scholarly journals RAPID ASSESSMENT OF BILATERAL COCHLEAR IMPLANTATION FOR CHILDREN IN KAZAKHSTAN

2014 ◽  
Vol 30 (4) ◽  
pp. 361-365 ◽  
Author(s):  
Lyazzat Kosherbayeva ◽  
David Hailey ◽  
Laura Kozhageldiyeva
Keyword(s):  
Cochlear Implantation ◽  
English Language ◽  
Rapid Assessment ◽  
Clinical Effectiveness ◽  
Health Technology ◽  
Deaf Children ◽  
Rehabilitation Period ◽  
The Republic ◽  
Impaired Children

Objectives:The aim of this study was to evaluate the effectiveness of bilateral cochlear implantation (CI) compared with unilateral CI for deaf children in the context of the Republic of Kazakhstan health system.Methods.A literature search was conducted, using the PubMed, Cochrane, and Embase data bases for studies that compared the effectiveness of bilateral and unilateral CI in children. The search included English language, publications from 2002–2012. Two reviewers independently evaluated all relevant studies. Administrative data relevant to CI in Kazakhstan were obtained from the Ministry of Health.Results: Three relevant systematic reviews and an health technology assessment report were found. There was evidence of incremental benefits from bilateral CI but the quality of the available studies was poor and there was little information on longer term outcomes. No conclusions could be drawn regarding later incremental improvements to speech perception, learning, and quality of life. To date, in the Republic of Kazakhstan there is not full coverage of audiological screening due to the lack of medical equipment. This leads to late detection of hearing-impaired children and a long rehabilitation period, requiring more resources. Age of implantation in children is late and only a small minority attend general schools.Conclusions:The clinical effectiveness of bilateral CI, an expensive health technology, requires further study. Given the current situation in Kazakhstan with audiological screening and access to unilateral CI, there appeared to be other priorities for improving services for children with profound hearing impairment.

PP048 Quality Of Health Care Through Integration: Experience Of Cochlear Implantation

2017 ◽  
Vol 33 (S1) ◽  
pp. 93-94
Author(s):  
Lyazzat Kosherbayeva ◽  
Aigul Medeulova ◽  
Abdulla Alzhanov
Keyword(s):  
Health Care ◽  
Healthcare System ◽  
Cochlear Implantation ◽  
Cost Utility ◽  
Economic Research ◽  
Rehabilitation Programs ◽  
Life Years ◽  
The Republic ◽  
The Cost

INTRODUCTION:The State Program for Health Development of the Republic of Kazakhstan (RK) “Densaulyk” for 2016–2019 initiated the modernization of primary health care with the introduction of family practice in order to ensure the availability, completeness and quality of health services on the basis of an integrated healthcare system focused on the needs of the population. The aim of this study was to determine the effectiveness of the cochlear implantation (CI) programs.METHODS:A literature search was conducted for all clinical trials, randomized controlled trials, and reviews in the PubMed, Cochrane, and Center for Reviews and Dissemination databases. Two reviewers independently evaluated all publications for selection. The analysis included the cost-effectiveness and benefit from the CI program.RESULTS:We analyzed the effectiveness of the services for CI in the RK and other countries (1). In our analysis, we identified that there is no research on Quality-adjusted Life Years (QALYs) and Cost-Utility Analysis (CUA) in RK. We found that, in general, the cost of CI and pre-surgical procedures are comparable with other countries. The length of stay in Kazakhstan was much higher (an average of 8 days) compared with other countries (3 days). Also in RK, there were significantly lower prices per hospital day and cost of various consultations. Postoperative costs of other countries consisted of one-third to two-thirds of the total costs for preoperative and implantation stages (2, 3). There was a little information on the effectiveness of rehabilitation programs in RK.CONCLUSIONS:Economic research like QALYs and CUA are new directions in the healthcare system in the RK. Lack of integration between primary care, rehabilitation and other services leads to difficulties in assessing the effectiveness of CI programs (for example, in our case, there was the restriction of assessment in only postoperative costs).

scholarly journals LINKING THE EVIDENCE: INTERMEDIATE OUTCOMES IN MEDICAL TEST ASSESSMENTS

2012 ◽  
Vol 28 (1) ◽  
pp. 52-58 ◽  
Author(s):  
Lukas P. Staub ◽  
Suzanne Dyer ◽  
Sarah J. Lord ◽  
R. John Simes
Keyword(s):  
Health Outcomes ◽  
Web Sites ◽  
English Language ◽  
Health Technology ◽  
Disease Classification ◽  
Test Results ◽  
Medical Test ◽  
Intermediate Outcomes ◽  
The Impact

Objectives: The aim of this study is to review how health technology assessments (HTA) of medical tests incorporate intermediate outcomes in conclusions about the effectiveness of tests on improving health outcomes.Methods: Systematic review of English-language test assessments in the HTA database from January 2005 to February 2010, supplemented by a search of the Web sites of International Network of Agencies for Health Technology Assessment (INAHTA) members.Results: A total of 149 HTAs from eight countries were assessed. Half evaluated tests for screening or diagnosis, a third for disease classification (including staging, prognosis, monitoring), and a fifth for multiple purposes. In seventy-one HTAs (48 percent) only diagnostic accuracy was reported, while in seventeen (11 percent) evidence of health outcomes was reported in addition to accuracy. Intermediate outcomes, mainly the impact of test results on patient management, were considered in sixty-one HTAs (41 percent). Of these, forty-seven identified randomized trials or observational studies reporting intermediate outcomes. The validity of these intermediate outcomes as a surrogate for health outcomes was not consistently discussed; nor was the quality appraisal of this evidence. Clear conclusions about whether the test was effective were included in approximately 60 percent of HTAs.Conclusions: Intermediate outcomes are frequently assessed in medical test HTAs, but interpretation of this evidence is inconsistently reported. We recommend that reviewers explain the rationale for using intermediate outcomes, identify the assumptions required to link intermediate outcomes and patient benefits and harms, and assess the quality of included studies.

THE USE AND IMPACT OF RAPID HEALTH TECHNOLOGY ASSESSMENTS

2000 ◽  
Vol 16 (2) ◽  
pp. 651-656 ◽  
Author(s):  
David Hailey ◽  
Paula Corabian ◽  
Christa Harstall ◽  
Wendy Schneider
Keyword(s):  
Health Technology Assessment ◽  
Healthcare System ◽  
Technology Assessment ◽  
Rapid Assessment ◽  
Health Technology ◽  
Decision Makers ◽  
Assessment Program ◽  
Detailed Evaluation ◽  
The Impact

Objectives: To consider the impact of rapid health technology assessments undertaken as part of a program in a provincial healthcare system in response to urgent requests for advice.Methods: Review of the development and preparation of 20 rapid assessment reports, communication with decision makers within the healthcare system, and appraisal of data subsequent to preparation of the reports.Results: Fourteen of the assessments were judged to have had an influence on policy and other decisions, as judged by responses from those who had requested advice. Another four were considered to have provided guidance, while having less immediate influence on decisions, and two others had no apparent impact. Quality of the assessments was considered acceptable, on the basis of literature that subsequently became available and from comments received.Conclusions: These brief reports are considered to be a useful component of a health technology assessment program. However, they should be regarded as provisional appraisals and followed up with more detailed evaluation where possible.

scholarly journals Certolizumab pegol (CIMZIA®) for the treatment of rheumatoid arthritis

2010 ◽  
Vol 14 (Suppl 2) ◽  
pp. 1-10
Author(s):  
M Connock ◽  
S Tubeuf ◽  
K Malottki ◽  
A Uthman ◽  
J Round ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Cost Effectiveness ◽  
Treatment Option ◽  
English Language ◽  
Certolizumab Pegol ◽  
Clinical Effectiveness ◽  
Quality Of Life Measures ◽  
Language Studies

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of certolizumab pegol (CZP) for adults with active rheumatoid arthritis (RA) that have not responded adequately to treatment with conventional disease modifying anti-rheumatic drugs (DMARDs) including methotrexate (MTX), in accordance with the licensed indication, based upon the evidence submission from the manufacturer to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The outcome measures included American College of Rheumatology (ACR) 20, 50 and 70 response rates and quality of life measures after 3 months and 6 months of treatment. The ERG examined the submission’s search strategies and considered they appeared comprehensive and that it was unlikely that relevant studies would have been missed. Only English language studies were considered in the submission and non-English language studies relevant to the decision problem may possibly have been ignored. The ERG analysed the first submitted economic model so as to itemise in detail clarification points that were brought to the attention of the manufacturer. In response the manufacturer submitted a modified cost-effectiveness analysis. The ERG undertook further analysis of this second model and other additional submitted evidence. The clinical evidence was derived from two multicentre blinded randomised controlled trials (RCTs) comparing CZP + MTX to placebo + MTX (the RAPID 1 and RAPID 2 trials). RAPID 1 lasted 52 weeks with 982 patients and RAPID 2 24 weeks with 619 patients. Evidence for clinical effectiveness of CZP in mono-therapy came from the 24-week FAST4WARD trial with 220 patients that compared CZP (400 mg every 4 weeks) versus placebo. The three key RCTs demonstrated statistically significant superiority of CZP + MTX versus placebo + MTX and of CZP versus placebo with respect to a variety of outcomes including ACR 20, ACR 50 and ACR 70 measures and quality of life measures at 3 and 6 months. On the basis of results from the indirect comparison meta-analyses, the manufacturer suggested that CZP may be at least as effective as other ‘biological’ DMARD (bDMARD) comparators and, in a few ACR measures at 3 and 6 months, more effective. CZP is an effective therapy for adult RA patients whose disease has failed to respond adequately to cDMARDs including MTX or who are intolerant of MTX. The cost-effectiveness of CZP relative to other bDMARDs is unclear because the economic modelling undertaken may have ignored relevant effectiveness data and potential differences between trial populations, and so may have included effectiveness results that were biased in favour of CZP; underestimated uncertainty in the relative effectiveness of compared DMARDs; and ignored the potential influence of differences between bDMARDs with regard to adverse events and their related costs and health impacts. The NICE guidance issued in October 2009 states that: the Committee is minded not to recommend certolizumab pegol as a treatment option for people with RA; and the Committee recommends that NICE asks the manufacturer of CZP for more information on the clinical effectiveness and cost-effectiveness of CZP for the treatment of people with RA. On receipt of this information and details of a patient access scheme NICE issued final guidance recommending CZP, under certain criteria, as a treatment option for people with RA.

scholarly journals OUR EXPERIENCE OF 400 COCHLEAR IMPLANTS IN THE STATE OF UP

2020 ◽  
Vol VOLUME 8 (ONE) ◽  
pp. 12-16
Keyword(s):  
Quality Of Life ◽  
Cochlear Implantation ◽  
Deaf Children ◽  
Speech Rehabilitation ◽  
Posterior Tympanotomy ◽  
Auditory Performance ◽  
Group 3 ◽  
Set Up

IIntroduction : This retrospective study is based on experience of 400 cochlear implantation at late Dr S N Mehrotra Charitable ENT foundation between 2016 to 2019. Materials and Methods: 400 children who were implanted between 2016-2019 in Mehrotra ENT Hospital were included in the study. Outcomes of all the implanted children were analyzed. Scoring system for auditory performance(REVISED CAP), speech rehabilitation(SIR) and quality of life(GCBI) were also taken into account for every child implanted taking into consideration practical issues in Indian set up. Results: Majority of children(54.25%) were in age group 3-5 years. All were pre lingual deaf children. 53.25% were implanted with CI 24 RE (ST) from Nucleus and rest with Digisonic SP. 92% were implanted through posterior tympanotomy. 89.8% had r o u n d w i n d o w i n s e r ti o n a n d 1 0 . 2 % cochleostomy. 83.3 % were in regular follow up. 25(6.25%) had abnormal cochlea. Complications were few and managed successfully. More than 90% had improvement in hearing and quality of life. Conclusion: Outcome in terms of auditory perception, speech and quality of life was excellent taking into considerations practical issues in Indian setup. Early age implantation, regular follow up, extensive rehabilitation, prior hearing aid users and presence of residual hearing are good prognostic factors in our experience of 400 cochlea r impl ants. Complications being minimal and manageable, surgery was safe. Keywords Cochlear implantation, abnormal cochlea, REVISED CAP, SIR, GCBI.

ENHANCING ENGLISH LANGUAGE PROFICIENCY IN THE IN-SERVICE TRAINING COURSE “BORDER CHECKS AT A ROAD BORDER CROSSING POINT”

2018 ◽  
Vol 2 (7) ◽  
pp. 191
Author(s):  
Marina Žukova ◽  
Inta Madžule
Keyword(s):  
Language Proficiency ◽  
English Language ◽  
English Language Proficiency ◽  
Border Crossing ◽  
Course Development ◽  
Training Course ◽  
Service Training ◽  
The Republic ◽  
Basic English

English language proficiency is one of the competences Latvian border guards should have in order to communicate successfully with persons who wish to travel and reside in the Schengen area. The present article is a survey of the in-service training course on basic English professional terminology “Border checks at road border crossing points” which has been developed and implemented in the State Border Guard College of the Republic of Latvia. The survey was carried out in the period from September 2015 until April 2018 and focused on the analysis of the course development process and results of its implementation. Based on the results of the questioning, the participants of the course and their own observations the authors put forward suggestions for possible improvements of the quality of the course and border guards English language training.

scholarly journals Comparison Of iNfliximab and ciclosporin in STeroid Resistant Ulcerative Colitis: pragmatic randomised Trial and economic evaluation (CONSTRUCT)

2016 ◽  
Vol 20 (44) ◽  
pp. 1-320 ◽  
Author(s):  
John G Williams ◽  
M Fasihul Alam ◽  
Laith Alrubaiy ◽  
Clare Clement ◽  
David Cohen ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Adverse Reactions ◽  
Randomised Trial ◽  
Clinical Effectiveness ◽  
Health Technology ◽  
Mean Difference ◽  
Serious Adverse Events ◽  
Steroid Resistant ◽  
Significant Difference

BackgroundThe efficacy of infliximab and ciclosporin in treating severe ulcerative colitis (UC) is proven, but there has been no comparative evaluation of effectiveness.ObjectiveTo compare the clinical effectiveness and cost-effectiveness of infliximab and ciclosporin in treating steroid-resistant acute severe UC.MethodBetween May 2010 and February 2013 we recruited 270 participants from 52 hospitals in England, Scotland and Wales to an open-label parallel-group, pragmatic randomised trial. Consented patients admitted with severe colitis completed baseline quality-of-life questionnaires before receiving intravenous hydrocortisone. If they failed to respond within about 5 days, and met other inclusion criteria, we invited them to participate and used a web-based adaptive randomisation algorithm to allocate them in equal proportions between 5 mg/kg of intravenous infliximab at 0, 2 and 6 weeks or 2 mg/kg/day of intravenous ciclosporin for 7 days followed by 5.5 mg/kg/day of oral ciclosporin until 12 weeks from randomisation. Further treatment was at the discretion of physicians responsible for clinical management. The primary outcome was quality-adjusted survival (QAS): the area under the curve (AUC) of scores derived from Crohn’s and Ulcerative Colitis Questionnaires completed by participants at 3 and 6 months, and then 6-monthly over 1–3 years, more frequently after surgery. Secondary outcomes collected simultaneously included European Quality of Life-5 Dimensions (EQ-5D) scores and NHS resource use to estimate cost-effectiveness. Blinding was possible only for data analysts. We interviewed 20 trial participants and 23 participating professionals. Funded data collection finished in March 2014. Most participants consented to complete annual questionnaires and for us to analyse their routinely collected health data over 10 years.ResultsThe 135 participants in each group were well matched at baseline. In 121 participants analysed in each group, we found no significant difference between infliximab and ciclosporin in QAS [mean difference in AUC/day 0.0297 favouring ciclosporin, 95% confidence interval (CI) –0.0088 to 0.0682;p = 0.129]; EQ-5D scores (quality-adjusted life-year mean difference 0.021 favouring ciclosporin, 95% CI –0.032 to 0.096;p = 0.350); Short Form questionnaire-6 Dimensions scores (mean difference 0.0051 favouring ciclosporin, 95% CI –0.0250 to 0.0353;p = 0.737). There was no statistically significant difference in colectomy rates [odds ratio (OR) 1.350 favouring infliximab, 95% CI 0.832 to 2.188;p = 0.223]; numbers of serious adverse reactions (event ratio = 0.938 favouring ciclosporin, 95% CI 0.590 to 1.493;p = 0.788); participants with serious adverse reactions (OR 0.660 favouring ciclosporin, 95% CI 0.282 to 1.546;p = 0.338); numbers of serious adverse events (event ratio 1.075 favouring infliximab, 95% CI 0.603 to 1.917;p = 0.807); participants with serious adverse events (OR 0.999 favouring infliximab, 95% CI 0.473 to 2.114;p = 0.998); deaths (all three who died received infliximab;p = 0.247) or concomitant use of immunosuppressants. The lower cost of ciclosporin led to lower total NHS costs (mean difference –£5632, 95% CI –£8305 to –£2773;p < 0.001). Interviews highlighted the debilitating effect of UC; participants were more positive about infliximab than ciclosporin. Professionals reported advantages and disadvantages with both drugs, but nurses disliked the intravenous ciclosporin.ConclusionsTotal cost to the NHS was considerably higher for infliximab than ciclosporin. Nevertheless, there was no significant difference between the two drugs in clinical effectiveness, colectomy rates, incidence of SAEs or reactions, or mortality, when measured 1–3 years post treatment. To assess long-term outcome participants will be followed up for 10 years post randomisation, using questionnaires and routinely collected data. Further studies will be needed to evaluate the efficacy and effectiveness of new anti-tumour necrosis factor drugs and formulations of ciclosporin.Trial registrationCurrent Controlled Trials ISRCTN22663589.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 44. See the NIHR Journals Library website for further project information.

Computer Graphics and Language Instruction for the Deaf

1978 ◽  
Vol 7 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Margaret S. Withrow
Keyword(s):  
English Language ◽  
Three Dimensional ◽  
Spoken Language ◽  
Language Instruction ◽  
Deaf Children ◽  
Residual Hearing ◽  
Educational Materials ◽  
Reading Abilities ◽  
Time Space ◽  
Impaired Children

Mastery of the English language in all of its various expressive and receptive forms is essential for success in the American school system. Deaf children, through an inability to hear the spoken language, generally have reduced language and reading abilities. Even when sound is amplified to allow optimum use of residual hearing, deaf and hearing impaired children do not receive clear signals of spoken language components. Educational materials are being developed employing videotape and computer generated three-dimensional animation which will coordinate written and spoken language. With this new technique the materials designer is able to control time, space and audition to emphasize specific linguistic principles.

scholarly journals Laparoscopic supracervical hysterectomy compared with second-generation endometrial ablation for heavy menstrual bleeding: the HEALTH RCT

2019 ◽  
Vol 23 (53) ◽  
pp. 1-108
Author(s):  
Kevin Cooper ◽  
Suzanne Breeman ◽  
Neil W Scott ◽  
Graham Scotland ◽  
Rodolfo Hernández ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Second Generation ◽  
Clinical Effectiveness ◽  
Health Technology ◽  
Endometrial Ablation ◽  
Total Hysterectomy ◽  
Significant Difference ◽  
Post Randomisation

Background Heavy menstrual bleeding (HMB) is a common problem that affects many British women. When initial medical treatment is unsuccessful, the National Institute for Health and Care Excellence recommends surgical options such as endometrial ablation (EA) or hysterectomy. Although clinically and economically more effective than EA, total hysterectomy necessitates a longer hospital stay and is associated with slower recovery and a higher risk of complications. Improvements in endoscopic equipment and training have made laparoscopic supracervical hysterectomy (LASH) accessible to most gynaecologists. This operation could preserve the advantages of total hysterectomy and reduce the risk of complications. Objectives To compare the clinical effectiveness and cost-effectiveness of LASH with second-generation EA in women with HMB. Design A parallel-group, multicentre, randomised controlled trial. Allocation was by remote web-based randomisation (1 : 1 ratio). Surgeons and participants were not blinded to the allocated procedure. Setting Thirty-one UK secondary and tertiary hospitals. Participants Women aged < 50 years with HMB. Exclusion criteria included plans to conceive; endometrial atypia; abnormal cytology; uterine cavity size > 11 cm; any fibroids > 3 cm; contraindications to laparoscopic surgery; previous EA; and inability to give informed consent or complete trial paperwork. Interventions LASH compared with second-generation EA. Main outcome measures Co-primary clinical outcome measures were (1) patient satisfaction and (2) Menorrhagia Multi-Attribute Quality-of-Life Scale (MMAS) score at 15 months post randomisation. The primary economic outcome was incremental cost (NHS perspective) per quality-adjusted life-year (QALY) gained. Results A total of 330 participants were randomised to each group (total n = 660). Women randomised to LASH were more likely to be satisfied with their treatment than those randomised to EA (97.1% vs. 87.1%) [adjusted difference in proportions 0.10, 95% confidence interval (CI) 0.05 to 0.15; adjusted odds ratio (OR) from ordinal logistic regression (OLR) 2.53, 95% CI 1.83 to 3.48; p < 0.001]. Women randomised to LASH were also more likely to have the best possible MMAS score of 100 (68.7% vs. 54.5%) (adjusted difference in proportions 0.13, 95% CI 0.04 to 0.23; adjusted OR from OLR 1.87, 95% CI 1.31 to 2.67; p = 0.001). Serious adverse event rates were low and similar in both groups (4.5% vs. 3.6%). There was a significant difference in adjusted mean costs between LASH (£2886) and EA (£1282) at 15 months, but no significant difference in QALYs. Based on an extrapolation of expected differences in cost and QALYs out to 10 years, LASH cost an additional £1362 for an average QALY gain of 0.11, equating to an incremental cost-effectiveness ratio of £12,314 per QALY. Probabilities of cost-effectiveness were 53%, 71% and 80% at cost-effectiveness thresholds of £13,000, £20,000 and £30,000 per QALY gained, respectively. Limitations Follow-up data beyond 15 months post randomisation are not available to inform cost-effectiveness. Conclusion LASH is superior to EA in terms of clinical effectiveness. EA is less costly in the short term, but expected higher retreatment rates mean that LASH could be considered cost-effective by 10 years post procedure. Future work Retreatment rates, satisfaction and quality-of-life scores at 10-year follow-up will help to inform long-term cost-effectiveness. TriaI registration Current Controlled Trials ISRCTN49013893. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 53. See the NIHR Journals Library website for further project information.

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