scholarly journals Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young

EP Europace ◽  
2021 ◽  
Author(s):  
Harshil Dhutia ◽  
Aneil Malhotra ◽  
Gherardo Finnochiaro ◽  
Sameer Parpia ◽  
Raghav Bhatia ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lifestyle Modification ◽  
Diagnostic Yield ◽  
Evaluation Process ◽  
Cost Effective ◽  
Fold Increase ◽  
Medical Intervention ◽  
Health Questionnaire ◽  
Limited Information ◽  
Select Group

Abstract Aims There is limited information on the role of screening with electrocardiography (ECG) for identifying cardiovascular diseases associated with sudden cardiac death (SCD) in a non-select group of adolescents and young adults in the general population. Methods and results Between 2012 and 2014, 26 900 young individuals (aged 14–35 years) were prospectively evaluated with a health questionnaire and ECG. Individuals with abnormal results underwent secondary investigations, the costs of which were being based on the UK National Health Service tariffs. Six hundred and seventy-five (2.5%) individuals required further investigation for an abnormal health questionnaire, 2175 (8.1%) for an abnormal ECG, and 114 (0.5%) for both. Diseases associated with young SCD were identified in 88 (0.3%) individuals of which 15 (17%) were detected with the health questionnaire, 72 (81%) with ECG and 2 (2%) with both. Forty-nine (56%) of these individuals received medical intervention beyond lifestyle modification advice in the follow-up period of 24 months. The overall cost of the evaluation process was €97 per person screened, €17 834 per cardiovascular disease detected, and €29 588 per cardiovascular disease associated with SCD detected. Inclusion of ECG was associated with a 36% cost reduction per diagnosis of diseases associated with SCD compared with the health questionnaire alone. Conclusion The inclusion of an ECG to a health questionnaire is associated with a five-fold increase in the ability to detect disease associated with SCD in young individuals and is more cost effective for detecting serious disease compared with screening with a health questionnaire alone.

scholarly journals Management of Hypertension: A Bangladeshi Perspective

1970 ◽  
Vol 39 (1) ◽  
pp. 40-43
Author(s):  
SM Mustafa Zaman ◽  
Mohammad Salman ◽  
Kaniz Fatema
Keyword(s):  
Cardiovascular Disease ◽  
Fruits And Vegetables ◽  
Lifestyle Modification ◽  
Clinical Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Lifestyle Changes ◽  
Optimum Level ◽  
Lifestyle Modifications

Hypertension is a silent killer. Bangladeshis are racially predisposed to cardiovascular disease, and the increasing burden of hypertension has only added to the problem. Economic constraints and the allure of additional benefits without adverse effects have made lifestyle modifications an attractive proposition in developing and developed countries alike. Blood pressure is a continuum and any increase above optimum level confers additional independent risk of cardiovascular disease. We review screening, diagnosis and management using lifestyle measures and pharmacotherapy. We then discuss the barriers and challenges to implementing this approach and what can be done regarding prevention, screening, lifestyle modification and pharmacotherapy in our country. By adopting a comprehensive population based approach including policy level interventions directed at promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt and rich in fruits and vegetables), increased physical activity, and a smoking free society, properly balanced with a high risk approach of cost effective clinical care, Bangladesh can effectively control hypertension and improve public health. DOI: 10.3329/bmj.v39i1.6232 Bangladesh Medical Journal 2010; 39(1): 40-43

Lifestyle intervention to prevent diabetes in men and women with impaired glucose tolerance is cost-effective

2007 ◽  
Vol 23 (2) ◽  
pp. 177-183 ◽  
Author(s):  
Peter Lindgren ◽  
Jaana Lindström ◽  
Jaakko Tuomilehto ◽  
Matti Uusitupa ◽  
Markku Peltonen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cost Saving ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Lifestyle Intervention ◽  
Intervention Program ◽  
Lifestyle Modification ◽  
Screening Program ◽  
Cost Effective ◽  
Population Based

Objectives: The Finnish Diabetes Prevention Study (DPS) was a randomized intervention program that evaluated the effect of intensive lifestyle modification on the development of diabetes mellitus type 2 in patients with impaired glucose tolerance. As such, a program is demanding in terms of resources; it is necessary to assess whether it would be money well spent. This determination was the purpose of this study.Methods: We developed a simulation model to assess the economic consequences of an intervention like the one studied in DPS in a Swedish setting. The model used data from the trial itself to assess the effect of intervention on the risk of diabetes and on risk factors for cardiovascular disease. Results from the United Kingdom Prospective Diabetes Study were used to estimate the risk of cardiovascular disease and stroke. Cost data were derived from Swedish studies. The intervention was assumed to be applied to eligible patients from a population-based screening program of 60-year-olds in the County of Stockholm from which the baseline characteristics of the patients was used.Results: The model predicted that implementing the program would be cost-saving from the healthcare payers' perspective. Furthermore, it was associated with an increase in estimated survival of .18 years. Taking into consideration the increased consumption by patients due to their longer survival, the predicted cost-effectiveness ratio was 2,363€ per quality-adjusted life-year gained.Conclusions: Lifestyle intervention directed toward high-risk subjects would be cost-saving for the healthcare payer and highly cost-effective for society as a whole.

scholarly journals 2D-3D integration of hexagonal boron nitride and a high-κ dielectric for ultrafast graphene-based electro-absorption modulators

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Hitesh Agarwal ◽  
Bernat Terrés ◽  
Lorenzo Orsini ◽  
Alberto Montanaro ◽  
Vito Sorianello ◽  
...  
Keyword(s):  
Boron Nitride ◽  
Hafnium Oxide ◽  
High Speed ◽  
Hexagonal Boron Nitride ◽  
Temperature Stability ◽  
Cost Effective ◽  
Fold Increase ◽  
Building Blocks ◽  
High Quality ◽  
New Device

AbstractElectro-absorption (EA) waveguide-coupled modulators are essential building blocks for on-chip optical communications. Compared to state-of-the-art silicon (Si) devices, graphene-based EA modulators promise smaller footprints, larger temperature stability, cost-effective integration and high speeds. However, combining high speed and large modulation efficiencies in a single graphene-based device has remained elusive so far. In this work, we overcome this fundamental trade-off by demonstrating the 2D-3D dielectric integration in a high-quality encapsulated graphene device. We integrated hafnium oxide (HfO2) and two-dimensional hexagonal boron nitride (hBN) within the insulating section of a double-layer (DL) graphene EA modulator. This combination of materials allows for a high-quality modulator device with high performances: a ~39 GHz bandwidth (BW) with a three-fold increase in modulation efficiency compared to previously reported high-speed modulators. This 2D-3D dielectric integration paves the way to a plethora of electronic and opto-electronic devices with enhanced performance and stability, while expanding the freedom for new device designs.

scholarly journals Impact of Proteinuria and Low eGFR on Lifetime Risk of Cardiovascular Disease Death: A Pooled Analysis of Data From the Evidence for Cardiovascular Prevention From Observational Cohorts in Japan Study

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
Y Imai ◽  
M Sakurai ◽  
H Nakagawa ◽  
A Hirata ◽  
Y Murakami ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Lifestyle Modification ◽  
Absolute Risk ◽  
Cardiovascular Prevention ◽  
Asian Population ◽  
Cardiovascular Death ◽  
Pooled Analysis ◽  
Lifetime Risk ◽  
National Budget ◽  
Public Grant

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): H20–Junkankitou [Seishuu]–Ippan–013; H23–Junkankitou [Seishuu]–Ippan–005; H26-Junkankitou [Seisaku]-Ippan-001; H29–Junkankitou–Ippan–003 and 20FA1002 OnBehalf EPOCH-JAPAN Introduction Absolute risk of Lifetime risk (LTR) is useful estimate for risk communication compared with short term risk or relative risk especially for young people. Proteinuria is leading cause of end-stage kidney disease (ESKD) and independent risk factor for cardiovascular disease (CVD). Although nonproteinuric renal disease is global burden of ESKD, it has been poorly focused. To date, there have been no reports of impact of proteinuria and low eGFR on LTR with the outcome of CVD death in Asian population. Purpose We aimed to estimate LTR of CVD death stratified by the status of proteinuria and low eGFR. Methods We used modified Kaplan-Meier approach to estimate the remaining lifetime risk of cardiovascular death based on EPOCH-JAPAN(Evidence for Cardiovascular Prevention From Observational Cohorts in Japan) database. LTR was estimated at each index age starting from 40 years for those with proteinuria and without proteinuria stratified by low eGFR, which is defined as eGFR <60 ml/min/1.73 m². Participants were classified into three groups, which were those with proteinuria (Proteinuria (+)), those without proteinuria with low eGFR (Proteinuria (-)/Low eGFR (+)), those without proteinuria without low eGFR (Proteinuria (-)/Low eGFR (-)). Results A total of 47,292 participants from 9 cohorts was included in the analysis. Mean follow-up period was 14.6 years with 690,463 person years and total CVD death was 1,075 in men and 1,193 in women. The LTRs at the index age of 40 years were as follows: 17.7% (95% confidence interval: 15.4 – 19.0%) in Proteinuria (-)/Low eGFR (-) group, 26.2% (20.2 – 31.1%) in Proteinuria (-)/low eGFR (+) group, 24.5% (15.1 – 29.3%) in Proteinuria (+) group for men; 15.3%(13.7 – 16.5%), 29.9%(14.7 – 46.8%) , 28.3%(19.4 – 34.7%) for women. Conclusions We observed that those without proteinuria with low eGFR have equivalently high LTR with those with proteinuria. These results indicate that even in the absence of proteinuria, low eGFR has high impact on LTR. Lifestyle modification from young age is necessary to prevent from renal dysfunction.

scholarly journals Cryoprobe biopsy for the diagnosis of acute hypoxemic respiratory failure of undetermined origin

2019 ◽  
Vol 21 (2) ◽  
pp. 119-123
Author(s):  
Marcos J Las Heras ◽  
Jose Dianti ◽  
Manuel Tisminetzky ◽  
Graciela Svetliza ◽  
Sergio E Giannasi ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Diagnostic Yield ◽  
Specific Treatment ◽  
Case Series ◽  
Safe Procedure ◽  
Hypoxemic Respiratory Failure ◽  
Acute Hypoxemic Respiratory Failure ◽  
Select Group ◽  
Lung Sample ◽  
Appropriate Treatment

Rationale Acute hypoxemic respiratory failure is a condition that comprises a wide array of entities. Obtaining a histological lung sample might help reach a diagnosis and direct an appropriate treatment in a select group of patients. Objective To describe our experience in the use of cryobiopsy for the diagnosis of acute hypoxemic respiratory failure of undetermined origin. Methods Retrospective analysis of case series of patients with acute hypoxemic respiratory failure who underwent lung cryobiopsy at the Intensive Care Unit of the Hospital Italiano de Buenos Aires, Argentina. Results Cryobiopsy yielded a histological diagnosis in all patients ( n = 10, 100%). This led to either a change in therapy or continuation of a specific treatment in eight of these patients. Cryobiopsy was found to be contributive in all the patients who did not meet Berlin criteria for acute respiratory distress syndrome. No major complications were associated with the procedure. Conclusions Cryobiopsy is a safe procedure with a high diagnostic yield in a selected group of patients.

Abstract W P153: HEALS Hypertension Control Program for Stroke Prevention in African American Communities

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sunita Dodani ◽  
Sahel Arora ◽  
Dale Kraemer
Keyword(s):  
Healthy Eating ◽  
Stroke Prevention ◽  
Lifestyle Modification ◽  
Control Program ◽  
Cost Effective ◽  
Complete Information ◽  
Lifestyle Changes ◽  
Evidence Based ◽  
Church Members ◽  
Randomized Controlled Studies

Stroke is the 4th leading cause of death and a leading cause of severe, long-term disability in US. African Americans (AAs) are at an elevated risk for cerebrovascular diseases. An approach of proven efficacy is to target a major modifiable risk factor for stroke, hypertension (HTN), and to do so using lifestyle changes (i.e., diet and exercise). The objective of this study was to implement and assess the efficacy of an evidence-based, socio-culturally tailored, lifestyle intervention called HEALS (Healthy Eating And Living Spiritually) adopted and modified from PREMIER and DASH studies in AA churches in Northeast Florida. Methods: 3- months HEALS program was delivered by trained church members to the high risk church members who were; a) church parishioners 25-75 years; and b) newly or known diagnosed with HTN/pre-HTN as per JNC-7 criteria. The outcomes were analyzed using ANOVA and Wilcoxon rank tests. Results: Of the 36 eligible, 32 (90%) provided complete information on outcomes and were included in the analysis. At baseline, 15 (42%) participants were pre-HTN, 9 (25%) had Stage 1 HTN, and 12 (33%) had Stage 2 HTN. Retention of 89% was observed at the end of 3- month HEALs intervention. After the completion of the 3-months intervention, the mean reduction in systolic blood pressure (SBP) and diastolic BP (DBP) were 6.72mmHg (p=.0425) and 4.00 mmHg (p=.0073), respectively. A mean weight reduction of 1.7 kg was also significant (p=0.0023). Further, positive trends in healthy eating occurred for the majority of the participants (60%), more than half consumed dark green or other vegetables frequently, while 75% consumed at least one fruit daily or weekly. Lower percentages (44%) reported consumption of 100% fruit juices or cooked beans regularly. Conclusion: The study provided much-needed information on the translation and sustainability of evidence-based lifestyle modification in community-based settings, particularly within churches, which represent the most influential institution in the community lives of AA. HEALS program can serve as a cost-effective model for stroke prevention. Future longitudinal randomized controlled studies on HEALS effectiveness are needed.

scholarly journals Big health data: the new frontier for cardiovascular disease

2020 ◽  
pp. 4-7
Keyword(s):  
Cardiovascular Disease ◽  
Population Studies ◽  
Large Population ◽  
Cost Effective ◽  
Health Data ◽  
Health Care Administrators ◽  
Health Records ◽  
Traditional Research ◽  
New Frontier ◽  
The World

Despite improvement in diagnosis and management, cardiovascular disease (CVD) is the leading cause of death and hospitalization throughout the world. The expansion of digital cardiology presents outstanding opportunities for clinicians, researchers, and health care administrators to improve outcomes and sustainability of health systems. Electronic big health data combining electronic health records (EHRs) from diverse individuals across a wide variety of platforms may provide a real-time solution to questions and problems relating to health. Very large population studies based on EHR are efficient and cost-effective, and offer an alternative to traditional research approaches. Indeed, digital cardiology can help researchers to enhance, diagnose, and manage CVD using dedicated algorithms that allow targeted and personalized CVD treatments

The use of hydroxyethyl cellulose as a transparent filling material in finishing polish

2018 ◽  
Vol 47 (4) ◽  
pp. 323-329 ◽  
Author(s):  
Jülide Erkmen
Keyword(s):  
Design Methodology ◽  
Cost Effective ◽  
Hydroxyethyl Cellulose ◽  
Filling Material ◽  
Limited Information ◽  
Content Type ◽  
Alkyd Resins ◽  
Volatile Organic ◽  
Water Saturated ◽  
Practical Implications

Purpose This study aims to propose a solution to decrease the environmental pollution caused by alkyd resins that harm the environment during their production and use. Design/methodology/approach A commercially produced polish formulation was used in the study. To reduce the use of this formulation in finishing polish, a water-saturated transparent solution of hydroxyethyl cellulose was used as a transparent filling material. Findings The use of hydroxyethyl cellulose at its optimum concentration in finishing polish only reduced the gloss by 0.027 per cent. The amount of alkyd was reduced by 24 per cent in weight. Research limitations/implications The literature contained highly limited information on this subject. No transparent filling material was found. Thus, no comparison can be made with other studies. Practical implications The results obtained from this study can help manufacturers in the polish industry to produce varnish in a more cost-effective and eco-friendly way. Originality/value Considerable amount of volatile organic compounds released into the atmosphere as a result of the use of solvent-based dye/varnishes in the woodworking industry alone proves the importance of water-based systems. The results of this study indicate both economic and environmental gain.

Applying Social Aspects in Home Telecare Design to Improve the Safety of Users and Quality of Service

2016 ◽  
pp. 1048-1072
Author(s):  
Lawrence Chidzambwa
Keyword(s):  
Quality Of Life ◽  
Patient Safety ◽  
Life Quality ◽  
Cost Effective ◽  
Medical Intervention ◽  
Social Dimension ◽  
Social Aspects ◽  
The Social ◽  
Solution Design

Telecare enables remote and cost-effective home treatment of patients, improving the safety and quality of life of frail individuals. However, despite increased availability of telecare devices, many are not fully used and often ignored due to poor social perception and experience. The research suggests the social aspects of quality and safety related to user experience have not been considered. This can lead to misuse or non-use of telecare devices, reducing patient safety and quality of life. This chapter explores the implications for the lack of social considerations in telecare and develops a series of models and methodologies to integrate the social dimension with the traditional medical intervention focus. By applying semiotics and normative behavioural theory, the authors show how a Normative Home Telecare Framework can improve telecare solution design and ensure take up and use of the devices and increase patient safety and life quality.

scholarly journals Evaluation of Etiology of Epistaxis and its Management in Dhulikhel Hospital

2015 ◽  
Vol 13 (1) ◽  
pp. 49-55 ◽  
Author(s):  
I Shrestha ◽  
M Pokharel ◽  
BL Shrestha ◽  
A Dhakal ◽  
RCM Amatya
Keyword(s):  
Surgical Treatment ◽  
Analytical Study ◽  
Cost Effective ◽  
Medical Intervention ◽  
P Value ◽  
Medical Sciences ◽  
Cross Sectional ◽  
Institutional Review ◽  
Specific Objective ◽  
Non Surgical Treatment

Background Epistaxis is one of the most common and most difficult emergencies presenting in 7-14% of the general population each year. Although its lifetime incidence is about 60%, only 6% require formal medical intervention but they can be serious and even life threatening.Objective The main objectives are to study different etiology, types, modality of treatment of epistaxis. Specific objective is also to find out if the modality of treatment is associated with age, site, amount of bleeding and etiology.Method It is a prospective, cross sectional, longitudinal, analytical study done in Department of ENT, Dhulikhel hospital, Kathmandu University School of Medical Sciences (KUSMS) from Aug. 2010 to Aug. 2013. Data was collected. This study was cleared through institutional review committee of hospital. Statistical analysis was done using SPSS 16.0.Result 487 patients were studied during the period. There was significant association between age group with type of treatment (p value 0.002); and with admission (p value < 0.001). Significance in the study was also shown in the correlation between site of bleeding and the type of treatment and also with alcohol intake with site of bleeding (p value < 0.001).However there was no significance between hypertension and the type of treatment methods chosen (p value >0.01).Conclusion Management of epistaxis is challenging. Most are managed by non surgical means whereas some by surgical treatment. Non surgical treatment is still useful, safe and cost effective. Type of treatment and need for hospital stay is related to age and site of bleeding.Kathmandu University Medical Journal Vol.13(1) 2015; 49-55

Sign in / Sign up

Export Citation Format

Share Document