Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients.

Abstract Thyrotropin (TSH) concentrations were measured in 1580 hospitalized patients and 109 normal persons. Using the mean +/- 3 SD limits of the log values for the controls (0.35-6.7 milli-int. units/L), the proportion of abnormal TSH results in the hospitalized patients was 17.2%. TSH was undetectable (less than 0.1 milli-int. unit/L) in 3.1% of patients, suggesting hyperthyroidism, and high (greater than 20 milli-int. units/L) in 1.6%, suggesting hypothyroidism. On follow-up of 329 patients, 62% with abnormal TSH (less than 0.35 or greater than 6.7 milli-int. units/L) and 38% with normal TSH concentrations, only 24% of those with undetectable TSH had thyroid disease: 36% of them were being treated with glucocorticoids and 40% had nonthyroidal illness (NTI). Although half the patients with TSH greater than 20 milli-int. units/L had thyroid disease, 45% of patients had high TSH values associated with NTI. TSH concentrations usually returned towards normal when patients' therapy with glucocorticoids was discontinued or they recovered from NTI. TSH test sensitivity appeared good when the mean +/- 3 SD limits of the reference population were used, i.e., no cases of hyper- or hypothyroidism, as identified by free thyroxin index (FT4I), were missed. However, TSH test specificity was inferior to that of the FT4I test (90.7% vs 92.3%), although specificity could be improved to 97.0% if the wider TSH reference limits of 0.1 to 20 milli-int. units/L were used--limits considered pathological if applied to outpatients. Evidently, different reference intervals for TSH are needed for hospitalized and nonhospitalized patients. We conclude that a "sensitive TSH assay" is not a cost-effective thyroid screening test for hospitalized patients as compared with the FT4I.

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Free thyroxin by radioimmunoassay: evaluation of a new direct method involving a radiolabeled thyroxin analog.

Clinical Chemistry ◽

10.1093/clinchem/29.10.1781 ◽

1983 ◽

Vol 29 (10) ◽

pp. 1781-1786 ◽

Cited By ~ 11

Author(s):

N P Kubasik ◽

P A Lundberg ◽

R G Brodows ◽

G D Hallauer ◽

D G Same ◽

...

Keyword(s):

Performance Evaluation ◽

Oral Contraceptives ◽

Thyroid Disease ◽

Direct Method ◽

Age Effect ◽

Free T4 ◽

Nonthyroidal Illness ◽

Serum Free ◽

Normal Individuals ◽

The Mean

Abstract We present here the first performance evaluation of a new direct method for free thyroxin (T4) in serum by radioimmunoassay, with use of coated tubes and a radiolabeled T4 analog (Diagnostic Products Corp.). The assay is precise and robust: within-run imprecision (CV), 3.1-6.6%; between-run imprecision, 4.0-7.9%; no demonstrable variation between technologists irrespective of experience with the method. No outliers were observed when we compared the free T4 results with serum total T4. Reference values are reported for a total of 1243 euthyroid subjects; there was no significant age effect on serum free T4 in women 26 to 72 years old. The biological variation was about +/- 35% of the mean (2 SD). Free T4 results are the same for serum and plasma. The assay performs well in hypothyroidism and hyperthyroidism, and distinguishes individuals with thyroid disease from normal individuals. Free T4 values in women taking oral contraceptives are normal. Depressed results were often observed in acute nonthyroidal illness and continuing pregnancy. These results were directly comparable with those of another commercial direct radiolabeled-T4 analog kit for free T4.

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Anatomic reconstruction for acromioclavicular joint injuries: a pilot study of a cost-effective new technique

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00325 ◽

2021 ◽

Vol 24 (4) ◽

pp. 209-214

Author(s):

Radhakrishnan Pattu ◽

Girinivasan Chellamuthu ◽

Kumar Sellappan ◽

Chendrayan Kamalanathan

Keyword(s):

Acromioclavicular Joint ◽

Cost Effective ◽

Anatomic Reconstruction ◽

X Rays ◽

Effective Technique ◽

Ac Joint ◽

Joint Injuries ◽

Cost Effective Technique ◽

The Mean

Background: The treatment for acromioclavicular joint injuries (ACJI) ranges from a conservative approach to extensive surgical reconstruction, and the decision on how to manage these injuries depends on the grade of acromioclavicular (AC) joint separation, resources, and skill availability. After a thorough review of the literature, the researchers adopted a simple cost-effective technique of AC joint reconstruction for acute ACJI requiring surgery.Methods: This was a prospective single-center study conducted between April 2017 and April 2018. For patients with acute ACJI more than Rockwood grade 3, the researchers performed open corococlavicular ligament reconstruction using synthetic sutures along with an Endobutton and a figure of 8 button plate. This was followed by AC ligament repair augmenting it with temporary percutaneous AC K-wires. Clinical outcomes were evaluated using the Constant Murley shoulder score. Results: Seventeen patients underwent surgery. The immediate postoperative radiograph showed an anatomical reduction of the AC joint dislocation in all patients. During follow-up, one patient developed subluxation but was asymptomatic. The mean follow-up period was 30 months (range, 24–35 months). The mean Constant score at 24 months was 95. No AC joint degeneration was noted in follow-up X-rays. The follow-up X-rays showed significant infra-clavicular calcification in 11 of the 17 patients, which was an evidence of a healed coracoclavicular ligament post-surgeryConclusions: This study presents a simple cost-effective technique with a short learning curve for anatomic reconstruction of acute ACJI. The preliminary results have been very encouraging.

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Positive behaviour support training for staff for treating challenging behaviour in people with intellectual disabilities: a cluster RCT

Health Technology Assessment ◽

10.3310/hta22150 ◽

2018 ◽

Vol 22 (15) ◽

pp. 1-110 ◽

Cited By ~ 8

Author(s):

Angela Hassiotis ◽

Michaela Poppe ◽

Andre Strydom ◽

Victoria Vickerstaff ◽

Ian Hall ◽

...

Keyword(s):

Technology Assessment ◽

Cost Effective ◽

Health Technology ◽

Service Users ◽

Challenging Behaviour ◽

The Mean ◽

Secondary Outcomes ◽

Positive Behaviour Support

Background Preliminary studies have indicated that training staff in Positive Behaviour Support (PBS) may help to reduce challenging behaviour among people with intellectual disability (ID). Objective To evaluate whether or not such training is clinically effective in reducing challenging behaviour in routine care. The study also included longer-term follow-up (approximately 36 months). Design A multicentre, single-blind, two-arm, parallel-cluster randomised controlled trial. The unit of randomisation was the community ID service using an independent web-based randomisation system and random permuted blocks on a 1 : 1 allocation stratified by a staff-to-patient ratio for each cluster. Setting Community ID services in England. Participants Adults (aged > 18 years) across the range of ID with challenging behaviour [≥ 15 Aberrant Behaviour Checklist – Community total score (ABC-CT)]. Interventions Manual-assisted face-to-face PBS training to therapists and treatment as usual (TAU) compared with TAU only in the control arm. Main outcome measures Carer-reported changes in challenging behaviour as measured by the ABC-CT over 12 months. Secondary outcomes included psychopathology, community participation, family and paid carer burden, family carer psychopathology, costs of care and quality-adjusted life-years (QALYs). Data on main outcome, service use and health-related quality of life were collected for the 36-month follow-up. Results A total of 246 participants were recruited from 23 teams, of whom 109 were in the intervention arm (11 teams) and 137 were in the control arm (12 teams). The difference in ABC-CT between the intervention and control arms [mean difference –2.14, 95% confidence interval (CI) –8.79 to 4.51; p = 0.528] was not statistically significant. No treatment effects were found for any of the secondary outcomes. The mean cost per participant in the intervention arm was £1201. Over 12 months, there was a difference in QALYs of 0.076 in favour of the intervention (95% CI 0.011 to 0.140 QALYs) and a 60% chance that the intervention is cost-effective compared with TAU from a health and social care cost perspective at the threshold of £20,000 per QALY gained. Twenty-nine participants experienced 45 serious adverse events (intervention arm, n = 19; control arm, n = 26). PBS plans were available for 33 participants. An independent assessment of the quality of these plans found that all were less than optimal. Forty-six qualitative interviews were conducted with service users, family carers, paid carers and service managers as part of the process evaluation. Service users reported that they had learned to manage difficult situations and had gained new skills, and carers reported a positive relationship with therapists. At 36 months’ follow-up (n = 184), the mean ABC-CT difference between arms was not significant (–3.70, 95% CI –9.25 to 1.85; p = 0.191). The initial cost-effectiveness of the intervention dissipated over time. Limitations The main limitations were low treatment fidelity and reach of the intervention. Conclusions Findings from the main study and the naturalistic follow-up suggest that staff training in PBS as delivered in this study is insufficient to achieve significant clinical gains beyond TAU in community ID services. Although there is an indication that training in PBS is potentially cost-effective, this is not maintained in the longer term. There is increased scope to develop new approaches to challenging behaviour as well as optimising the delivery of PBS in routine clinical practice. Trial registration This study is registered as NCT01680276. 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. 22, No. 15. See the NIHR Journals Library website for further project information.

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Risk of Benign and Malignant Thyroid Disorders in Subjects Treated for Paediatric/Adolescent Neoplasia: Role of Morphological and Functional Screening

Children ◽

10.3390/children8090767 ◽

2021 ◽

Vol 8 (9) ◽

pp. 767

Author(s):

Giulia Sapuppo ◽

Martina Tavarelli ◽

Emanuela Cannata ◽

Milena La Spina ◽

Marco Russo ◽

...

Keyword(s):

Cancer Survivors ◽

Clinical Benefit ◽

Thyroid Disease ◽

Consecutive Series ◽

Functional Evaluation ◽

Functional Screening ◽

Adolescent Cancer ◽

Thyroid Screening ◽

High Incidence

Background: Patients treated for paediatric/adolescent (P/A) neoplasia have a high incidence of both benign and malignant thyroid diseases. Given the high incidence of sequelae, literature data show a clinical benefit of morpho-functional thyroid screening in paediatric/adolescent cancer survivors and a careful lifetime follow-up. Patients and methods: The incidence of thyroid alterations was evaluated in a consecutive series of 343 patients treated with chemotherapy (CHE) and radiotherapy (RTE) or only with CHE for P/A tumours between 1976 and 2018 (mean age at time of primary paediatric malignancy 7.8 ± 4.7 years). All patients underwent thyroidal morpho-functional evaluation between 2000 and 2019. Results: 178 patients (51.9%) were treated only with CHE and 165 (48.1%) with CHE+RTE. A functional and/or structural thyroid disease was diagnosed in 147 (42.5%; 24.2% in CHE and 62.4% in CHE+RTE group; p = 0.0001). Of note, 71 (20.7%) patients with no evidence of disease at first evaluation developed a thyroid alteration during the follow-up. Primitive hypothyroidism was diagnosed in 54 patients (15.7%; 11.2% in CHE vs. 20.6% in CHE+RTE group; p = 0.01) and hyperthyroidism in 4. Sixty-three patients developed thyroid nodules (18.4%; 4.0% in CHE and 14.1% in CHE+RTE group; p < 0.001); thyroid cancer was diagnosed in 30 patients (8.7%; 4.5% in CHE and 12.4% in CHE + RTE group; p = 0.007). Conclusions: In patients treated with CHE+RTE, the prevalence of hypothyroidism and nodular pathology, both malignant and benign, were significantly greater than in patients treated with CHE. However, also in the CHE group, the frequency of thyroid disease is not negligible and the pathogenetic mechanisms remain to be clarified. Our data suggest the clinical benefit of morpho-functional thyroid screening in P/A cancer survivors.

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The burden of chronic elbow dislocations in Cambodia and early results of a cost-effective surgical approach

Tropical Doctor ◽

10.1177/0049475518808637 ◽

2018 ◽

Vol 49 (1) ◽

pp. 14-19

Author(s):

Alice E Mortimer ◽

Alex Nicholls ◽

Aziz Rawal ◽

Saqib Noor ◽

Heang Oy ◽

...

Keyword(s):

Posterior Approach ◽

Elbow Dislocation ◽

Cost Effective ◽

Lateral Approach ◽

Significant Loss ◽

Range Of Movement ◽

Loss To Follow Up ◽

Early Results ◽

The Mean

Chronic elbow dislocation presents a surgical challenge and there is difficulty in balancing stability with early mobilisation. We present a series of 103 patients treated with open reduction via a posterior approach and provide early results of an alternative combined medial and lateral approach (Soddo technique, Anderson et al.). Of the 103 patients, 81% initially consulted a traditional healer and the mean dislocation period was 11 weeks. There was significant loss to follow-up. Only 12 patients having undergone the posterior approach had complete datasets. The mean preoperative arc of movement was 10° and the postoperative arc was 65° at a mean follow-up of 16 weeks. Five patients treated with the Soddo technique had sufficient follow-up data. The mean preoperative arc was 20° and the mean postoperative arc was 95° (mean follow-up of 20 days). Those having undergone the Soddo technique achieved a 20° greater increase in range of movement and no re-dislocations.

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P582Real-world experience with ehealth telemonitoring in patients with hypertension

European Heart Journal ◽

10.1093/eurheartj/ehz747.0192 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Blok ◽

G A Somsen ◽

B Stavrov ◽

I I Tulevski ◽

B J H Van Den Born ◽

...

Keyword(s):

Blood Pressure ◽

Real Life ◽

Home Monitoring ◽

Cost Effective ◽

Healthcare Team ◽

Therapeutic Action ◽

Real Life Setting ◽

Target Values ◽

The Mean

Abstract Background Hypertension is the strongest modifiable risk factor for cardiovascular disease worldwide, while incidence and prevalence remain high. Home-monitoring is known to improve blood pressure in patients with hypertension. Despite promising results, few home monitoring programs have successfully been integrated into daily care and little evidence exists on their cost-effectiveness. The Dutch HartWacht eHealth program, initiated in June 2016, is one of the first eHealth programs that is fully reimbursed and integrated into clinical practice. Purpose The purpose of the study is to demonstrate the effect of an integrated and cost-effective telemonitoring program in a real-life setting. Methods In the HartWacht program patients with uncontrolled hypertension (office BP >140/90) receive a blood pressure monitor that is connected to their smartphone and integrated with their personal electronic patient file. Measurements are checked by a dedicated health care team. If values exceed pre-defined thresholds, patients are contacted by the team for swift therapeutic action. In this study, the first results of the program are evaluated. Comparisons were made between last office blood pressure before the program; average blood pressure of first week of home measurement (twice daily, morning and evening); and blood pressure of home measurement at three, six and twelve months after start. Results 122 patients started the HartWacht program for hypertension (female: 57 (46.7%); mean age: 61.2 (±9.5) years; mean follow-up: 13.4 (±7.6) months; mean number of anti-hypertensive drugs at start of HartWacht: 1.8 (±0.9); mean number of medication changes per year during follow-up (including changes in dose): 1.0 (±1.6); mean number of contact moments per year during follow-up (including calls with nurse or cardiologist): 4.9 (±5.0)). At final follow-up, 67 patients participated at least one year. Others started later or stopped the program, mainly because of reaching normotensive values (n=22; home BP <135/85). The mean last office systolic blood pressure (SBP) measurement (n=122) was 157.9 mmHg (±19.2). The mean home SBP in the first week (n=120) was 139.9 mmHg (±13.9). After 3 months the mean home SBP lowered to 133.8 mmHg (±14.9), a significant decrease compared to week 1 (mean: 6.1 (±13.8), p<0.001). After this moment the mean home SBP was stable: 132.5 mmHg (±12.6) at six months (n=99) and 132.2 mmHg (±12.4) at 12 months (n=67). No correlation was found between the number of medication adaptations and/or contact moments with the healthcare team and reaching target values. Conclusion This integrated eHeatlh telemonitoring program demonstrates significant and persistent blood pressure reduction in a real-life setting. As measurements are continuously monitored, swift therapeutic action is guaranteed. The Dutch HartWacht program has proven to be cost-effective, is reimbursed, and has the potential to be scaled up (inter-)nationally.

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Thyroid Function and Prevalence of Anti-Thyroperoxidase Antibodies in a Population with Borderline Sufficient Iodine Intake: Influences of Age and Sex

Clinical Chemistry ◽

10.1373/clinchem.2005.055194 ◽

2006 ◽

Vol 52 (1) ◽

pp. 104-111 ◽

Cited By ~ 124

Author(s):

Elizabeth H Hoogendoorn ◽

Ad R Hermus ◽

Femmie de Vegt ◽

H Alec Ross ◽

Andre LM Verbeek ◽

...

Keyword(s):

At Risk ◽

The Netherlands ◽

Thyroid Function ◽

Thyroid Disease ◽

Total Population ◽

Reference Population ◽

Population Based ◽

Iodine Intake ◽

The Mean ◽

Thyroperoxidase Antibodies

Abstract Background: We present a large European population-based study of thyroid function, performed in a population with longstanding borderline sufficient iodine intake. Methods: The Nijmegen Biomedical Study is a population-based survey conducted in the eastern part of The Netherlands. Randomly selected inhabitants received a postal questionnaire on lifestyle and medical history, which was filled out by 9371 individuals (41.7%). We measured serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and anti-thyroperoxidase antibodies (TPOAbs) in 6434 responders. A reference population of 5167 individuals was selected by excluding those at risk for thyroid disease. Results: Overt thyrotoxicosis was found in 0.4% of the total population and subclinical thyrotoxicosis in 0.8%. Overt hypothyroidism was found in 0.4% and subclinical hypothyroidism in 4.0%. In individuals older than 60 years, mean FT4 concentrations increased with age. Mean TSH decreased with age, from 1.46 mIU/L at 18–24 years to 1.07 mIU/L after 85 years. The mean TSH in the total population did not differ from the mean TSH in the reference population; the exclusion of those at risk for thyroid disease, however, lowered the upper limit of the TSH reference interval considerably. In the total population, 8.6% of males and 18.5% of females had positive TPOAbs. The presence of TPOAbs was associated with abnormally high and low TSH concentrations. Conclusion: In inhabitants of the eastern part of The Netherlands, serum TSH gradually decreases with age, whereas after age 60, serum FT4 increases, possibly because of the development of thyroid autonomy after longstanding borderline sufficient iodine intake.

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Evaluate the effectiveness of tonsillectomy and long-acting penicillin on the levels of the antistreptolysin O titer in children with recurrent tonsillitis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191660 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1692

Author(s):

Alekh Kumar ◽

Nupur Kumari

Keyword(s):

Cost Effective ◽

Chronic Tonsillitis ◽

P Value ◽

Bleeding Diathesis ◽

Recurrent Tonsillitis ◽

Long Term Follow Up ◽

The Mean ◽

Long Acting

Background: Tonsillitis is widespread among children and has serious poststreptococcal complications, and both the patients and clinician have to face the question on what is the role and benefit of using long-acting penicillin and whether it is an alternative method of treatment to surgery?. This study was carried out to evaluate the effectiveness of tonsillectomy compared with long-acting penicillin in the treatment of recurrent tonsillitis, comparing their effects on the levels of the antistreptolysin O titer (ASOT).Methods: A total of 100 patients aged 4-15 years with recurrent tonsillitis and signs of chronic tonsillitis, after exclusion of patients with bleeding diathesis, anemia, chronic illness, and criteria of rheumatic fever, were included in this study, they were divided to two groups comprising 50 patients each. The first group was treated by tonsillectomy, whereas the second group was treated using long-acting penicillin monthly for 6 months. They were clinically evaluated, ASOT levels were recorded for all patients before management and after 6 months.Results: The mean ASOT readings before management and after 6 months for the tonsillectomy group were 518.29 and 117.13 IU/ml, respectively (P value <0.004), whereas for the penicillin group, they were 526.70 and 262.98 IU/ml, respectively (P value <0.072).Conclusions: This study demonstrates that the first line of treatment of recurrent chronic tonsillitis is tonsillectomy, as it is both clinically effective and cost-effective for children and that the second line of treatment is long-acting penicillin with a long-term follow-up and in patients have contraindications for surgery such as bleeding diathesis.

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Evaluation of efficacy and safety of terbinafine and itraconazole in superficial mycoses: a prospective, randomized, controlled and cost-effective analysis study

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20203138 ◽

2020 ◽

Vol 9 (8) ◽

pp. 1222

Author(s):

D. Aruna ◽

M. Padmaja ◽

S. P. Vijayalakshmi

Keyword(s):

Cost Effective ◽

Clinical Score ◽

Study Groups ◽

Fungal Culture ◽

Open Label ◽

Superficial Mycoses ◽

Significant Difference ◽

The Mean

Background: Superficial mycoses are common worldwide. Dermatophytic infections can greatly affect quality of life. Several newer antimycotic agents, have been reported effective and safe. Hence this study was planned to analyse effectiveness as well as cost effectiveness of these treatments.Methods: It were a prospective, randomized, parallel, open label, comparative study. Fifty patients were included in the study and divided into 2 groups. They were randomized to receive either oral terbinafine 250 mg or itraconazole 100 mg once daily for 4 weeks. Scaling, erythema and pruritus were rated as clinical score 0 to 3: 0 - absent, 1 - mild, 2 - moderate, and 3 - severe for the above three target symptoms. Total symptom score was assessed. Pruritus was also graded on visual analogue scale (VAS). Mycological cure was assessed by skin scraping with KOH mounts and fungal culture. Clinical efficacy scoring and VAS were assessed before the study and at each follow up visit at 2 and 4 weeks. Patients were followed up for another 4 weeks after completion of the treatment.Results: There was highly significant decrease p<000.1 in the mean total symptoms scores in both the study groups from baseline. No significant difference in the mean total symptoms score was observed when compared between groups. ADRs were more in terbinafine group.Conclusions: Both terbinafine and itraconazole are effective and safe against superficial mycoses, but adverse effects are more with terbinafine. Itraconazole was found to be cost effective compared to terbinafine.

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Analysing the efficacy of polidocanol in injection snoreplasty

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20200069 ◽

2020 ◽

Vol 6 (2) ◽

pp. 258

Author(s):

Manjunath K. ◽

Amardeep Singh ◽

Manjunatha Rao S. V. ◽

Akash Aradhya S.

Keyword(s):

Cost Effective ◽

Neck Surgery ◽

Spray Application ◽

Invasive Treatment ◽

Randomised Study ◽

Medical College ◽

Primary Snoring ◽

Cost Effective Treatment ◽

The Mean

Background: Injection snoreplasty was recently introduced as a safe, effective, and minimally invasive treatment for primary snoring. The objective of the study was to assess the effectiveness of the treatment in our patients.Methods: The study was a prospective, non-randomised study done on 40 patients with primary snoring. Study was done in the Department of Otorhinolaryngology and Head and Neck Surgery at Basaveshwara Medical College and Hospital, Chitradurga over 8 months between March 2019 to October 2019. The data was collected from patients about their symptoms. Detailed clinical and radiological examination was done in all patients. Almost each and every causes of snoring were ruled out. 1-3% polidocanol injection of about 1 ml with insulin syringe was administered in all the patients in 1 to 3 sittings after 10% LOX spray application on the site. Patients were assessed after 1, 3 and 6 months and their improvement was noted. Results: There were 24 (60%) males and 16 (40%) females enrolled in our study with mean age as 42±5 years. The average BMI of patients was 27.14±3.1 kg/m2. All the patients except 4 were initially injected 1% polidocanol injection; the others were injected 3%. 4 (10%) patients were re-injected at 1 month and 4 (10%) had 2nd re-injection at 3 months follow up. The mean improvement in symptoms was 58%. Eleven patients (27.5%) had moderate snoring while the rest had severe snoring. The only side effect was pain which in majority of patients was mild. There was no correlation between BMI and percentage of improvement.Conclusions: Injection snoreplasty is a safe and cost-effective treatment for primary snoring.

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