Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation

2020 ◽  
Vol 42 (2) ◽  
pp. 180-186 ◽  
Author(s):  
Heidi Arponen ◽  
Ritva Hirvensalo ◽  
Veronica Lindgren ◽  
Anu Kiukkonen
Keyword(s):  
Patient Compliance ◽  
Subjective Experience ◽  
Treatment Compliance ◽  
Cost Effective ◽  
Twin Block ◽  
Wear Time ◽  
Compliance Level ◽  
Number Of Patients ◽  
Orthodontic Patients ◽  
Removable Appliance

Summary Background Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance. Materials/methods The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire. Results In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7–23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type. Limitations Study assessed a relatively small number of patients. Conclusions/implications Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.

scholarly journals Effect of psychological characteristics and malocclusion severity on compliance of removable orthodontic appliances by 10-12-year-old orthodontic patients: A research article

2020 ◽  
Author(s):  
Navid Naseri ◽  
Niloofar Bassagh ◽  
Tahereh Baherimoghadam ◽  
Zahra Hashemi ◽  
Elmira Bassagh
Keyword(s):  
Orthodontic Treatment ◽  
Treatment Compliance ◽  
Subscale Score ◽  
Psychological Characteristics ◽  
Orthodontic Appliances ◽  
Orthodontic Appliance ◽  
Compliance Level ◽  
Orthodontic Patients ◽  
Removable Orthodontic Appliances ◽  
General Self Efficacy

Abstract Background : Treatment compliance plays fundamental roles in achieving the best results in orthodontic treatment. Some psychological characteristics such as general self-efficacy (GSE) are correlated with the level of tolerance of individuals. This study aimed to assess the correlation of psychological characteristics such as GSE and level of malocclusion with compliance of removable orthodontic appliances. Methods : The Index of Orthodontic Treatment Need (IOTN) of 50 patients between 10-12 years who required removable orthodontic appliances was determined prior to the onset of treatment. They were also requested to fill out the GSE scale (GSES). The removable orthodontic appliance compliance questionnaire was also filled out by patients at 1 (T1), 3 (T2), and 6 (T3) months after the delivery of the removable orthodontic appliance. Results : The GSES score had significant correlations with the total score of the compliance questionnaire, and subscale score of satisfaction with the appliance during eating and oral hygiene practice, duration of usage of the appliance, and interest in using it (P<0.05). The IOTN had no significant correlation with the compliance questionnaire. Conclusions: The level of compliance of removal orthodontic appliances by patients can be predicted using the GSES. The IOTN is not efficient for prediction of the compliance level of removal orthodontic appliances by patients.

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

2000 ◽  
Vol 35 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Robert A. Quercia ◽  
Ronald Abrahams ◽  
C. Michael White ◽  
John D'Avella ◽  
Mary Campbell
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Hemodialysis Patients ◽  
Cost Avoidance ◽  
Number Of Patients ◽  
Epoetin Alpha ◽  
Clinical Benefits ◽  
Unit Dose ◽  
One Year ◽  
Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

scholarly journals Does daily wear time of Twin Block reliably predict its efficiency of class II treatment?

2021 ◽  
Author(s):  
Michal Sarul ◽  
Marek Nahajowski ◽  
Grzegorz Gawin ◽  
Joanna Antoszewska-Smith
Keyword(s):  
Statistical Significance ◽  
Characteristic Curve ◽  
Class Ii ◽  
Class I ◽  
Rank Test ◽  
Treatment Efficiency ◽  
Significance Level ◽  
Twin Block ◽  
Wear Time ◽  
Class Ii Treatment

Abstract Purpose The objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency. Materials and methods The study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients’ cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro–Wilk test, Wilcoxon signed-rank test, Student’s t-test, Levene’s test, Mann–Whitney U test, Kruskal–Wallis test, χ2 test, and Spearman’s rank correlation coefficient with p < 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system. Results DWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs < 7.5 h correlated with significantly less improvement of the investigated variables. However, DWT > 7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability. Conclusions Class II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

scholarly journals Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre

2021 ◽  
Vol 11 (8) ◽  
pp. 3365
Author(s):  
Benjie Law ◽  
Hui Yuh Soh ◽  
Syed Nabil ◽  
Rama Krsna Rajandram ◽  
Abd Jabar Nazimi ◽  
...  
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Control Group ◽  
Platelet Rich Fibrin ◽  
Tissue Healing ◽  
Number Of Patients ◽  
Short Period ◽  
Oral And Maxillofacial Region ◽  
Surgical Adjunct ◽  
Autologous Platelet

Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.

Changes in the Complexity of Orthodontic Treatment for Patients Referred to a Teaching Hospital

1988 ◽  
Vol 15 (1) ◽  
pp. 27-32 ◽  
Author(s):  
C. D. Stephens ◽  
N. W. Harradine
Keyword(s):  
General Practitioner ◽  
Orthognathic Surgery ◽  
Orthodontic Treatment ◽  
Further Training ◽  
Fixed Appliance ◽  
Dental Hospital ◽  
Orthodontic Patients ◽  
Specialist Treatment ◽  
Fixed Appliances ◽  
Removable Appliance

The records of 200 orthodontic patients accepted for treatment by the Orthodontic Department of the Bristol Dental Hospital in 1977 were compared with 200 taken on in 1985 in order to determine whether there had been any change in the proportion of referred cases requiring more complex procedures. Within each sample, cases were categorized as follows: (a) suitable for removable appliance treatment by an undergraduate or general practitioner; (b) requiring simple one arch fixed appliance treatment such as might he attempted by a general practitioner after a period of further training; (c) needing specialist treatment such as full multibracketed fixed appliances or orthognathic surgery. It was found that there had been no change in the proportions of simple and complex cases referred during the 8-year period although the proportion of patients now receiving complex treatment had increased greatly. Possible explanations and implications are discussed.

scholarly journals Telemedicine Strategy to Rescue CPAP Therapy in Sleep Apnea Patients with Low Treatment Adherence: A Pilot Study

2021 ◽  
Vol 10 (18) ◽  
pp. 4123
Author(s):  
Onintza Garmendia ◽  
Ramon Farré ◽  
Concepción Ruiz ◽  
Monique Suarez-Girón ◽  
Marta Torres ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Cost Effective ◽  
Smartphone Application ◽  
Poor Adherence ◽  
Therapeutic Effects ◽  
Cpap Adherence ◽  
Included Patient ◽  
Number Of Patients ◽  
Nasal Pressure ◽  
Voice Recorder

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient′s adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

scholarly journals Economic Evaluations of Cabazitaxel for Treatment of Post-docetaxel Metastatic Castration-resistant Prostate Cancer: Evidence from a Systematic Review

2019 ◽  
pp. 1-8
Author(s):  
Nikinaz Ashrafi Shahmirzadi ◽  
Pardis Zaboli ◽  
Monireh Afzali ◽  
Bereket Molla Tigabu ◽  
Mirhamed Hajimiri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Cost Effective ◽  
Bibliographic Databases ◽  
Economic Evaluations ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Radium 223 ◽  
Number Of Patients ◽  
Effective Option

Background and Objectives: Prostate cancer is an ever-increasing global incidence and has become the fifth leading cause of cancer-related mortality in men. A significant number of patients with prostate cancer develop metastatic castration-resistant prostate cancer (mCRPC). There are a few second-line treatment options for patients with post-docetaxel mCRPC. This systematic review aimed to assess the cost-effectiveness of cabazitaxel for the treatment of mCRPC. Materials and Methods: Electronic bibliographic databases including: PubMed/Medline, NICE, CRD, and Scopus were searched in January 2018 for identifying full economic evaluations published in English and Persian. The risk of assessment bias and descriptive analyses of individual studies’ findings were presented. Results: Three articles that fulfilled the inclusion criteria were included in the current study. All the included records had a reasonable quality. Cabazitaxel was not recommended as the most cost-effective option for the treatment of docetaxel-refractory mCRPC. Abiraterone acetate and radium-223 were the recommended cost-effective treatments for mCRPC treatment. Conclusion: We found that, in general, while cabazitaxel had equal or slightly higher improvement in Quality-adjusted Life Year (QALY) as compared to the alternatives, it incurred a high cost. Despite the inclusion of a few studies in this review, cabazitaxel was not found to be a cost-effective option. Therefore, we recommend full economic evaluations to be conducted in this area.

Abstract 3772: Alternate Listing Transplantation is a Cost-Effective Treatment for End-Stage Heart Failure Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mark J Russo ◽  
Jonathan M Chen ◽  
Kimberly N Hong ◽  
Michael Argenziano ◽  
Ryan R Davies ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Cost Model ◽  
Case Series ◽  
Cost Effective ◽  
Intention To Treat ◽  
Cost Effective Treatment ◽  
Number Of Patients ◽  
Transplant Candidates ◽  
End Stage

BACKGROUND: In order to offer the benefit of heart transplantation to a greater number of patients some centers match high-risk recipients (HR) with non-standard or ”marginal” donors (MD) in a strategy known as Alternate Listing Transplantation (ALT). However, pairing sicker recipients with lower quality donor organs remains both clinically and ethically controversial. The purpose of this study was to determine the cost-effectiveness of this strategy. METHODS: The United Network of Organ Sharing provided deidentified patient-level data. UNOS data was used to determine clinical outcomes, including waiting time, post-transplant survival, length of stay, re-hospitalizations, episodes of rejection, and infection, based on all adult heart transplant candidates (age [gt] 18 yo) and listed between 1995–2005 (n=35,049). Through a systematic literature review of randomized controlled trials and case series that estimated related costs, a cost model (see Table ) using an intention-to-treat assumption was developed to calculate the incremental cost-effectiveness ratio (ICER) for HR candidates who subsequently received marginal donor hearts (HTR) compared with candidates who were not transplanted (NTXP). High-risk recipient criteria included age [gt] 65yo, retransplantation, HepC+, HIV+, CrCl <30 ml/min, DM with PVD, DM with Crcl <40 ml/min. MD criteria included age [gt] 55yo, DM, HIV+, HepC+, EF<45%, and donor:recipient weight <0.7. RESULTS: Median survival from listing was 0.55 yrs and 5.1 yrs in the HTR and NTXP groups, respectively. The estimated ICER was $66,645($34,046–$127,491) ICER varied by HR recipient criteria. CONCLUSIONS: The ICER for ALT falls at the upper limits acceptability for being cost-effective. However, stratified analysis by HR group suggests that this strategy is not appropriate for all groups. Cost Model Assumptions

Abstract W P191: Patient Compliance High with Long-Term Continuous ECG Monitor

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Judith C Lenane ◽  
Angela J Fought ◽  
Jay H Alexander
Keyword(s):  
San Francisco ◽  
Patient Compliance ◽  
Cryptogenic Stroke ◽  
Standard Of Care ◽  
Interquartile Range ◽  
Ecg Monitoring ◽  
Wear Time ◽  
Stroke Population ◽  
Total Wear

Introduction: Long term ECG monitoring to detect atrial fibrillation in a cryptogenic stroke is now the emerging standard of care. The advent of patch based ECG monitors raises the question of patient compliance with this new modality. Hypothesis: We assessed the hypothesis that patient compliance, as measured by Leads-On detection for patch based ECG monitoring, is constant over time. Methods: We performed a retrospective analysis from ZIO® Patch (Patch) devices (iRhythm, San Francisco, CA). The Patch is a continuous recording single lead ECG monitor that can be worn for up to 14 days. The primary endpoint of Leads-On is the percentage of time the device is applied to the patient during the wear period, which was derived from a second channel in the device. The data are gathered by ZEUS software and exported in a CSV file. The compliance data were analyzed overall and in categories at days: 0-1, 1-2, 2 to 7, >7 to 10 and >10 to 14. A secondary endpoint, percent Analyzable Time (percentage of ECG record that was available for detection by the algorithm during the wear period and signifies signal quality), was assessed for the same time increments. Results: The dataset consisted of 18,885 records. The total wear time ranged from 0.10 up to 14.01 days, with a median of 12.51. The medians and interquartile ranges for the percent Leads On and percent of Analyzable Time were 100% (99.99-100%) and 97.99% (94.64-99.26%). In Table 1, the interquartile ranges for percent Leads On and Analyzable Time was wider when the Patch was worn less than a day, but remains above 74%. Total wear time in days n Percent Leads On Percent Analyzable Time Median Interquartile Range Median Interquartile Range 0.10-<1 105 99.65 86.52-100 92.86 74.19-96.97 1-<2 407 100 99.88-100 97.37 90.96-99.02 2-<7 4124 100 100-100 97.96 94.3-99.26 7-<10 2963 100 99.98-100 97.79 94.33-99.19 10+ 11286 100 100-100 98.07 95.00-99.29 Conclusion: Patient compliance with long term ECG patch monitors is high as measured by Leads-On detection. High patient compliance results in a large volume of quality ECG. Further study is needed to compare patient compliance with ECG patch based monitors with other monitoring modalities, particularly in the cryptogenic stroke population.

scholarly journals Use of Betel Leaves in Pediatric Stoma Care

2014 ◽  
Vol 1 (2) ◽  
pp. 148-152
Author(s):  
Md. Ashraf Ul Huq ◽  
A K M Mizanur Rahman ◽  
Tahmina Hossain
Keyword(s):  
Zinc Oxide ◽  
Cost Effective ◽  
College Hospital ◽  
Mucosal Ulceration ◽  
Medical College ◽  
Betel Leaf ◽  
Number Of Patients ◽  
Peristomal Skin ◽  
Two Parameters ◽  
Stoma Care

Background: To find out a practicable, cost effective and easily available alternative of commercial stoma care devices for pediatric patients in a developing country.Methods: The study was conducted in the department of Pediatric Surgery in Dhaka Medical College Hospital, Bangladesh, during two years period from May 2009 to April 2011. Number of patients was 162 with age range 2 days to 7 years, mean age 2.3 years. As early as a colostomy or ileostomy had started functioning, a central hole was made in a betel leaf. The hole could just snugly accommodate the stoma. After applying a layer of zinc oxide paste over the peristomal skin the leaf was placed as such the stoma rotrudes through the hole. The smooth shiny surface of the leaf would face upwards and rough surface downwards. Another intact betel leaf with the shiny surface also facing upwards would cover the stoma. The leaves did not act as a reservoir rather simply acted as a barrier between the effluent and the peristomal skin. Fifty seven patients with colostomy and 11 with leostomy used stoma appliances (wafer with bag). Eighty six patients with colostomy and 8 patients with ileostomy used betel leaves and zinc oxide paste. Mean length of time between creation and closure of a colostomy was 9 months and that of an ileostomy was three months. It was ensured that each individual patient had used his or her respective stoma care method till closure of the stomas. Two parameters were used to evaluate the outcome of the above mentioned stoma care methods: (a) peristomal skin excoriation and (b) insultto the stomal mucosa in the form of ulceration.Results: Among the patients who used stoma appliances 21.53% developed peristomal skin excoriation, 7.69% developed mucosal ulceration and 6.34% patients developed local hypersensitivity reaction to stoma adhesive. On the contrary, patients who were managed with betel leaves 20.93% developed peristomal skin excoriation and 8.13% developed mucosal ulceration. No incidence of allergic reaction to local application of betel leaf and zinc oxide occurred. Average cost for betel leaves was less than 0.50 US$ per month in comparison to about 30 US$ for ostomy appliances.Conclusion: Betel leaves may be used as a cheap, easily available, non irritant and effective alternative of commercial appliances to protect the stomas and peristomal skin in pediatric patients.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19534

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