scholarly journals Evidence base of clinical diagnosis: Rational, cost effective use of investigations in clinical practice

BMJ ◽  
2002 ◽  
Vol 324 (7340) ◽  
pp. 783-785 ◽  
Author(s):  
R. Winkens
Keyword(s):  
Clinical Practice ◽  
Clinical Diagnosis ◽  
Cost Effective ◽  
Evidence Base ◽  
Effective Use

The CSF p-tau181/Aβ42 Ratio Offers a Good Accuracy “In Vivo” in the Differential Diagnosis of Alzheimer’s Dementia

2019 ◽  
Vol 16 (7) ◽  
pp. 587-595 ◽  
Author(s):  
Roberto Santangelo ◽  
Alessandro Dell'Edera ◽  
Arianna Sala ◽  
Giordano Cecchetti ◽  
Federico Masserini ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Diagnosis ◽  
Fdg Pet ◽  
Amyloid Β ◽  
Cost Effective ◽  
Daily Clinical Practice ◽  
Different Types ◽  
Experimental Trials ◽  
Csf Findings

Background: The incoming disease-modifying therapies against Alzheimer’s disease (AD) require reliable diagnostic markers to correctly enroll patients all over the world. CSF AD biomarkers, namely amyloid-β 42 (Aβ42), total tau (t-tau), and tau phosphorylated at threonine 181 (p-tau181), showed good diagnostic accuracy in detecting AD pathology, but their real usefulness in daily clinical practice is still a matter of debate. Therefore, further validation in complex clinical settings, that is patients with different types of dementia, is needed to uphold their future worldwide adoption. Methods: We measured CSF AD biomarkers’ concentrations in a sample of 526 patients with a clinical diagnosis of dementia (277 with AD and 249 with Other Type of Dementia, OTD). Brain FDG-PET was also considered in a subsample of 54 patients with a mismatch between the clinical diagnosis and the CSF findings. Results: A p-tau181/Aβ42 ratio higher than 0.13 showed the best diagnostic performance in differentiating AD from OTD (86% accuracy index, 74% sensitivity, 81% specificity). In cases with a mismatch between clinical diagnosis and CSF findings, brain FDG-PET partially agreed with the p-tau181/Aβ42 ratio, thus determining an increase in CSF accuracy. Conclusions: The p-tau181/Aβ42 ratio alone might reliably detect AD pathology in heterogeneous samples of patients suffering from different types of dementia. It might constitute a simple, cost-effective and reproducible in vivo proxy of AD suitable to be adopted worldwide not only in daily clinical practice but also in future experimental trials, to avoid the enrolment of misdiagnosed AD patients.

Cost-Effective Use of Institutional Clinical Practice Guidelines in the Management of Ventriculoperitoneal Shunt Malfunction Paper #728

Neurosurgery ◽  
1996 ◽  
Vol 39 (3) ◽  
pp. 643
Author(s):  
John K. Park ◽  
David M. Frim ◽  
Marc S. Schwartz ◽  
Liliana C. Goumnerova ◽  
Peter McL. Black ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Ventriculoperitoneal Shunt ◽  
Cost Effective ◽  
Shunt Malfunction ◽  
Effective Use

Cost-Effective Use of Institutional Clinical Practice Guidelines in the Management of Ventriculoperitoneal Shunt Malfunction

Neurosurgery ◽  
1996 ◽  
Vol 39 (3) ◽  
pp. 643-643
Author(s):  
John K. Park ◽  
David M. Frim ◽  
Marc S. Schwartz ◽  
Liliana C. Goumnerova ◽  
Peter McL. Black ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Ventriculoperitoneal Shunt ◽  
Cost Effective ◽  
Shunt Malfunction ◽  
Effective Use

Place of Structured Psychotherapies in Clinical Practice

2003 ◽  
Vol 11 (2) ◽  
pp. 204-208 ◽  
Author(s):  
Michael Robertson
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Psychological Distress ◽  
Clinical Practice ◽  
Mental Health Care ◽  
Cost Effective ◽  
Evidence Base ◽  
Social Model ◽  
Cost Effective Alternative

Objective: To critically evaluate the place of structured psychotherapies in contemporary psychiatric practice. Conclusions: Structured psychotherapies are a valuable intervention in psychiatrists’ management of mental illness and psychological distress. They enjoy the support of a solid evidence base of efficacy, although the information provided by empirical research is misleading if not balanced with the wisdom of clinical experience. These treatments do not represent a cost-effective alternative to longer-term therapies. In the hands of experienced clinicians, structured psychotherapies can be highly effective in a variety of practice settings and help to deliver quality mental health care along the bio-psycho-social model.

scholarly journals New frontiers in enzyme immobilisation: robust biocatalysts for a circular bio-based economy

2021 ◽  
Author(s):  
Roger A. Sheldon ◽  
Alessandra Basso ◽  
Dean Brady
Keyword(s):  
Cost Effective ◽  
Continuous Processing ◽  
Enzyme Immobilisation ◽  
Recent Advances ◽  
Effective Use

This tutorial review focuses on recent advances in technologies for enzyme immobilisation, enabling their cost-effective use in the bio-based economy and continuous processing in general.

scholarly journals An Exonuclease I-Aided Turn-Off Fluorescent Strategy for Alkaline Phosphatase Assay Based on Terminal Protection and Copper Nanoparticles

Biosensors ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 139
Author(s):  
Yan Wang ◽  
Ying Yan ◽  
Xinfa Liu ◽  
Changbei Ma
Keyword(s):  
Alkaline Phosphatase ◽  
Human Serum ◽  
Clinical Diagnosis ◽  
Copper Nanoparticles ◽  
Cost Effective ◽  
Fast Method ◽  
Exonuclease I ◽  
Alkaline Phosphatase Assay ◽  
Phosphatase Assay ◽  
Phosphatase Alkaline

As an important DNA 3′-phosphatase, alkaline phosphatase can repair damaged DNA caused by replication and recombination. It is essential to measure the level of alkaline phosphatase to indicate some potential diseases, such as cancer, related to alkaline phosphatase. Here, we designed a simple and fast method to detect alkaline phosphatase quantitively. When alkaline phosphatase is present, the resulting poly T-DNA with a 3′-hydroxyl end was cleaved by exonuclease I, prohibiting the formation of fluorescent copper nanoparticles. However, the fluorescent copper nanoparticles can be monitored with the absence of alkaline phosphatase. Hence, we can detect alkaline phosphatase with this turn-off strategy. The proposed method is able to quantify the concentration of alkaline phosphatase with the LOD of 0.0098 U/L. Furthermore, we utilized this method to measure the effects of inhibitor Na3VO4 on alkaline phosphatase. In addition, it was successfully applied to quantify the level of alkaline phosphatase in human serum. The proposed strategy is sensitive, selective, cost effective, and timesaving, having a great potential to detect alkaline phosphatase quantitatively in clinical diagnosis.

The socio-spatial politics of royalties and their distribution: A case study of the Surat Basin, Queensland

2021 ◽  
pp. 0308518X2110266
Author(s):  
Neil Argent ◽  
Sean Markey ◽  
Greg Halseth ◽  
Laura Ryser ◽  
Fiona Haslam-McKenzie
Keyword(s):  
Cost Effective ◽  
Indigenous Communities ◽  
Energy Extraction ◽  
Grant Application ◽  
Coal Seam Gas ◽  
Spatial Politics ◽  
Developmental Needs ◽  
Development Fund ◽  
Effective Use

This paper is concerned with the socio-spatial and ethical politics of redistribution, specifically the allocation of natural resources rents from political and economic cores to the economic and geographical peripheries whence the resource originated. Based on a case study of the coal seam gas sector in Queensland's Surat Basin, this paper focuses on the operation of the Queensland State Government's regional development fund for mining and energy extraction-affected regions. Employing an environmental justice framework, we critically explore the operation of these funds in ostensibly helping constituent communities in becoming resilient to the worst effects of the ‘staples trap’. Drawing on secondary demographic and housing data for the region, as well as primary information collected from key respondents from mid-2018 to early 2019, we show that funds were distributed across all of the local government areas, and allocated to projects and places primarily on a perceived economic needs basis. However, concerns were raised with the probity of the funds’ administration. In terms of recognition justice, the participation of smaller and more remote towns and local Indigenous communities was hampered by their structural marginalisation. Procedurally, the funds were criticised for the lack of local consultation taken in the development and approval of projects. While spatially concentrated expenditure may be the most cost-effective use of public monies, we argue that grant application processes should be open, transparent and inclusive, and the outcomes cognisant of the developmental needs of smaller communities, together with the need to foster regional solidarity and coherence.

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

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