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Symplicity HTN-3 Clinical Trial

Symplicity HTN-3 Clinical Trial | Heart and Vascular Health | Scoop.it

Website from the manufacturer Medtronic sponsoring the US trial for renal denervation in resistent hypertension.  This device is available for use in Australia, Canada and Europe, but not yet approved in the US.  The trial Symplicity HTN-3 is a US Pivotal trial for American patients with resistant hypertension defined as blood pressure greater than 160 despite at least 3 maximum dose medications including at least one diuretic.  The trial section http://www.symplifybptrial.com/candidate/ gives patients an opportunity to see if they are candidates fotr the trial.

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How to Fend Off a Food Craving

How to Fend Off a Food Craving | Heart and Vascular Health | Scoop.it
New research challenges the body knows what it needs theory. What the siren call of that cupcake really means—and how to ignore it.

A cupcake is calling you.

Functional MRI scans showed that sensory memory food cravings activate the same parts of the brain that drug and alcohol cravings do, including the hippocampus, which helps store memories; the insula, involved in perception and emotion; and the caudate, which is important for learning and memory. The circuit is driven by dopamine, the neurotransmitter responsible for reward-driven learning.

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How Physicians Interpret Research Funding Disclosures

How Physicians Interpret Research Funding Disclosures | Heart and Vascular Health | Scoop.it

My comment:  Doctors can do a good job distinguishing high quality research from lower quality research, and use this discriminating ability to make wise choices for their patients.  BUT, doctors discount the value of research if it is sponsored by drug companies.  This surprises me.  Are doctors now appropriately cynical after the scandals that occurred with incomplete & fraudulent reporting during Vioxx and Avandia development ? This study implies that doctors don't beleive big pharma can be trusted.

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The 269 respondents (53.5% response rate) perceived the level of study rigor accurately. Physicians reported that they would be less willing to prescribe drugs tested in low-rigor trials than those tested in medium-rigor trials (odds ratio, 0.64; 95% confidence interval [CI], 0.46 to 0.89; P=0.008) and would be more willing to prescribe drugs tested in high-rigor trials than those tested in medium-rigor trials (odds ratio, 3.07; 95% CI, 2.18 to 4.32; P<0.001). Disclosure of industry funding, as compared with no disclosure of funding, led physicians to downgrade the rigor of a trial (odds ratio, 0.63; 95% CI, 0.46 to 0.87; P=0.006), their confidence in the results (odds ratio, 0.71; 95% CI, 0.51 to 0.98; P=0.04), and their willingness to prescribe the hypothetical drugs (odds ratio, 0.68; 95% CI, 0.49 to 0.94; P=0.02). Physicians were half as willing to prescribe drugs studied in industry-funded trials as they were to prescribe drugs studied in NIH-funded trials (odds ratio, 0.52; 95% CI, 0.37 to 0.71; P<0.001). These effects were consistent across all levels of methodologic rigor.

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Yogurt Linked to Lower BP

Yogurt Linked to Lower BP | Heart and Vascular Health | Scoop.it

My comment: "Smart foods" or "super foods" are very attractive to Americans:  Eat more, get healthier.  The abstract noted here made me recall the Dannon Yogurt commercial suggesting people living in the Republic of Georgia lived long lives due to yogurt consumption.  See it here.  http://www.youtube.com/watch?v=R9RJBgNB1ZI

Adding yogurt (or other healthy foods) is not the answer.  Replacing less healthy foods with more healthy alternatives is sensible and can be recommended.

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Yogurt may help prevent hypertension as part of a healthy diet, an observational study suggested.

People who ate at least the equivalent of one serving every three days were 31% less likely to develop high blood pressure than those who ate no yogurt at all. An even stronger effect was seen among individuals who were not taking antihypertensive drugs, according to their analysis of the Framingham Heart Study Offspring Cohort reported at the AHA's High Blood Pressure Research meeting in Washington, D.C.

The finding reinforces the known role of low-fat dairy products in reducing blood pressure and the association supports the DASH diet recommendation of two to three servings of low-fat dairy per day. However, "when we talk about adding heart healthy foods we always want to think about what will they replace in the diet, not necessarily adding them on top of your existing diet in order to maintain a healthy weight,"  The  study of 2,197 adults in the offspring cohort of the Framingham Heart Study who did not have high blood pressure at baseline. Participants answered dietary questions and were followed for blood pressure along with other measures in the longitudinal study.  44% of the participants reported that they ate yogurt at least once a month. During the 14 years of follow-up, blood pressures rose and 913 of the participants developed hypertension. Yogurt intake rose too, and those with high intake -- more than 2% of their daily calories from yogurt -- were less likely to develop hypertension.  The odds ratio of incident hypertension was 0.69 compared with individuals who didn't eat yogurt, with a significant 95% confidence interval of 0.54 to 0.87 after adjustment for demographic and lifestyle factors and cholesterol-lowering medication use.

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By 2014 10-15% of social media reviews will be fake

By 2014 10-15% of social media reviews will be fake | Heart and Vascular Health | Scoop.it

My comment:  Fake endorsements are a problem when we want to choose a restaurant or evaluate a piece of technology for possible purchase.  Having fake or "bought" or other less than authentic evaluations when it comes to our healthcare is much more concerning.  Will healthcare "sellers" like doctors, hospitals, clinics, drug manufacturers use this strategy to drive purchasing.  Caveat Emptor.  The idea that a large number endorsements improve reliability of the evaluations is certianly called into question by these fake reviews.

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Several years ago, the FTC’s Guide Concerning the Use of Endorsements and Testimonials in Advertising impacted the blogging community, which responded angrily. Bloggers under this ruling have been required to disclose to readers of any payments, affiliations, or free products recieved in exchange for a review.
While the noise around blogging has died down, criminal online and social media practices have consequently evolved. Businesses can easily purchase “Likes” on Facebook or “Followers” on Twitter for a low as five dollars on sites like Fiverr. Anyone resorting to this strategy would know that they would be acquiring fake users or users that have no interest in your business, but with the pressure on marketers to perform, paying to bolster a company’s reputation with a few more thousand followers can be incredibly tempting.

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Improving 'Door to Balloon Time' (D2B) for Angioplasty Patients

Improving 'Door to Balloon Time' (D2B) for Angioplasty Patients | Heart and Vascular Health | Scoop.it

My comment : The particular kind of heart attack called STEMI identified by EKG is the highest immediate risk of all heart attacks and hospitals have dramatically improved systems of care to quickly open these blocked arteries.  Every minute more heart muscle is lost with a higher likelihood of death or severe long term complications such as heart failure.  The success described in the article is a great accomplishment for patients. The one part we are not improving is the "pain to door" time.  The longer the patient waits with chest pain to activate the emrgency system the worse the outcome.  Call 911 to start the "Race to Open a Blocked Artery".

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The current standard is 90 minutes, but many hospitals aim for a faster standard of as soon as possible.\Researchers who studied Medicare data from more than 300,000 patients at 900 hospitals found so-called door-to-balloon times fell from a median of 96 minutes in 2005 to 64 minutes in 2010. The best-performing hospitals regularly achieved times under 60 minutes, which "may become the new standard," the study, published last year in the journal Circulation, concluded.

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Hospitals to Congress: Drop Payment Cap Proposal

Hospitals to Congress: Drop Payment Cap Proposal | Heart and Vascular Health | Scoop.it

My comment: Unfortunately this is the way things are going from the Medicare adminstrator CMS.  Fees for important services like Echocardiograms and Nuclear stress tests have been dramatically cut when done in physician offices to rates that cannot be sustained.  Many physicians have merged with hospitals because the EXACT same service billed by the hospital is reimbursed 4 times higher.  (Echocardiogram $1,605 vs. $373)

See Same Doctor Visit, Double the Cost

http://professional.wsj.com/article/SB10000872396390443713704577601113671007448.html?mg=reno64-wsj

So now CMS intends to cut the reimbursement to the outpatient physician level.  Common sense & fairness would lead to a fair payment regardless of where the service is provided but these are the capricious aspects of our reimbursement system.  Physician groups should not be paid so little and hospitals should not be paid so much.

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The nation’s four largest hospital associations and their allies are urging Congress to oppose a cap on payments for outpatient services.

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ACE Inhibitor as Indulgence Pill

ACE Inhibitor as Indulgence Pill | Heart and Vascular Health | Scoop.it

My comment:  Sounds like an attractive option.  Eat what you want but take a pill to avoid the consequences.  Unfortunately, this has already been tried in a large human study called NAVIGATOR. http://www.nejm.org/doi/full/10.1056/NEJMoa1001121

Using the medicine Valsartan had a very small effect on reducing the progresion to diabetes (16%) and no effect on cardiovascular risk.  We still have to eat right and exercise. Sorry.

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A steady diet of hamburgers, fries, and Coke might not hurt the heart and the waistline as much with the ACE inhibitor captopril on board. 

Researchers at Emory University in Atlanta fed a high-fat diet with plenty of trans fat and high-fructose corn syrup to mice, with all the expected unhealthy effects on obesity, insulin resistance, and heart parameters.

But adding captopril to the drinking water along with the unhealthy diet reduced and even reversed weight gain, blocked abdominal fat gain, and improved glucose tolerance compared with controls. The drug also prevented the cardiac hypertrophy and cardiac dysfunction that developed in the other mice.

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Harder Exercise Tied to Lower Heart Risk in Kids

Harder Exercise Tied to Lower Heart Risk in Kids | Heart and Vascular Health | Scoop.it

Vigorous physical activity -- as opposed to less-intense exercise -- appears to be key in reducing cardiometabolic risk in children and teens, researchers found.

Percentage of children & teens with high blood pressure declined from 20.2% to 8%, reported online in Archives of Pediatrics & Adolescent Medicine.

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Medical debt in Massachusetts persists

Medical debt in Massachusetts persists | Heart and Vascular Health | Scoop.it

Medical debt in Massachusetts persists: Data unchanged since passage of 2006 health law

Architects of the pioneering 2006 Massachusetts health law, which required most residents to have insurance, expected it would reduce families’ medical debt. But the most recent data suggest the scope of medical debt has remained largely unchanged.

Temporary lapses in insurance coverage and increasingly common plans with high deductibles and copayments have contributed to medical debt, leaving some people struggling to pay bills for hospitals, doctors, and ambulance companies. Rising health costs and the recession also probably played a role.

Although the law has failed to cut medical debt, some analysts say it may have prevented an increase in Massachusetts.

see full article at http://goo.gl/JgqAG

 

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Cardiac Benefits of Red Wine Not From the Alcohol

Cardiac Benefits of Red Wine Not From the Alcohol | Heart and Vascular Health | Scoop.it

Drinking moderate amounts of nonalcoholic red wine -- but not its intoxicating equivalent -- lowered blood pressure in men with a high cardiovascular risk, a randomized, crossover study showed.

 

Drinking moderate amounts of nonalcoholic red wine -- but not its intoxicating equivalent -- lowered blood pressure in men with a high cardiovascular risk, a randomized, crossover study showed.

After 4 weeks of drinking the nonalcoholic wine, blood pressure fell by an average of 5.8/2.3 mm Hg (P<0.02).

In contrast, drinking standard red wine for 4 weeks and gin during another 4-week period had no significant effect, although blood pressure did decrease a bit with the wine (Circulation Research).

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Big Data in Your Blood

Big Data in Your Blood | Heart and Vascular Health | Scoop.it

My comment:  Wearable, easy to use devices have great potential for collaborative care between patients & physicans,  The amalgamation of Big Data from these sources may have even grerater utility from a public health standpoint.  Imagine seeing an outbreak of influenza by real time observation of vital signs such as body temperature. Imagine clincial trials where participants can have data collection done from home.

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Sensors of your heart, blood, and brain are coming to market. These may a boon to science and personal health. For the companies involved, they may be goldmines of intimate real-time data on millions of subjects.

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Million Hearts | Facebook

Million Hearts | Facebook | Heart and Vascular Health | Scoop.it

Team Up. Pressure Down. is a nationwide program to lower blood pressure and prevent hypertension through patient-pharmacist engagement.
Videos for patients on diagnosis & risks. Other resources include blood pressure guide, journal and medication tracker.
Good way for patient to get to know about America's most important silent killer. Join the online community.

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Are Drugs Better Than Carotid Stents?

Are Drugs Better Than Carotid Stents? | Heart and Vascular Health | Scoop.it

My comment: This is an important question for our patients and unfortunately we will porbably never get an answer because the study would be expensive and there is no likely source for funding an outcomes study that would be needed.  With all blocked arteries (heart, head or legs) the options for treatment are medications to control or slow the progression of the blockage OR stents OR surgery.  The benefits and safety hazards are improving for all three so making comparisons using older data is not useful,.  For now we know stents are about equivalent to surgery in blocked carotid arteries.  Is medicine equal or even better? 

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A debate is taking place among physicians over whether drug therapies to prevent stroke have surpassed stents or carotid artery surgery as the best treatment for many patients with artery blockage in the neck.

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ACO part of Obamacare not popular

ACO part of Obamacare not popular | Heart and Vascular Health | Scoop.it

My comment: ACO's (accountability care organizations) are programs only bureaucrats love.  It may not matter if patients, doctors and hospitals hate them; there may not be an option in the near future.

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Those who would be expected to carry out Obamacare are beginning to revolt.

Although it has been championed as a potential model by the Obama administration, the Cleveland Clinic (pictured)  has declined to participate in the administration's "pioneer" ACO progrm. Hospitals & doctors are revolting because ACOs saddle them with significant financial risks and substantial new administrative burdens. Patients won’t like them because they’ll put government bureaucrats — not their doctors — in charge of their care. Ultimately, ACOs will reduce competition throughout the healthcare market place — and raise costs.

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Infographic - Patient Non Adherence in the US

Infographic - Patient Non Adherence in the US | Heart and Vascular Health | Scoop.it

My Comment:  Non adherence and Non compliance are big problems.  It is difficult to solve because its multifactorial.  I beleive that regular phsycian review of the utility of the medications (at each visit) and emphasis on why each drug is important and backing this up with objective measures (Blood pressure, cholesterol results) is the best strategy to improve adherence.  Assuming patuients are taking their medications is definiitely ineefective. The pharma industry can help with education on disease states.

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Did you know that a massive $30 billion in revenue is lost each year due to non-adherence?

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Infographic - Patient Adherence in the US

Infographic - Patient Adherence in the US | Heart and Vascular Health | Scoop.it

Patient Adherence, or the extent to which a patient abides by their treatment regime, is a continuing issue globally and non-adherence is costing us all dear. However for all the talk about adherence programmes, better patient engagement and education, have you ever stopped to think about just how much non-adherence really costs?

 

In anticipation for 2012 Patient Summit USA, we have been giving this issue a great deal of thought, and decided it was time to illustrate just how much of a pressing issue non-adherence is becoming. As a result, our creative-types have come up with an infographic which I think you'll find puts the issues into stark perspective.

 

As you'll see, non-adherence remains a costly issue within healthcare, and if we can do anything to ensure it gets the attention, and the resources it deserves, we will.


Via nrip, Lionel Reichardt / le Pharmageek
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A Major Glitch for Digitized Health-Care Records

A Major Glitch for Digitized Health-Care Records | Heart and Vascular Health | Scoop.it

My comment: Electronic records (EMR or EHR) are supposed to deliver better health care quality and save billions of dollars.  It's not looking so good so far.  Evidence to the contrary is not welcome by the enthuisiasts and proponents of digitized records and some of these enthusiasts are the government and the payers who have created carrots and sticks to make sure this process continues.  Absent portability, interoperability and security are still with us for many years.

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Job strain as a risk factor for heart disease

Job strain as a risk factor for heart disease | Heart and Vascular Health | Scoop.it

My comment: The risk of job strain or the more common American term "stress" was small (only 3.4%) Dr. Debabrata Mukherjee writing for Cardiosource.org puts this in perspective: risks of "smoking (36%), abdominal obesity (20%) & physical inactivity (12%). While society strives to reduce job strain and improve working conditions, we need to continue to focus on eliminating smoking and encouraging lifestyle modifications (i.e., healthy diet and regular physical activity), which are far more impactful methods of reducing the incidence of cardiovascular diseases."

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Previous assessments of psychosocial stress (job strain) as a risk factor for coronary heart disease are inconsistent.  This study analysed the relation between job strain and coronary heart disease  Thirteen European studies (1985—2006) of men & women without coronary heart disease who were employed at baseline were assessed. Job strain was measured with questionnaires and coronary heart disease defined as the first heart attack (MI) or coronary death.

30,214 (15%) of participants reported job strain and (mean follow-up 7·5 years), recorded 2358 events of incident coronary heart disease. After adjustment for sex and age, the hazard ratio for job strain versus no job strain was 1·23 (95% CI 1·10—1·37).

An association between job strain and coronary heart disease for sex, age groups, socioeconomic strata, and region, and after adjustments for socioeconomic status, and lifestyle and conventional risk factors. The population attributable risk for job strain was 3·4%.
The  findings suggest that prevention of workplace stress might decrease disease incidence; however, this strategy would have a much smaller effect than would tackling of standard risk factors, such as smoking.

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Fish Oil Pills Do Not Prevent Cardiovascular Events

Fish Oil Pills Do Not Prevent Cardiovascular Events | Heart and Vascular Health | Scoop.it

My Comment:  We could save allot of health care resources (and have less burping)  if we stopped using fish oil and stopped doing fish oil research.  Enough is enough!  Eat fish, dont take fish oil pills.

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Pooled from 20 randomized trials evaluating the effects of consuming omega-3s on adults which included 68,680 participants, results revealed no decrease in risk of all-cause mortality, cardiac death, sudden death, myocardial infarction (MI), or stroke when supplementation was employed.

The findings "do not justify the use of omega-3 as a structured intervention in everyday clinical practice or guidelines supporting dietary omega-3 polyunsaturated fatty acid administration," researchers concluded.

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Highest-Calorie Menu Item at McDonald's? Not a Burger - WSJ.com

Highest-Calorie Menu Item at McDonald's? Not a Burger - WSJ.com | Heart and Vascular Health | Scoop.it

McDonald's said it will be begin listing calorie information on its menus in the U.S., as the fast-food chain pushes its nutrition-conscious efforts.

 

But other choices won't be so clear-cut, like the Double Cheeseburger with 440 calories or the Southwest Salad with Crispy Chicken, which weighs in at 450. McDonald's highest-calorie item isn't a burger at all, but the 1,150-calorie Big breakfast with hotcakes and large biscuit. And the healthy-sounding 22-ounce mango pineapple smoothie matches the 350 calories in the grilled chicken sandwich.

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Lip Cancer risk for those on Blood Pressure Meds

Lip Cancer risk for those on Blood Pressure Meds | Heart and Vascular Health | Scoop.it

Take Home Message: Sun Protection for All: But Especially for Those Receiving Certain Hypertensive Medications

 

This study  characterized the risk of lip cancer associated with blood pressure medications. these and other commonly used antihypertensive drugs.

Methods In a comprehensive medical care program, we evaluated prescriptions dispensed and cancer occurrence from August 1, 1994, to February 29, 2008. We identified 712 patients with lip cancer (cases) and 22 904 comparison individuals. At least a 5-year supply of a drug yielded the following odds ratios (95% CIs), respectively, compared with no use: hydrochlorothiazide, 4.22 (2.82-6.31); hydrochlorothiazide-triamterene, 2.82 (1.74-4.55); lisinopril, 1.42 (0.95-2.13); nifedipine, 2.50 (1.29-4.84); and atenolol, 1.93 (1.29-2.91). When the other drugs were excluded, the odds ratio for atenolol was reduced to 0.54 (0.07-4.08).

These data support an increased risk of lip cancer in non-Hispanic whites receiving treatment for hypertension with long-term use of photosensitizing drugs.

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Cholesterol Screening Rates Higher

Cholesterol Screening Rates Higher | Heart and Vascular Health | Scoop.it

The number of U.S. adults screened for high blood cholesterol rose significantly from 2005 to 2009. Results of a national survey on behavioral risks showed that the overall percentage of adults screened for high blood cholesterol within 5 years of the survey rose from 72.7% in 2005 to 76% in 2009. 

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Nearly 1 in 6 Americans has uncontrolled high blood pressure

Nearly 1 in 6 Americans has uncontrolled high blood pressure | Heart and Vascular Health | Scoop.it

Uncontrolled high blood pressure -- defined as having a systolic (top reading) of 140 or above or having a diastolic (bottom reading) of 90 or above -- is “public health enemy number two” behind smoking, said CDC Director Thomas Frieden; it contributes to 1,000 deaths in this country every day and causes $131 billion a year in healthcare costs.  See the Million Hearts Campaign for more info.

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Cardiology Visits Up, but Stress Testing Flat

Cardiology Visits Up, but Stress Testing Flat | Heart and Vascular Health | Scoop.it

My comment:  physicians are screening less.  Eliminting inappropriate screening is desirable, but will the pendulum swing too far?  Will improtant opportuniites to screen, identify and treat cardiovascular disease before serious consequences like heart attack and death be missed?

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In 2011, the median number of patient visits per cardiologist topped 2,000, an increase of nearly 30% since 2004; yet, the increase in the number of stress tests performed -- including echo, SPECT, and PET -- was only 2%, according to the survey.

Six reasons for the decline in nuclear testings:

1. Increasing adoption of appropriate-use criteria

2.  Challenging economic climate(high unemployment)

3.  Higher deductibles and copays for patients

4. Concern for radiation exposure by physicians & patients
5. Hosptial system based billing (pays more)
6.  Shortage of molybdenum-99 over the last several years

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