Current cost-effective work-up of the glaucoma suspect

1996 ◽  
Vol 7 (2) ◽  
pp. 59-64 ◽  
Author(s):  
Donald L. Budenz ◽  
Paul F. Palmberg
Keyword(s):  
Cost Effective ◽  
Glaucoma Suspect ◽  
Effective Work ◽  
Work Up

scholarly journals PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

2018 ◽  
Vol 22 (7) ◽  
pp. 1-114 ◽  
Author(s):  
Paula Ghaneh ◽  
Robert Hanson ◽  
Andrew Titman ◽  
Gill Lancaster ◽  
Catrin Plumpton ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Diagnostic Accuracy ◽  
Cost Effective ◽  
Diagnostic Value ◽  
Pet Ct ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals Telekardiológia: A telemedicina feladatai és kötelességei

2017 ◽  
Vol 158 (44) ◽  
pp. 1741-1746
Author(s):  
János Borbás ◽  
Erzsébet Forczek ◽  
Róbert Sepp ◽  
Ferenc Bari
Keyword(s):  
Blood Pressure Monitoring ◽  
Medical Science ◽  
Cost Effective ◽  
Effective Work ◽  
Remote Diagnostics ◽  
The Past ◽  
Medical Associations ◽  
Development Phases ◽  
Guidelines And Recommendations ◽  
Further Development

Abstract: Telemedicine is a young science that integrates innovations of information-technology and telecommunications into medical science. A successful telemedicine procedure should guarantee reduced workload of the healthcare system with well secured and cost-effective processes. Our goal was to collect the development phases of telemedicine projects through existing telecardiology solutions. Subsequent to reviewing international publications we analyzed the past and present situation of blood pressure monitoring, remote diagnostics of electrocardiography, implantable cardioverter defibrillator monitoring and pocket ultrasound devices. In case of new solutions (a) several internationally accepted, confidently reproducible “good practices” are needed for creating (b) guidelines and recommendations of international medical associations. They have to ensure (c) cost-effective work, with well-designed sustainability and (d) patient confidentiality. Improving (e) education for professionals and patients is essential. We recommend to telemedicine developers to use our standards in order to introduce their products more effectively into clinical practice. It is encouraging that current possibilities of telecardiology partly or fully meet the aforementioned criteria. Further development of the topic can contribute to financial sustainability of our healthcare and might be able to resolve limitations of human resources. Orv Hetil. 2017; 158(44): 1741–1746.

Deep venous thrombosis and cancer (about 68 cases)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19672-19672
Author(s):  
A. Tahri ◽  
M. El Hattaoui ◽  
N. Charei ◽  
M. El Belghiti ◽  
L. Mahmal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cost Effective ◽  
Spiral Ct ◽  
Physical Exam ◽  
Basic Work ◽  
The Mean ◽  
Work Up

19672 Background: The association between cancer and deep venous thrombosis (DVT) has been known for a century. The goal of this retrospective study is to evaluate the risk factors and the characteristics of patients presenting with a DVT to determine the interest of a malignancy work up. Methods: This is a monocentric retrospective study of 405 DVT’s ± pulmonary embolism reported between January 2003 and July 2006, confirmed by sonogram and spiral CT. The risk factors for the embolic events as well as the diagnosis work up done to determine the origin of the embolism were analyzed. Results: In our population the mean age was 50 years, 300 patients (74 %) presented with at least one risk factor for thrombosis event, 68 cases were found to have a malignancy (16.8%) from which 9 were occult malignancies (found among 109 cases of idiopathic DVT’s).The mean age of the patients diagnosed with cancer was significantly higher with a female predominance. These malignancies were distributed as follow: 50% gynecologic origin, 25% gastrointestinal, 10% pulmonary, 9 % urologic and 6% of hematologic origin. The risk factors identified were: Surgery (OR = 4) and Chemotherapy (OR=6). The occult malignancies were mentioned during the encounter with 6 patients. The physical exam, abdomino-pelvic sonograms were sufficient for the etiologic diagnosis in 8 cases. Other exams like (tumor markers, gastrointestinal endoscopies) were non contributive, a part of the clinical orientation they provided. Conclusions: DVT’s do occur more frequently in operated cancer patients or those who received chemotherapy. The malignancies are more frequently of gynecologic or gastrointestinal origin. It appears that an extensive diagnosis work up is not cost effective, a basic work up including: a thorough history, a complete physical exam, simple blood tests (inflammatory markers and CBC) as well as a abdomino-pelvic sonogram are sufficient for the screening of a malignancy, extensive work up should be done as a second option. No significant financial relationships to disclose.

PSVII-21 Canadian Vytelle technology for determining residual feed intake epdsin raising Qazaq Aqbas bull calves

2021 ◽  
Vol 99 (Supplement_3) ◽  
pp. 447-448
Author(s):  
Dauren Matakbayev ◽  
Assel Tilepova ◽  
Anuarbek T Bissembayev
Keyword(s):  
Feed Intake ◽  
Average Daily Gain ◽  
Residual Feed Intake ◽  
Cost Effective ◽  
Effective Work ◽  
Bull Calves ◽  
Selection For ◽  
Group 2 ◽  
Daily Gain ◽  
Group 1

Abstract The Abstract reviews the experience of implementing Vytelle technology in ZhanaBereke LLP, Akmola region in Kazakhstan. The trial objects are Qazaq Aqbas bull calves: group 1 aged 10–11 months (n = 22), group 2 aged 11–12 months (n = 24). Data analysis showed that more reliable Residual Feed Intake calculated for each individual animal on the basis of their phenotypes and information on pedigree, were found in group 1. The average RFI EPD for group 1 is -0.0607, for group 2 is -0.0297. The RFI% Rank in terms of RFI EPD for both trial groups varied within 4 ... 96%. However, the average RFI% Rank was lower in the first group (45%) compared to the second group (56%). From which it follows that the RFI EPD is higher in group 1. Average Daily Gain EPDs (ADG EPD) higher in group 1 -0.0018. A higher ADG EPDs indicate a more cost-effective metric. The ADG% Rank in terms of ADG EPD for group 1 varied within 1 ... 62%, for group 2: 1 ... 63%. The average ADG% Rank was slightly lower in the first group (30%) compared to the second group (33%). From the presented data, it follows that the breeding valueaccording to the ADG EPD is higher in group 1. The average Dry Matter Intake by animals per day during the trial (DMI EPD) is equal to -0,0600 in the first group, and -0,0292 in the second group. The DMI% RANK in terms of DMI EPD for group 1 varied within 31 ... 93%, for group 2: 38 ... 96%. The DMI% RANK was lower in the first group (60%) compared to the second group (67%). Summarizing the above, we can conclude that selection for this characteristic is less effective, work will continue to increase this indicator.

A Review on Recent Advances in the Synthesis of Aziridines and their Applications in Organic Synthesis

2021 ◽  
Vol 25 ◽  
Author(s):  
Tanzeela Qadir ◽  
Andleeb Amin ◽  
Deeptanu Sarkar ◽  
Praveen Kumar Sharma
Keyword(s):  
Organic Synthesis ◽  
Cost Effective ◽  
High Reactivity ◽  
Small Ring ◽  
Cyclic Amines ◽  
Electrophilic Reagents ◽  
Synthetic Intermediates ◽  
Synthetic Approaches ◽  
Work Up ◽  
Stable Ring

: Aziridines are the saturated three-membered cyclic amines that constitute an important group of synthetic intermediates. These could act as a precursor for diverse organic compounds owing to the reactivity due to the ring strain associated with them. The outstanding property of aziridines is their high reactivity towards various nucleophilic and electrophilic reagents to acquire more stable ring-opened or ring-expanded amines that could be obtained from the release of strain energy intrinsic in a small ring. As such, aziridines could be used in the synthesis of 4-7 membered heterocycles of biological and industrial significance, such as azetidines, imidazoles, thiazoles, pyrazines, pyrimidines, benzothiazines, benzodiazepines, etc. Earlier synthesis of aziridines was considered a laborious task due to their instability. However, various synthetic approaches leading to the formation of aziridines are now available in the literature. Recently, green, cost-effective and approaches based on simpler work-up for these reactions have attracted researcher's attention. This review article deals with synthetic routes of aziridines and aziridine applications in organic synthesis.

Microwave-assisted C-C, C-O, C-N, C-S bond formation and multicomponent reactions using magnetic retrievable nanocatalysts

2021 ◽  
Vol 08 ◽  
Author(s):  
Manavi Yadav ◽  
Mahima Dutta ◽  
Pema Tanwar ◽  
Reena Jain ◽  
Anju Srivastava ◽  
...  
Keyword(s):  
Organic Synthesis ◽  
Bond Formation ◽  
Activation Parameters ◽  
Cost Effective ◽  
Molecular Scaffolds ◽  
Bond Forming ◽  
Microwave Assisted ◽  
Work Up ◽  
Reaction Media ◽  
Yield And Purity

: Microwave-assisted organic synthesis has been perceived as one of the most powerful and sustainable tools to accomplish expeditious organic synthesis through a greener way on account of its specific features including targeted heating, reaction homogeneity, rapidity, possible modifications of activation parameters, improved selectivity, yield and purity, along with simpler work-up. Another rapidly growing field for the development of green and sustainable protocol is the application of the magnetic nanocatalysts. They not only meet the need for facile recovery from the reaction media after completion of a reaction but also provide the best attributes of nanotechnology along with the elimination of auxiliary substances and catalyst loss, thereby, making the overall process clean, fast and cost-effective. Thus, the amalgamation of magnetic nanocatalysts and microwave irradiation present an ideal blend for the development of sustainable methods in synthetic organic chemistry. Amidst various bond forming reactions, carbon-carbon (C–C) and carbon-heteroatom (C-X, where X= O, N, S) bond formations are essentially used to devise privileged molecular scaffolds for synthetic organic and medicinal chemistry. This review gives a succinct overview of the synthesis and application of various modified magnetic nanocomposites as task-specific catalysts for microwave assisted C-C and C-X bond formation reactions in recent years. (This review consists of more than 190 references)

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