Knowledge Update on the Economic Evaluation of Pacemaker Telemonitoring Systems

(1) Introduction: In the last two decades, telemedicine has been increasingly applied to telemonitoring (TM) of patients with pacemakers; however, presently, its growth has significantly accelerated because of the COVID-19 pandemic, which has pushed patients and healthcare workers alike to seek new ways to stay healthy with minimal physical contact. Therefore, the main objective of this study was to update the current knowledge on the differences in the medium-and long-term effectiveness of TM and conventional monitoring (CM) in relation to costs and health outcomes. (2) Methods: Three databases and one scientific registry were searched (PubMed, EMBASE, Scopus, and Google Scholar), with no restrictions on language or year of publication. Studies published until July 2021 were included. The inclusion criteria were: (a) experimental or observational design, (b) complete economic evaluation, (c) patients with implanted pacemakers, and (d) comparison of TM with CM. Measurements of study characteristics (author, study duration, sample size, age, sex, major indication for implantation, and pacemaker used), analysis, significant results of the variables (analysis performed, primary endpoints, secondary endpoints, health outcomes, and cost outcomes), and further miscellaneous measurements (methodological quality, variables coded, instrument development, coder training, and intercoder reliability, etc.) were included. (3) Results: 11 studies met the inclusion criteria, consisting of 3372 enrolled patients; 1773 (52.58%) of them were part of randomized clinical trials. The mean age was 72 years, and the atrioventricular block was established as the main indication for device implantation. TM was significantly effective in detecting the presence or absence of pacemaker problems, leading to a reduction in the number of unscheduled hospital visits (8.34–55.55%). The cost of TM was up to 87% lower than that of CM. There were no significant differences in health-related quality of life (HRQoL) and the number of cardiovascular events. (4) Conclusions: Most of the studies included in this systematic review confirm that in the TM group of patients with pacemakers, cardiovascular events are detected and treated earlier, and the number of unscheduled visits to the hospital is significantly reduced, without affecting the HRQoL of patients. In addition, with TM modality, both formal and informal costs are significantly reduced in the medium and long term.

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Long-Term Physical Health Outcomes of Resettled Refugee Populations in the United States: A Scoping Review

Journal of Immigrant and Minority Health ◽

10.1007/s10903-021-01146-2 ◽

2021 ◽

Author(s):

Gayathri S. Kumar ◽

Jenna A. Beeler ◽

Emma E. Seagle ◽

Emily S. Jentes

Keyword(s):

Health Outcomes ◽

Physical Health ◽

Public Health Practice ◽

The United States ◽

Inclusion Criteria ◽

Physical Health Outcomes ◽

Increased Risk ◽

The Us ◽

Bhutanese Refugee

AbstractSeveral studies describe the health of recently resettled refugee populations in the US beyond the first 8 months after arrival. This review summarizes the results of these studies. Scientific articles from five databases published from January 2008 to March 2019 were reviewed. Articles were included if study subjects included any of the top five US resettlement populations during 2008–2018 and if data described long-term physical health outcomes beyond the first 8 months after arrival in the US. Thirty-three studies met the inclusion criteria (1.5%). Refugee adults had higher odds of having a chronic disease compared with non-refugee immigrant adults, and an increased risk for diabetes compared with US-born controls. The most commonly reported chronic diseases among Iraqi, Somali, and Bhutanese refugee adults included diabetes and hypertension. Clinicians should consider screening and evaluating for chronic conditions in the early resettlement period. Further evaluations can build a more comprehensive, long-term health profile of resettled refugees to inform public health practice.

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Handling uncertainty in economic evaluations of patient level data: A review of the use of Bayesian methods to inform health technology assessments

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309990316 ◽

2009 ◽

Vol 25 (4) ◽

pp. 546-554 ◽

Cited By ~ 7

Author(s):

C. Elizabeth McCarron ◽

Eleanor M. Pullenayegum ◽

Deborah A. Marshall ◽

Ron Goeree ◽

Jean-Eric Tarride

Keyword(s):

Decision Making ◽

Economic Evaluation ◽

Bayesian Methods ◽

Likelihood Function ◽

Economic Evaluations ◽

Inclusion Criteria ◽

Patient Level Data ◽

Patient Level ◽

Level Data ◽

Study Characteristics

Objectives: Due to potential advantages (e.g., using all available evidence), Bayesian methods have been proposed to assist healthcare decision making. This review provides a detailed description of how Bayesian methods have been applied to economic evaluations of patient level data. The results serve both as a reference and as a means by which to examine the appropriate application of Bayesian methods to inform decision making.Methods: MEDLINE, EMBASE, and Cochrane Economic Evaluation databases were searched to identify studies, published up to November 2007, meeting three inclusion criteria: (i) the study conducted an economic evaluation, (ii) sampling uncertainty was incorporated using Bayesian methods, (iii) the likelihood function was informed by patient level data from a single source. Data were collected on key study characteristics (e.g., prior distribution, likelihood function, presentation of uncertainty).Results: The search identified 366 potentially relevant studies, from which 103 studies underwent full-text review. Sixteen studies met the inclusion criteria. Half of the studies used uninformative priors; most studies incorporated the potential dependence between costs and effects, and presented cost-effectiveness acceptability curves. Results were sensitive to changes in the priors and likelihoods.Conclusions: Limited use of informative priors, among the included studies, gives policy makers little guidance on one of the main benefits of Bayesian methods, the ability to integrate all available evidence to capture the uncertainty inherent in decision making.

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Role of Dental Implant Homecare in Mucositis and Peri-implantitis Prevention: A Literature Overview

The Open Dentistry Journal ◽

10.2174/1874210601913010470 ◽

2019 ◽

Vol 13 (1) ◽

pp. 470-477

Author(s):

Vittorio Checchi ◽

Fabrizio Racca ◽

Davide Bencivenni ◽

Laura Lo Bianco

Keyword(s):

Clinical Trials ◽

Home Care ◽

Cohort Studies ◽

Dental Implants ◽

Randomized Clinical Trials ◽

Current Knowledge ◽

Good Evidence ◽

Inclusion Criteria ◽

Dental Floss ◽

Care Practices

Background: Correlation between high plaque index and inflammatory lesions around dental implants has been shown and this highlights the importance of patient plaque control. Until now, knowledge of peri-implant home care practices has been based on periodontal devices. Objective: The aim of this overview is to identify the presence of scientific evidence that peri-implant homecare plays a role in mucositis and peri-implantitis prevention. Methods: Different databases were used in order to detect publications reflecting the inclusion criteria. The search looked into peri-implant homecare studies published from 1991 to 2019 and the terms used for the identification of keywords were: Dental implants, Brush, Interproximal brushing, Interdental brushing, Power toothbrush, Cleaning, Interdental cleaning, Interspace cleaning, Flossing, Super floss, Mouth rinses, Chlorhexidine. The type of studies included in the selection for this structured review were Randomized Clinical Trials, Controlled Clinical Trials, Systematic Reviews, Reviews, Cohort Studies and Clinical cases. Results: Seven studies fulfilled all the inclusion criteria: 3 RCTs, one Consensus report, one cohort study, one systematic review and one review. Other 14 studies that partially met the inclusion criteria were analyzed and classified into 3 different levels of evidence: good evidence for RCTs, fair evidence for case control and cohort studies and poor evidence for expert opinion and case report. Conclusion: Not much research has been done regarding homecare implant maintenance. Scientific literature seems to show little evidence regarding these practices therefore most of the current knowledge comes from the periodontal literature. Manual and powered toothbrushes, dental floss and interdental brushes seem to be useful in maintaining peri-implant health. The use of antiseptic rinses or gels does not seem to have any beneficial effects. It can be concluded that to better understand which are the most effective home care practices to prevent mucositis and peri-implantitis in implant-rehabilitated patients, new specific high evidence studies are needed.

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Methylphenidate Treatment of Attention-Defit/Hyperactivity Disorder Secondary to Traumatic Brain Injury: A Critical Appraisal of Treatment Studies

CNS Spectrums ◽

10.1017/s1092852900009019 ◽

2004 ◽

Vol 9 (3) ◽

pp. 217-226 ◽

Cited By ~ 33

Author(s):

Charles Jin ◽

Russell Schachar

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Clinical Trials ◽

Current Knowledge ◽

Meta Analysis ◽

Cognitive Outcomes ◽

Double Blind ◽

Stimulant Treatment ◽

Hyperactivity Disorder ◽

Study Characteristics

ABSTRACTObjective:Are stimulants effective in treating attention-deficit/hyperactivity disorder secondary to traumatic brain injury (ADHD/TBI)? The authors reviewed and examined the current knowledge on efficacy of stimulant treatment ADHD/TBI.Method:A systematic review of the literature using a quality assessment scale to assess the quality of randomized clinical trials was undertaken. We identified all studies in which stimulants had been administered to individuals with ADHD/TBI. Information was extracted on study characteristics, interventions, and outcomes. A meta-analysis was not performed because of the limited number of studies with strict research design and the heterogeneity of outcome measures. Seven studies involving 118 subjects, 41 of whom were children and adolescents, were identified.Results:Of the seven identified studies, one was a chart review, one used a single-blind, placebo-controlled crossover design, and five were double-blind, placebo-controlled crossovers. These studies used >50 subjective and objective tests to measure behavioral and cognitive outcomes. Methylphenidate (MPH) effects on behavior (hyperactivity, impulsivity) were evident but were not as robust as those typically observed with MPH in primary ADHD. The effect of MPH on cognition was less apparent. More favorable outcome was associated with initiation of treatment soon after head injury, although this factor was not systematically studied, and trials with relativly long durations. Studies with negative MPH response reported neither improvement in behavioral nor cognitive symptoms.Conclusion:There is only modest evidence to support the efficacy of MPH in the treatment of ADHD/TBI. While MPH might still be a promising treatment for ADHD/TBI, there is need for rigorous treatment outcome research among representative samples of ADHD/TBI individuals.

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Shedding light on maternal sunlight exposure during pregnancy and considerations for public health policy

Health Science Inquiry ◽

10.29173/hsi298 ◽

2020 ◽

Vol 11 (1) ◽

pp. 112-118

Author(s):

Peter Anto Johnson ◽

John Christy Johnson

Keyword(s):

Public Health ◽

Health Policy ◽

Health Outcomes ◽

Birth Outcomes ◽

Public Health Policy ◽

Current Knowledge ◽

Sunlight Exposure ◽

Adverse Birth Outcomes ◽

Exposure During Pregnancy

Sunlight exposure during pregnancy could be implicated in the physiological development and growth of the fetus, as well as long-term health after birth. Although several studies suggest the involvement of ultraviolet radiation-mediated vitamin D synthesis, current knowledge regarding the effects of sunlight exposure during pregnancy remains limited. We aimed to (i) summarize the existing body of research studying the influence of sunlight exposure on fetal growth-related birth outcomes and long-term health outcomes and (ii) determine its implications for therapeutics and public health policy. Of the studies identified on birth outcomes, the majority (5/8) demonstrated an association between sunlight exposure and reduced adverse birth outcomes (e.g., low birth weight, preterm births, small for gestational age, etc.), 2/8 studies showed no association, and 1/8 suggested a negative association between sunlight exposure and reduction of these adverse birth outcomes. Of the studies examining long-term health outcomes, sunlight exposure during pregnancy was shown to promote skeletal growth and development (2/6), and reduce the incidence of multiple sclerosis (2/6), asthma (2/6) and pneumonia (1/6). However, several of these studies used different methodologies and populations making it difficult to compare and integrate findings. Based on these results, we examined: the importance of exposure at different stages of pregnancy, proposed mechanisms by which sunlight exposure could lead to optimal outcomes, epidemiological differences influencing the findings, and necessary practical considerations prior to the implementation of public health policy recommendations. While these findings are promising, more rigorous research is warranted to support these recommendations.

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