Is self-monitoring an effective option for people receiving long-term vitamin K antagonist therapy? A systematic review and economic evaluation

Wearable activity trackers (wearables) embed numerous behaviour change techniques (BCTs) that have previously been shown to increase adult physical activity (PA). With few children and adolescents achieving PA guidelines, it is crucial to explore ways to increase their PA. This systematic review examined the acceptability, feasibility, and effectiveness of wearables and their potential mechanisms of action for increasing PA in 5 to 19-year-olds. A systematic search of six databases was conducted, including data from the start date of each database to December 2019 (PROSPERO registration: CRD42020164506). Thirty-three studies were included. Most studies (70%) included only adolescents (10 to 19 years). There was some—but largely mixed—evidence that wearables increase steps and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. There were no apparent differences in effectiveness based on the number of BCTs used and between studies using a wearable alone or as part of a multi-component intervention. Qualitative findings suggested wearables increased motivation to be physically active via self-monitoring, goal setting, feedback, and competition. However, children and adolescents reported technical difficulties and a novelty effect when using wearables, which may impact wearables’ long-term use. More rigorous and long-term studies investigating the acceptability, feasibility, and effectiveness of wearables in 5 to 19-year-olds are warranted.

Download Full-text

Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Health Scope ◽

10.5812/ealthscope.112833 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Maryam Khoramrooz ◽

Asra Asgharzadeh ◽

Saeide Alidoost ◽

Zeynab Foroughi ◽

Saber Azami ◽

...

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Home Care ◽

Hospital Care ◽

Cost Effective ◽

Stroke Patients ◽

Life Years ◽

Effective Option ◽

The Cost

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

Download Full-text

ORAL ANTICOAGULANTS IN THE TREATMENT OF VENOUS THROMBOEMBOLIC COMPLICATIONS: FOCUS ON APIXABAN

Medical Council ◽

10.21518/2079-701x-2017-7-56-62 ◽

2017 ◽

pp. 56-62 ◽

Cited By ~ 1

Author(s):

M. Yu. Gilyarov ◽

E. V. Konstantinova

Keyword(s):

Vitamin K ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Factor Xa ◽

Vitamin K Antagonist ◽

Fixed Dose ◽

Vein Thrombosis ◽

Venous Thromboembolic ◽

Deep Vein

Venous thromboembolism (VTE), comprising deep vein thrombosis and pulmonary embolism, is a common condition associated with a significant clinical and economic burden. Anticoagulant therapy is the mainstay of treatment for VTE. Current guidelines recommend the use of either low molecular weight heparins or fondaparinux overlapping with and followed by a vitamin K antagonist for the initial treatment of VTE, with the vitamin K antagonist continued when long-term anticoagulation is required. These traditional anticoagulants have practical limitations that have led to the development of direct oral anticoagulants that directly target either Factor Xa or thrombin and are administered at a fixed dose without the need for routine coagulation monitoring. The paper reviews results of the trials of apixaban application for treatment and/or long-term secondary prevention of VTE. The paper analyses effectiveness and safety of apixaban in different groups of patients, as well as features of apixaban application in every day practice.

Download Full-text