. Over five years, the number of veterans who had amputations increased, from about six in 2013 to 38 in 2018, according to internal emails released in the suit. The VA did not respond to ProPublica’s questions about the rise in amputations or whether it was due to complications from the procedures.

An internal VA email released in a whistleblower lawsuit

Even though Ament testified in December 2022 that he became aware of the excessive use of devices during his investigation that began about five years ago, neither he nor the VA have publicly acknowledged these findings outside of the lawsuit. It is unclear whether VA representatives informed the patients whose records were reviewed about their findings. ProPublica reached out to more than half a dozen veteran community groups in the Wichita area and none were aware of the investigation nor the allegations of overuse of vascular procedures at the facility.

The VA says that if its ongoing review finds instances of substandard care, it will reach out to affected patients and inform them about possible complications and benefits they may be entitled to. The press secretary said the review will take several months. Ament declined to respond to ProPublica’s questions, citing the ongoing case.

In 2018, Ament turned over his findings to the criminal division of the VA’s Office of Inspector General. He also shut down interventional radiology procedures at the facility’s catheter lab.


Federal agents separately opened an investigation into the same unit in the facility, looking into allegations of kickbacks.

More than 40 pages of expense reports from Medtronic, revealed in the whistleblower case, show sales representatives treating Dole health care workers to hundreds of meals over several years — lunches at Dempsey’s Biscuit Co.; business meals at the Scotch & Sirloin steakhouse; dinner at Chester’s Chophouse & Wine Bar, price per attendee: $122.39.

Federal agents obtained the receipts.

“Robert J. Dole VAMC employees may have received improper gratuities, in the forms of paid lunches, dinners, etc., from sales representatives from Medtronic,” wrote Nathen Howard, a special agent in the VA OIG, in an investigation memo from February 2019.

This kind of relationship could violate VA policy, which forbids federal employees from receiving any gifts, including meals, from people who do business or seek to do business with a federal institution. For health care workers, violating this policy could have serious implications for patients. Numerous studies have shown that even modest industry-sponsored gifts, including meals, may influence prescribing or treatment behavior of health care professionals.

The agents opened their investigation into kickbacks at the Wichita facility in response to the whistleblower lawsuit, which was filed by Thomas Schroeder in 2017. The VA OIG would not confirm or deny whether it was continuing to investigate kickbacks at the facility. The VA did not directly answer ProPublica’s questions about kickbacks at the Dole VA, but it said that every employee must complete an annual ethics training, which covers gift rules.

In latest years, Medtronic has settled a handful of other cases that have alleged kickbacks between company representatives and health care professionals.

In 2018, Medtronic’s subsidiary Covidien paid $13 million to settle claims with the U.S. Department of Justice that it paid kickbacks to health care institutions that used its mechanical blood clot devices. In 2019, the same subsidiary paid $17 million to resolve allegations that it provided in-kind marketing support to doctors using its vein products. And in 2020, Medtronic paid more than $8 million to settle claims that representatives had paid kickbacks to a neurosurgeon, including scores of lavish meals at a restaurant that the doctor owned, to induce him to purchase the company’s medication pumps.

Schroeder’s lawsuit is not the first time Medtronic’s vascular devices were named in an alleged kickback scheme. In early 2015, Medtronic acquired Covidien, and shortly after the merger, its subsidiary ev3 Inc. agreed to pay $1.25 million to resolve allegations that it had paid doctors who were “high volume users” of its atherectomy devices to act as evangelists for the company, and had provided physicians with company shares to participate in clinical trials for their tools.

The whistleblower in this earlier case, a former sales representative for the company, also alleged that the subsidiary was gaming Medicare’s payment system. Hospitals were often hesitant to conduct atherectomy procedures because of the low reimbursement rates. According to the suit, sales representatives encouraged doctors to admit patients for longer stays to reap greater reimbursements and make a profit, even though such stays were often not medically indicated.

“Medical device makers that try to boost their profits by causing patients to be admitted for unnecessary and expensive inpatient hospital stays will be held accountable,” special agent Thomas O’Donnell, from the Office of Inspector General at the U.S. Department of Health and Human Services, said in a press release for the settlement. “Both patients and taxpayers deserve to have medical decisions made based on what is medically appropriate.”

Medtronic spokesperson Xiong said that in each case, the company “cooperated fully with the DOJ to resolve its concerns and, where wrongdoing was found, took appropriate remedial action.”

Seton Hall Law School professor Jacob Elberg, a former assistant U.S. attorney for the District of New Jersey who led its health care and government fraud unit, is concerned by the frequency of such settlements in the last two decades. “There are, at this point, dump questions as to whether the sanctions imposed by DOJ are sufficient to deter wrongdoing and to lead to meaningful change, especially within the medical device industry.”

Although the Department of Justice has declined to intervene in the lawsuit involving the Dole VA at this time, the case is ongoing and further depositions with Medtronic sales representatives and a former VA employee are scheduled for this month.

VA employees and doctors named in the suit declined to comment or did not respond to ProPublica’s questions about the alleged kickbacks and whether sales representatives may have influenced veterans’ treatment plans. In interviews with federal investigators, according to released transcripts, several of the employees who were questioned denied receiving frequent meals from sales representatives, contradicting Medtronic’s expense reports.

Their statements also stand in contrast to Medtronic representative Kari Kirk’s final text messages during that procedure in June 2017, which ultimately lasted more than three hours.

“Now u done??” her colleague asked.

“Just finished,” she texted. “Running to get them lunch!”

“👍🍺🎉”

Fri, 17 Feb 2023 06:07:00 -0600 en text/html https://www.propublica.org/article/medtronic-medical-device-kickbacks-lawsuit-kansas
Killexams : 9 Sneaky Female Heart Attack Symptoms Women Might Be Ignoring

According to 2020 data in the Journal of the American College of Cardiology, “Cardiovascular disease remains the leading cause of death for women in the United States and worldwide.” Paula Montana De La Cadena, MD, a Cardiologist at Miami Cardiac & Vascular Institute says one in three women die from cardiovascular disease, and 45% of women over age 20 years have some form of cardiovascular disease. “While symptoms can be different in women than they are in men, it doesn’t necessarily mean that women have ‘atypical symptoms’ as it has been erroneously engrained,” Dr. Montana De La Cadena says. “It just means that these symptoms in women have been potentially 'understudied.’”

Female cardiovascular patients can often require a more nuanced approach and understanding of symptoms,” explains Jayne Morgan, MD, cardiologist and the clinical director of the COVID task force at Piedmont Hospital in Atlanta, GA. “One size does not fit all,” Dr. Morgan says. “Gender bias exists in cardiology, to the detriment of women.”

13 Common Health Conditions That Affect Men and Women Differently

There’s a big disconnect between what women think a heart attack would feel like—excruciating chest pain—and what it often does feel like. “Other than the reproductive system, the cardiovascular system has the most differences between genders,” says Jean McSweeney, PhD, RN, professor and associate dean for research at the University of Arkansas for Medical Sciences College of Nursing in Little Rock, Arkansas. So it’s to be expected that the female heart attack symptoms—while sometimes shared with men in a general sense—can also be experienced differently.

We have much smaller vessels in our heart,” says Dr. McSweeney, who was among the first to zero in on women’s heart attack symptoms in a 2003 study, published in the journal Circulation. “And we’re constructed differently.” 

According to  Judith Hilevi Lichtman, PhD, department chair and associate professor of epidemiology at the Yale School of Public Health in New Haven, CT: When a woman’s main arteries are blocked, she’ll often experience a constellation of signs, including chest pain, pressure, or tightness, along with multiple non-chest symptoms. What’s more, not every woman experiences the same symptoms, and the symptoms don’t necessarily happen all at once. 

A UCLA Heart Doctor Just Shared the Age When Many Women’s Heart Disease Risk Increases

“Women's symptoms can be less dramatic than the crushing chest pain and tightness, and shortness of breath that drives most men to the hospital,” Dr. Morgan says. “Instead they may manifest in nonspecific ways such as fatigue, jaw pain, back pain, or a common complaint of 'feeling rundown.'" Dr. Morgan says all of these are often attributed to life's stressors, the need for sleep, and more.

She adds that women have better outcomes when they're seen by a female cardiologist than a male cardiologist, but most doctors don’t feel prepared in this department. “Only 22% of primary care physicians, and only 42% of cardiologists, feel well prepared to assess women's risk of cardiovascular disease,” Dr. Morgan says, based on a 2019 nationwide survey of primary care physicians and cardiologists published in Current Treatment Options in Cardiovascular Medicine.

We spoke with experts and female heart-attack survivors about what some of those symptoms might be and what they feel like. These aren't entirely inclusive of every heart attack symptom a woman might experience, but they're nine that might surprise you.

The Best and Worst Diets for Your Cholesterol, Says UCLA Cardiologist

Woman pressing her hand against a painful shoulder © Tharakorn/Shutterstock Woman pressing her hand against a painful shoulder

A funky-feeling arm

"I felt like my arm was asleep,” says Tara Robinson, a school counselor, who, incredibly, survived three heart attacks in one week at the age of 40. For the first two, the feeling would emerge for a couple of minutes and then go away. By the time she arrived at the hospital after the third—when the sensations were more intense and persistent—the symptoms were gone and she was sent back home without treatment. “I thought maybe I was working out too hard at the gym or I slept on my arm wrong,” she says.

Another heart attack survivor, Lilly Rocha, described general soreness in her entire upper left side, in her arm along with her jaw and chest. Rocha was traveling a lot for her career and regularly flying internationally, so she attributed the soreness to the stress of travel. It wasn’t until a co-worker (who had himself experienced a heart attack) insisted on taking her to a hospital did she realize the shocking truth: She’d just had a heart attack.

11 Signs You Might Be Headed For a Heart Attack

woman with cheek pain or chin pain.Acute pain in a woman Salivary gland . Female holding hand to spot of nape-aches. Concept photo with read spot indicating location of the pain. © ANN PATCHANAN/Shutterstock woman with cheek pain or chin pain.Acute pain in a woman Salivary gland . Female holding hand to spot of nape-aches. Concept photo with read spot indicating location of the pain.

A really sore jaw

Along with arm issues, fatigue, and shortness of breath, jaw problems often emerge months before an attack and then intensify during the real event. “It’s like the way your mouth feels after you’ve come home from the dentist and the Novocaine hasn’t quite worn off,” Robinson describes. 

As with the arm, the jaw also acts up because of what doctors call “referred” pain, explains Suzanne Steinbaum, DO, attending cardiologist and the director of Women’s Cardiovascular Prevention, Health, and Wellness at The Mount Sinai Hospital in New York City and author of Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life. “That pain comes from the heart,” she says. 

Dr. McSweeney recalls a patient who first complained about her jaw to her dentist and was given treatment for TMJ. When that didn’t help, her wisdom tooth was removed. Of course, the pain only got worse—until she ended up in the hospital with a heart attack and was finally properly treated.

11 Silent Signs of Heart Trouble You Shouldn’t Ignore

Business woman feeling painful from stomachache illness during working at office, hands touching her stomach and awareness of her Appendicitis sickness. Health insurance care. Insurance concept. © NaruFoto/Shutterstock Business woman feeling painful from stomachache illness during working at office, hands touching her stomach and awareness of her Appendicitis sickness. Health insurance care. Insurance concept.

Nausea and vomiting

In a 2018 Circulation study that examined women and men who experienced a heart attack before age 55, two-thirds of women said they’d experienced epigastric (upper-abdominal) issues, such as indigestion, nausea, or stomach pain, notes Dr. Lichtman, the article’s lead author. Only half the men reported similar problems.

As Robinson describes that day she was rushed to the hospital with her third heart attack: “I wanted to vomit so badly.” After treatment, she adopted lifestyle changes that included eating a heart-healthy diet—and she now helps lead other patients in living healthier.

woman taking a deep breath while sitting on couch at home © fizkes/Getty Images woman taking a deep breath while sitting on couch at home

Shortness of breath

An early symptom of a heart condition can be the need to prop yourself up in bed in order to breathe better. “You feel out of breath because when your arteries are blocked, there is not enough oxygen being delivered throughout the body,” explains Dr. Steinbaum. “If the heart has been damaged or a heart attack is happening, the heart may not have the ability to push the blood forward and this can cause fluid to back up into the lungs.” 

15 Heart Attack Prevention Tips Every Woman Must Know

woman laying on couch at home exhausted and worried © tommaso79/Getty Images woman laying on couch at home exhausted and worried

Extreme fatigue

"Women tend to dismiss heart attack symptoms because we are used to feeling uncomfortable on a monthly basis," says Dr. Steinbaum. "The key to knowing when to get checked is to assess whether the things you do every day, and are normal for you, suddenly become difficult or you get symptoms while trying to do them." Robinson remembers having to crawl back to her bedroom after cleaning her shower; she felt weak and wanted to take a nap.

Dr. McSweeney tells of one patient who reported being so tired that she could only make one side of the bed. She needed to rest before making the other. "It's not this pronounced in every woman," says Dr. McSweeney, the lead author of the American Heart Association's Scientific Statement on women and heart disease. But if the fatigue gets progressively worse, or you don't feel better after you've slept, you should see your doctor.

It’s easy to write off fatigue as a side effect of life—aging, working, caring for children and parents (sometimes simultaneously) and other general life stresses. For women, the hormonal changes of perimenopause and menopause can be exhausting. “In the many discussions of health equity, a large, underserved, and poorly managed population in medicine and clinical trials is the menopausal woman,” Dr. Morgan says. “During menopause, lipid levels rise, and women's risk of heart attacks only further increases.” In short: It might not be “just fatigue.”

This Is Exactly What to Do If You Think You’re Having a Heart Attack

© Tom Merton/Getty Images

Upper-back pain

Robinson reports that her back problem was the only symptom she’d describe as actually painful. “It felt as if it was behind my heart,” she says.

Other women have described it as a sharp pain between the shoulder blades, which intensified at the time of the heart attack. Here are nine physical and emotional ways female heart disease is different.

old age, health problem and people concept - close up of senior woman suffering from heartache at home © Syda Productions/Shutterstock old age, health problem and people concept - close up of senior woman suffering from heartache at home

An odd feeling in the chest

Women don’t necessarily describe it as "chest pain." “They may call it ‘chest tightness’ or ‘chest pressure,'” says Dr. Lichtman, who adds that women may not associate their symptoms with a heart attack because they’re experiencing other symptoms unrelated to the chest, like fatigue or muscle pain.

“I felt a strong tingling sensation,” Rocha recalls. “Almost like electricity was shooting out of my chest.” She recalls that the sensation would come and go, and in the beginning would lasted two or three minutes at a time. 

About six months before her heart attack, Rocha went to her primary care physician (who was also her OBGYN) because she was convinced she had breast cancer. The doctor did a breast exam, found nothing, and sent her home. Rocha eventually noticed that her entire left side—chest, jaw, and arm—just felt “weird.” 

A woman coughing © Rawpixel.com/Shutterstock A woman coughing

Flu-like symptoms

“Women might say, ‘I’m so tired. I must have a virus,'” says Dr. Steinbaum. They might convince themselves that all they have are flu symptoms, many of which resemble the conditions above, including body aches, fatigue, and nausea, which can also be signs of menopause and dismissed. 

Trust that you know your body. If the sensations seem different or more intense than anything you’ve felt before, get it checked out. While they may turn out not to be symptoms of a heart condition or precursors to a heart attack, you’re better off ruling out the possibility—even if you’re under 55 and especially if you have a family history of early-onset heart disease.

6 Clear Signs You’re Getting Sick

High blood pressure

During pregnancy, many women experience pre-eclampsia, eclampsia, hypertension, or even gestational diabetes, and Dr. Morgan says this is this is akin to failing a stress test. “After the healthy baby is delivered safely, these women should be referred to a cardiologist for follow-up because their risk of heart disease is now twice as high as a woman who did not experience these complications,” Dr. Morgan says. “But many women still do not receive the specialty care they deserve after delivery.”

Dr. Montana De La Cadena points out that high blood pressure or hypertension puts women approximately three times at a greater risk of developing heart failure. “What’s extremely important to emphasize is that there are cardiovascular risk factors unique to women that most female patients don’t know about,” she says. “These conditions include hypertensive disorders like pre-eclampsia, as well as gestational diabetes, pre-term birth, pregnancy loss, premature menopause and polycystic ovarian syndrome.”

Women who have had these complications during pregnancy should follow-up with their primary care physician to monitor hypertension and diabetes. Their increased risk for developing cardiovascular diseases should be considered in hopes of preventing cardiovascular disease. 

Additional writing and reporting by Jaime Stathis

The post 9 Sneaky Female Heart Attack Symptoms Women Might Be Ignoring appeared first on The Healthy.

Wed, 15 Feb 2023 03:46:00 -0600 en-US text/html https://www.msn.com/en-us/health/other/9-sneaky-female-heart-attack-symptoms-women-might-be-ignoring/ar-AA17xfL6
Killexams : 3 Medical Stocks with Excellent Vital Signs and 1 to Avoid

Amid strong demand for medical products, technological advancements, and government support, the healthcare industry’s growth prospect looks promising in the near future. Therefore, quality medical stocks UnitedHealth Group (UNH), Abbott Laboratories (ABT), and Nature’s Sunshine Products (NATR) might be solid buys now. However, fundamentally weak SNDL Inc. (SNDL) might be best avoided. Read on….

The Fed’s aggressive rate hikes to curb the stubbornly high inflation have plagued the economy for some time. But on the flip side, the medical industry, which thrived during the pandemic years, is envisioned to remain buoyed amid volatilities, thanks to rapid technological advancements, rising healthcare awareness among the population, and government support.

Over the past year, the Health Care Select Sector SPDR ETF (XLV) has gained 2.6%, outpacing the S&P 500, which lost 7.8%. In addition, the global healthcare services market is projected to grow at a 9% CAGR to reach $18.98 trillion by 2028.

In addition, government initiatives in support of the American population would be beneficial for millions to overcome the financial challenges in seeking healthcare solutions. Moreover, they should also bode well for the healthcare industry.

Furthermore, medical companies face an inelastic demand for their products and services despite challenges such as high inflation, snarled supply chain, and labor shortages. CNBC’s Jim Cramer believes that healthcare stocks have stayed relatively steady in 2022.

Against this backdrop, fundamentally sound medical stocks UnitedHealth Group Incorporated (UNH), Abbott Laboratories (ABT), and Nature’s Sunshine Products, Inc. (NATR) could be ideal buys now. However, given its weak fundamentals, SNDL Inc. (SNDL) might be avoided.

Stocks to Buy:

UnitedHealth Group Incorporated (UNH)

UNH is a diversified healthcare company. The company operates through four segments: Optum Health; OptumInsight; OptumRx; and UnitedHealthcare. It offers consumer-oriented health benefit plans and services, software and information products, health care coverage, and well-being services.

On January 23, 2023, Optum Rx, UNH’s pharmacy services company, launched Price Edge, a tool that seamlessly compares direct-to-consumer pricing for traditional generic drugs with insurance pricing to ensure members receive the lowest prescription drug price. This should benefit the company.

On November 16, 2022, UNH and Life Time Group Holdings, Inc. (LTH) announced an expansion of their relationship to include access to all Life Time locations. This is expected to help UNH deliver additional value to its customers, thereby driving appreciation of brand equity and market expansion.

The stock’s trailing-12-month EBITDA margin of 9.82% is 163.6% higher than the industry average of 3.73%. Its trailing-12-month ROCE is 26.26% compared to the industry average of negative 39.80%.

On November 4, UNH announced its quarterly dividend of $1.65 per share, which was payable to shareholders on December 13, 2022. This reflects the company’s ability to pay back its shareholders.

For the fiscal fourth quarter that ended December 31, 2022, UNH’s total revenues increased 12.3% year-over-year to $82.79 billion. In addition, adjusted net earnings attributable to UNH common shareholders came in at $5.06 billion and $5.34 per share, up 18.1% and 19.2% year-over-year, respectively.

Analysts expect UNH’s revenue for the fiscal first quarter ending March 2023 to come in at $89.76 billion, indicating a 12% year-over-year growth. Street expects the company’s EPS for the same quarter to grow 10.7% year-over-year to $6.07. The company surpassed the consensus EPS and revenue estimates in each of the trailing four quarters, which is impressive.

UNH has gained 1.2% over the past month to close the last trading session at $495.35. It has gained 3.9% over the past five days.

UNH’s POWR Ratings reflect its fundamental strength. The stock has an overall rating of A, which translates to a Strong Buy in our proprietary rating system. The POWR Ratings assess stocks by 118 different factors, each with its own weighting.

UNH has a B grade for Growth, Stability, Sentiment, and Quality. In the A-rated 11-stock Medical – Health Insurance industry, it is ranked #2.

Beyond what has been stated above, we’ve also given UNH grades for Value and Momentum. Get all UNH ratings here.

Abbott Laboratories (ABT)

ABT discovers, develops, manufactures, and sells diversified healthcare products. The company operates through four segments: Established Pharmaceutical Products; Diagnostic Products; Nutritional Products; and Medical Devices.

On February 9, 2023, ABT and Cardiovascular Systems, Inc. (CSII), a medical device company, announced a definitive agreement for ABT to acquire CSII. After this acquisition, ABT is expected to gain an innovative, complementary solution in treating vascular disease through CSII's leading atherectomy system.

On January 17, ABT announced that the U.S. Food and Drug Administration (FDA) had approved the company's latest-generation transcatheter aortic valve implantation (TAVI) system, Navitor™, to treat people with severe aortic stenosis who are at high or extreme risk for open-heart surgery.

Michael Dale, senior vice president of ABT's structural heart business, said, "Our Navitor valve builds upon our industry-leading portfolio of minimally invasive devices that surpass existing standards of care to address a range of heart diseases."

On December 9, ABT declared a quarterly common dividend of 51 cents per share, indicating an increase of 8.5%, payable to shareholders on February 15, 2023. This marks ABT’s 51st consecutive year of dividend growth and the 396th consecutive quarterly dividend payment. This reflects the company’s cash generation abilities.

ABT’s trailing-12-month EBITDA margin of 27.58% is 640.2% higher than the 3.73% industry average. Its trailing-12-month gross profit margin of 56.53% is 2.2% higher than the 55.29% of the industry average.

For the fourth quarter that ended December 31, 2022, ABT’s net sales stood at $10.09 billion, whereas, for the fiscal year that ended December 31, 2022, it increased 1.3% year-over-year to $43.65 billion. 

During the fourth quarter that ended December 31, 2022, the company’s operating earnings stood at $1.30 billion. Its net earnings came in at $1.03 billion, while earnings per common share came in at $1.03.

Analysts expect ABT to report revenue and EPS of $40.01 billion and $4.40 for the fiscal year ending December 2023, respectively. The company surpassed the consensus EPS and revenue estimates in each of the trailing four quarters, which is impressive.

Over the past three months, the stock has gained 4.3% to close the last trading session at $108.52. Moreover, it has also gained marginally intraday.

ABT’s POWR Ratings reflect its promising prospects. The stock has an overall rating of B, which equates to Buy in our proprietary rating system.

ABT has a B for Value, Stability, Sentiment, and Quality. It is ranked #8 of 147 stocks in the Medical – Devices & Equipment industry. 

Click here to see ABT’s ratings for Growth and Momentum.

Nature’s Sunshine Products, Inc. (NATR)

Natural health and wellness company NATR primarily manufactures and sells nutritional and personal care products in Asia, Europe, North America, Latin America, and internationally.

On November 3, 2022, CEO Terrence Moorehead said, “We remain confident that we will navigate this unique period of volatility and uncertainty, bolstered by our strong balance sheet and team of experts on the ground.”

NATR’s forward EV/Sales of 0.34x is 80.4% lower than the industry average of 1.76x. Its forward Price/Sales of 0.42x is 64.5% lower than the industry average of 1.19x.

NATR’s trailing-12-month gross profit margin of 71.59% is 127% higher than the 31.53% industry average. Its trailing-12-month ROTA of 4.96% is 38% higher than the 3.60% industry average.

NATR’s net sales stood at $104.51 million for its fiscal third quarter that ended September 30, 2022. Its gross profit came in at $74.87 million. Its total current liabilities came in at $63.89 million for the period that ended September 30, 2022, compared to $76.67 million for the period that ended December 31, 2021.

NATR’s revenue is expected to rise marginally year-over-year to $420.60 million in the fiscal year ending December 2023. Its EPS is estimated to come in at $0.18 in the same period. The company surpassed the consensus revenue estimates in each of the trailing four quarters.

The stock has gained 13.5% over the past three months and rose marginally intraday to close the last trading session at $9.27.

NATR’s positive outlook is reflected in its POWR Ratings. The stock’s overall A rating indicates a Strong Buy in our proprietary rating system.

NATR has an A grade for Value and Quality and a B for Stability and Sentiment. In the B-rated Medical – Consumer Goods industry, it is ranked first out of the nine stocks.

Click here for the additional POWR Ratings for NATR (Growth and Momentum).

Stock to Avoid:

SNDL Inc. (SNDL)

SNDL, headquartered in Calgary, Canada, engages in the production, distribution, and sale of cannabis products, operating through the Cannabis Operations and Retail Operations segments. It engages in the cultivation, distribution, and sale of cannabis for the adult-use markets and private sale of recreational cannabis through corporate-owned and franchised retail cannabis stores.

SNDL’s trailing-12-month gross profit margin of 19.07% is 65.5% lower than the 55.29% industry average. Its trailing-12-month net income margin of negative 54.54% compares to the negative 5.84% industry average.

SNDL’s net loss for the fiscal third quarter that ended September 30, 2022, stood at CAD98.84 million ($74.04 million) compared to the net earnings of CAD16.71 million ($12.51 million) in the prior-year quarter. Its loss from operations expanded 365% year-over-year to CAD88.54 million ($66.32 million).

SNDL’s current asset declined to CAD526.03 million ($394.01 million) for the period that ended September 30, 2022, compared to CAD728.18 million ($545.42 million) for the period that ended December 31, 2021.

Analysts expect SNDL’s EPS to be negative $0.06 in the fiscal year ending December 2023. The consensus revenue estimate is expected to come in at $746.59 million. The company missed Street EPS estimates in each of the trailing four quarters.

Over the past month, the stock has plunged 10.6% to close the last trading session at $2.03. Moreover, it has declined 10.4% over the past five days.

It is no surprise that SNDL has an overall rating of D, which equates to Sell in our POWR Ratings system.

The stock has an F grade for Momentum and Stability and a D for Quality and Sentiment. Of the 172 stocks in the D-rated Medical – Pharmaceuticals industry, SNDL is ranked #139.

Beyond what we’ve stated above, click here to see additional SNDL ratings for Growth and Value.

What To Do Next?

Get your hands on this special report:

3 Stocks To DOUBLE This Year

What gives these stocks the right stuff to become big winners, even in this brutal stock market?

First, because they are all low-priced companies with the most upside potential in today’s volatile markets.

But even more important is that they are all top Buy rated stocks according to our coveted POWR Ratings system, and they excel in key areas of growth, sentiment and momentum.

Click below now to see these 3 exciting stocks that could double or more in the year ahead.

3 Stocks To DOUBLE This Year


UNH shares were unchanged in premarket trading Tuesday. Year-to-date, UNH has declined -6.57%, versus a 7.95% rise in the benchmark S&P 500 index during the same period.



The stock market dynamics sparked Sristi's interest during her school days, which led her to become a financial journalist. Investing in undervalued stocks with solid long-term growth prospects is her preferred strategy. Having earned a master's degree in Accounting and Finance, Sristi hopes to deepen her investment research experience and better guide investors.

More...

The post 3 Medical Stocks with Excellent Vital Signs and 1 to Avoid appeared first on StockNews.com

Mon, 13 Feb 2023 23:54:00 -0600 en text/html https://www.entrepreneur.com/finance/3-medical-stocks-with-excellent-vital-signs-and-1-to-avoid/445006
Killexams : US Heart and Vascular partners with Orion Medical

Houston-based cardiovascular physician practice Orion Medical has partnered with US Heart and Vascular, a management services organization formed in 2021 with cardiovascular practice affiliates in Arizona, Kansas and Texas.

Orion Medical was founded in 2012 and has grown to have two locations in Houston, along with locations in Pasadena and Friendswood, Texas. It employs seven physicians and is accredited as a vein center, according to a Feb. 7 release.

The practice focuses on the prevention and treatment of heart and vascular disease, sleep medicine, clinical research and comprehensive varicose vein therapies. The transaction with USHV was officially closed Jan. 31.

Tue, 07 Feb 2023 03:22:00 -0600 en-gb text/html https://www.beckersasc.com/cardiology/us-heart-and-vascular-partners-with-orion-medical.html
Killexams : Peripheral Vascular Devices And Equipment Global Market Report 2023

ReportLinker

Major players in the peripheral vascular devices and equipment market are Medtronic, Boston Scientific Corporation, Abbott, Cook group, Angiomed GmbH & Co, Medizintechnik KG, Terumo Corporation, ENDOLOGIX inc, Bolton medical Inc, and JOTEC.

New York, Feb. 10, 2023 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Peripheral Vascular Devices And Equipment Global Market Report 2023" - https://www.reportlinker.com/p06277197/?utm_source=GNW

The global peripheral vascular devices and equipment market will grow from $7.77 billion in 2022 to $8.27 billion in 2023 at a compound annual growth rate (CAGR) of 6.4%. The Russia-Ukraine war disrupted the chances of global economic recovery from the COVID-19 pandemic, at least in the short term. The war between these two countries has led to economic sanctions on multiple countries, surge in commodity prices, and supply chain disruptions, causing inflation across goods and services effecting many markets across the globe. The peripheral vascular devices and equipment market is expected to grow to $10.04 billion in 2027 at a CAGR of 5.0%.

The peripheral vascular devices and equipment market consist of sales of peripheral vascular stents, percutaneous transluminal angioplasty balloons, PTA drug-eluting balloons, embolic protection devices, inferior vena cava filters, Aortic stent-grafts, synthetic surgical drafts, and peripheral guide wires.Values in this market are ‘factory gate’ values, that is the value of goods sold by the manufacturers or creators of the goods, whether to other entities (including downstream manufacturers, wholesalers, distributors and retailers) or directly to end customers.

The value of goods in this market includes related services sold by the creators of the goods.

Peripheral vascular devices and equipment are used to treat peripheral vascular diseases which are slow and progressive blood circulation disorders caused by blockages, narrowing, or spasms in blood vessels outside the heart and brain including arteries and veins.

North America was the largest region in peripheral vascular devices and equipment market in 2022.Western Europe was the second-largest region in peripheral vascular devices and equipment market.

The regions covered in the peripheral vascular devices and equipment market report are Asia-Pacific, Western Europe, Eastern Europe, North America, South America, the Middle East, and Africa.

The main types of peripheral vascular devices and equipment are peripheral vascular stents, percutaneous transluminal angioplasty balloons, catheters, PTA guide wires, atherectomy devices, chronic total acclusion devices, aortic stents, synthetic surgical grafts, embolic protection devices, and inferior vena cava filters.The catheter is a tubular medical device for insertion into canals, vessels, passageways, or body cavities to permit injection or withdrawal of fluids or to keep a passage open.

The applications involved are the treatment of peripheral blood vessels damaged and the treatment of peripheral blood vessels blockage. The various end-users are hospital applications and clinic applications.

The peripheral vascular devices and equipment market is driven by the rising number of people with peripheral artery diseases.Peripheral artery diseases are caused when arteries in the human body are blocked by plaque consisting of fats, cholesterol, and other substances restricting their blood flow to important organs.

Lower extremity peripheral artery disease (PAD) affects >230 million adults worldwide and is associated with increased risk of various adverse clinical outcomes (other cardiovascular diseases such as coronary heart disease and stroke and leg outcomes such as amputation.The disease is different in younger populations; but, the incidence rises sharply, with over 20% of people over 80 years old having PAD.

According to the Center for Disease Control and Prevention (CDC), approximately 8.5 million people in the USA are suffering from peripheral artery diseases, of which 12-20% are aged above 60 years.

Stringent approval processes, product recalls and failures act as a restraint to the peripheral vascular devices and equipment market.Product recalls and failures potentially affect the brand image of the companies within this market.

According to the US Food and Drug Administration (FDA), a product recall is made to perform corrective actions or prevent hazardous effects to patients. For instance, in January 2022, Medtronic was instructed to recall its artery-clearing HawkOne System due to reported injuries. \ To reduce incidences associated with the peripheral devices and ensure that the devices are safe and have the least adverse reactions, FDA is restricting devices for use, sending field safety notices, and making product recall to correct the devices. These stringent approval processes and regulatory policies may impact the peripheral devices and equipment market.

Bio-absorbable stents are gaining popularity in the peripheral vascular devices and equipment market to eliminate thrombogenic risk factors and enhance clinical applicability.Bio-absorbable stents are made of natural soluble materials that disappear after insertion and eliminate the risk of late stent thrombosis.

They help in protecting the body from inflammation or reduced blood flow due to late-stent thrombosis (a condition where the stent used for treatment stays inside the body for a prolonged period).Companies in this market are increasing their focus on developing and commercializing bio-absorbable stents.

For instance, in 2020, Boston Scientific is demanded to start its Synergy Megatron bioabsorbable polymer coronary stent system.It is intended for large proximal vessels, including over main, bifurcations, and ostial lesions.

It is made in 3.5 mm to 5.0 mm diameters. It owns enhanced strength and the capacity to create tapered vessels.

In January 2022, the U.S Food and Drug Administration issued notice to Medtronic plc for Class I medical device recall for its HawkOne System for clearing out clogged arteries. The notice was issue after certain instances of injuries were reported.

In September 2021, Boston Scientific, a US-based manufacturer of medical devices acquired Devoro Medical, Inc for an undisclosed amount.This acquisition of devoro medical inc will add the WOLF platform and advances efforts to ensure physicians have the right tools to Boost procedural efficiencies.

Devoro Medical, Inc, is a US-based manufacturer of medical technology.

The countries covered in the peripheral vascular devices and equipment market are Brazil, China, France, Germany, India, Indonesia, Japan, Russia, South Korea, UK, USA, and Australia.

The market value is defined as the revenues that enterprises gain from goods and/or services sold within the specified market and geography through sales, grants, or donations in terms of currency (in USD ($) unless otherwise specified).

The revenues for a specified geography are consumption values – that is, they are revenues generated by organizations in the specified geography within the specified market, irrespective of where they are produced. It does not include revenues from resales either further along the supply chain or as part of other products.

The peripheral vascular devices and equipment market research report is one of a series of new reports that provides peripheral vascular devices and equipment market statistics, including peripheral vascular devices and equipment industry global market size, regional shares, competitors with a peripheral vascular devices and equipment market share, detailed peripheral vascular devices and equipment market segments, market trends and opportunities, and any further data you may need to thrive in the peripheral vascular devices and equipment industry. This peripheral vascular devices and equipment market research report delivers a complete perspective of everything you need, with an in-depth analysis of the current and future scenario of the industry.
Read the full report: https://www.reportlinker.com/p06277197/?utm_source=GNW

About Reportlinker
ReportLinker is an award-winning market research solution. Reportlinker finds and organizes the latest industry data so you get all the market research you need - instantly, in one place.

__________________________

CONTACT: Clare: clare@reportlinker.com US: (339)-368-6001 Intl: +1 339-368-6001
Fri, 10 Feb 2023 00:13:00 -0600 en-US text/html https://finance.yahoo.com/news/peripheral-vascular-devices-equipment-global-132600413.html
Killexams : Naughty Boy says first years after mum's dementia diagnosis were 'most difficult'

The 42-year-old put his career on hold when beloved mum Zahida, 68, suffered a stroke after a fall in 2017, which led to vascular dementia

Video Loading

Video Unavailable

This Morning: Naughty Boy discusses his mum's dementia

Music producer and I’m A Celebrity star Naughty Boy opens up to Lizzie Catt about living with his mother after her vascular dementia diagnosis

He has topped the charts with Beyonce and Emeli Sande, and hung out in the I’m A Celebrity castle. But since moving in with his mum following her dementia diagnosis, producer Naughty Boy, also known as Shahid Khan or Shah, has taken on a very different role: ambassador for Dementia UK.

The 42-year-old put his career on hold when beloved mum Zahida, 68, suffered a stroke after a fall in 2017, which led to vascular dementia.

Despite the progressive nature of the disease, Shah believes the first years were the most difficult.

“All I was doing was Googling,” he explains. “With hindsight, I wouldn’t recommend that. One call to Dementia UK and a chat with one of their Admiral Nurses made me feel like my family weren’t the only ones going through this.

“The first couple of years and lockdown were the worst, but we persevered and got through. I think that could have broken me but becoming an ambassador for Dementia UK and becoming a voice for a struggle that I had been so private and quiet about empowered me, and I think it empowered Mum as well.

His mother Zahida, 68, suffered a stroke after a fall in 2017 (

Image:

DAILY MIRROR)
The fall led to vascular dementia (

Image:

Getty Images for Brit Asia)

“When I first spoke about dementia I got an influx of social media ­messages. Nobody expected Naughty Boy to be living with his mum who has dementia, but why not?”

Shah says life is easier now they’re in a routine and have a live-in carer in place, after going through 13 others. He’s found that staying on top of Zahida’s other health problems improves her symptoms.

After discovering cataracts could be exacerbating the hallucinations she suffers as part of her dementia, Shah came out of the I’m A Celebrity castle in 2021 “with a mission: let’s fix Mum’s eyes. Mum has a heart condition so it’s not as simple for her to be sedated, but we found a surgeon who could do it”.

He adds: “Combined with getting the right hearing aids, it really helped.

“A year after Mum had the stroke I bought my first house in Buckinghamshire. Everything Mum needs is downstairs as she can’t climb the stairs any more. My dad had been caring for her for a year and needed a break.

“My sister handles all the medical appointments, and I live with Mum so she wakes up in the morning, she sees me. When she goes to bed at night, she sees me. I’m so busy but I still want Mum to feel like she’s a priority. I’m so lucky I’m in a position to live with my mum and have a live-in carer and I know not everyone has that option.”

Growing up, Shah says his mum would cook him whatever he fancied.

Shah says life is easier now they’re in a routine and have a live-in carer in place (

Image:

ITV)

“Ask my older brother and sister, they’ll say I’m a little bit spoiled because I’m the youngest… When I first opened my studio in Ealing, Mum was getting food sent over in a taxi – the bill was ridiculous. But she wanted to make sure I ate and I wanted to make sure I had Mum’s food.

“When she stopped cooking and moved in with me, I made sure I learned to cook the food she loves. Food became a love language between us. When I was a kid she’d accommodate everything so I want to accommodate this stage of her life. As children we get so much love from our mothers, I didn’t want to have any regrets.”

Shah, who started his career with a studio set-up in his parent’s shed in Watford, said making music at home and sharing food together proved “a beautiful full circle”. “Of course, I wish Mum didn’t have dementia, but I have got to know her in a way I never have before. Although it is frustrating and worrying, if you look for the glimmers of light they’ll help you get through.”

The loss of a sense of purpose, he says, has been hard to watch.

“My mum used to be cooking for her family, and cleaning her house. Imagine that gets wiped away, and your sense of purpose is just going from the bedroom to the dining table.”

His mum lives with him in Buckinghamshire (

Image:

ITV)

But Zahida still gets visits from her son’s famous friend and collaborator Emeli Sande and is hoping to head out to a glitzy premiere soon.

“Mum loves Emeli, she comes to the house and will sing her a song.

“Mum’s favourite song of mine is the Beyonce one, Runnin’, she ­immediately perks up. We’re a Muslim family and she loves prayers recited with a melody, it eases and soothes her. She enjoys the Bollywood music she grew up with, and loves Baharon Phool Barsao, her and Dad’s wedding song.”

Shah will finally release Heartland, the follow-up to his 2013 debut album Hotel Cabana, this year.

“I believe everything happens for a reason. My second album was supposed to come out a year after the Beyonce song, but that’s when Mum had the stroke. It was a little break but I’m not mad at it.

“I put music to the side until I knew Mum was comfortable and safe, and I think I made the best album I could because of this experience.

“My album is dedicated to her. The language is more love-fuelled, it evolved into something more beautiful and timeless.”

*Naughty Boy is supporting Dementia UK’s campaign #ILiveWithDementia. obtain the Living with Dementia guide here. For support call the charity’s helpline, 0800 888 6678.

* Follow Mirror Celebs on Snapchat, Instagram, Twitter and Facebook.

Read More

Read More

Read More

Read More

Read More

Mon, 13 Feb 2023 04:35:00 -0600 en text/html https://www.mirror.co.uk/3am/celebrity-news/naughty-boy-says-first-years-29207476
ANCC-CVNC exam dump and training guide direct download
Training Exams List