scholarly journals What Is Known and Unknown About Twice-Weekly Hemodialysis

2015 ◽  
Vol 40 (4) ◽  
pp. 298-305 ◽  
Author(s):  
Yoshitsugu Obi ◽  
Rieko Eriguchi ◽  
Shuo-Ming Ou ◽  
Connie M. Rhee ◽  
Kamyar Kalantar-Zadeh
Keyword(s):  
Quality Of Life ◽  
De Novo ◽  
Urine Volume ◽  
Cost Effective ◽  
Standard Of Care ◽  
Treatment Regimens ◽  
Interdialytic Weight Gain ◽  
Cost Effective Treatment ◽  
Incremental Hemodialysis

Background: The 2006 Kidney Disease Outcomes Quality Initiative guidelines suggest twice-weekly or incremental hemodialysis for patients with substantial residual kidney function (RKF). However, in most affluent nations de novo and abrupt transition to thrice-weekly hemodialysis is routinely prescribed for all dialysis-naïve patients regardless of their RKF. We review historical developments in hemodialysis therapy initiation and revisit twice-weekly hemodialysis as an individualized, incremental treatment especially upon first transitioning to hemodialysis therapy. Summary: In the 1960's, hemodialysis treatment was first offered as a life-sustaining treatment in the form of long sessions (≥10 hours) administered every 5 to 7 days. Twice- and then thrice-weekly treatment regimens were subsequently developed to prevent uremic symptoms on a long-term basis. The thrice-weekly regimen has since become the ‘standard of care' despite a lack of comparative studies. Some clinical studies have shown benefits of high hemodialysis dose by more frequent or longer treatment times mainly among patients with limited or no RKF. Conversely, in selected patients with higher levels of RKF and particularly higher urine volume, incremental or twice-weekly hemodialysis may preserve RKF and vascular access longer without compromising clinical outcomes. Proposed criteria for twice-weekly hemodialysis include urine output >500 ml/day, limited interdialytic weight gain, smaller body size relative to RKF, and favorable nutritional status, quality of life, and comorbidity profile. Key Messages: Incremental hemodialysis including twice-weekly regimens may be safe and cost-effective treatment regimens that provide better quality of life for incident dialysis patients who have substantial RKF. These proposed criteria may guide incremental hemodialysis frequency and warrant future randomized controlled trials.

scholarly journals Vaginal apical and anterior reconstruction using ultralight weight mesh: two-year follow-up

2018 ◽  
Vol 67 (3) ◽  
pp. 55-63
Author(s):  
Dmitry D. Shkarupa ◽  
Nikita D. Kubin ◽  
Eduard N. Popov ◽  
Ekaterina A. Shapovalova ◽  
Gleb V. Kovalev ◽  
...  
Keyword(s):  
Quality Of Life ◽  
De Novo ◽  
Urine Volume ◽  
Operation Time ◽  
Pelvic Organ ◽  
Stage Ii ◽  
Apical Prolapse ◽  
Pelvic Floor Reconstruction

Introduction. Anterior and apical prolapse is the most common type of pelvic organ prolapse. The insufficient  effectiveness of native tissue repair in the pelvic organs leads to the search of new methods of the pelvic floor reconstruction. Objective. The current analysis was undertaken to evaluate the efficiency of the use of the Pelvix anterior mesh system (Lintex) with sacrospinous fixation of the apex in the treatment of anterior and apical prolapse. Methods. This study involved 150 women suffering from anterior-apical prolapse (stages III and IV). Reconstruction with the use of the mesh was performed in all the patients. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, and validated questionnaires (PFDI-20, PFIQ-7, PISQ-12) were used. All the listed parameters were determined before the surgery and on follow-up visits in 1, 6, 12, and 24 months after the treatment. Results. Mean operation time was 47 minutes. No cases of intraoperative clinically significant bleeding were reported. Anatomical cure rate (< stage II / asymptomatic stage II, according to the Baden-Walker system) at 12 months was found to be 94.4%, and at 24 months — 92.7%. Within the first month of follow-up, de novo stress urinary incontinence and de novo urgency occurred in 8.0% and 7.2% of patients, respectively. Statistically significant (p < 0.05) improvement in uroflowmetry parameters and decreased post-voiding urine volume were achieved after the surgery and did not change by 24 months. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period. Conclusion. The use of the Pelvix anterior mesh system in the surgical correction of the anterior and apical prolapse is a safe uterus-sparing technique. At two-year follow-up, it provides a high anatomical efficiency, normalizes urodynamic parameters and improves quality of life.

scholarly journals A COST-EFFECTIVE ANALYSIS OF TIOTROPIUM WITH FORMOTEROL AND BUDESONIDE WITH FORMOTEROL BASED ON EFFICACY AND QUALITY OF LIFE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS

2018 ◽  
Vol 11 (11) ◽  
pp. 348
Author(s):  
Kameswari Garnepudi ◽  
Ivaturi Shravanthi ◽  
Keerthana Sivakumar ◽  
Maithili Sharma M ◽  
Kurakula Manasa
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Effective Treatment ◽  
Pulmonary Rehabilitation ◽  
Cost Effective ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Cost Effective Treatment ◽  
Effective Analysis

Objectives: The primary objective of the study was to conduct the cost-effective analysis of tiotropium with formoterol versus budesonide with formoterol in the management of Stage-I chronic obstructive pulmonary disease (COPD) based on efficacy and quality of life (QoL). The study also aims to analyze the improvement of the QoL through pulmonary rehabilitation. The secondary objective was to evaluate the incidence of depression and anxiety in COPD patients.Methods: A prospective interventional study, with a sample size of 74 patients diagnosed with COPD Stage-I was conducted for 6 months. The study population was divided based on simple randomization into two main groups, one receiving tiotropium with formoterol and the other receiving budesonide with formoterol. Based on spirometry, their pulmonary function test (PFT) was recorded. The patients QoL was recorded using the WHOQoL-BREF questionnaire.Results: Data of 74 patients were collected for both the zero-degree and first-degree follow-up. The patients demonstrated good compliance with the transinhaler of the prescribed drugs. A significant improvement after providing pulmonary rehabilitation in PFT, i.e., forced expiratory volume1/ forced vital capacity values (p=0.000**) and the WHOQoL scoring (P = 0.001**) was observed in patients receiving tiotropium with formoterol. Tiotropium with formoterol was found to be more cost-effective treatment than budesonide with formoterol.Conclusion: The study showed that transinhalation of 9 mcg/12 mcg tiotropium/formoterol once a day is a better cost-effective treatment than 200 mcg/6 mcg transinhalation of budesonide/formoterol twice a day.

scholarly journals Management of Melasma through Panchakama- A case study

2020 ◽  
Vol 6 (3) ◽  
pp. 135-138
Author(s):  
Poonam Verma ◽  
◽  
Latika ◽  
D Prasanth ◽  
Santoshkumar Bhatted ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Cost Effective ◽  
Medical Treatments ◽  
Cost Effective Treatment ◽  
Negative Impacts ◽  
New Treatments

Introduction. Skin reflects our physiology and emotions too. In present era each and every one desire to have healthy and beautiful skin. Any changes or disease of skin creates apart from physical and psychological and social negative impacts. Hyperpigmentation or melasma is one of the such raised problem in our country as it has significant impact on beauty and appearance. It is more prevalent in women, in an estimated 9:1 ratio compared to men. In addition, there are high expenditures related to medical treatments and procedures whose results do not always meet the expectations of patients. hence it is need of an hour to provide safe and cost effective treatment for the skin disease like melasma. In addition to traditional treatments for melasma, there are also promising new treatments, including topical, oral, and procedural therapies Materials & Methods: It is a Case report on 28 year old female patient diagnosed as a case of Melasama (Vyanga) managed through Ayurveda treatment like Vaman Karma and Ayurveda medication Assessment was made on the basis of significant change in MASI score and quality of life (melas Qol) Observation & Results: Observation was done before treatment after treatment and during follow up The changes computed in Masi score in which degree of pigmentation decline to 10 to 6, quality of life improve 60 to 48. Conclusion: The computed data from the present study shows that Vamana Karma along with Ayurvedic oral Ayurveda medication is effective in the treatment of melasma (Vyanga).

scholarly journals Does Qigong Practice Have Benefits on the Management of Parkinson’s Disease?

J ◽  
2019 ◽  
Vol 2 (3) ◽  
pp. 352-363
Author(s):  
António Moreira ◽  
Luís Carlos Matos ◽  
Ana Maria Conceição
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cost Effective ◽  
Chronically Ill ◽  
The Elderly ◽  
Functional Mobility ◽  
Cost Effective Treatment ◽  
Hand Eye Coordination

Parkinson’s disease (PD) is a progressive neurological disorder leading to loss of autonomy and a decline in quality of life. Qigong, a practice rooted in traditional Chinese medicine, has been positively reported on a variety of complaints of chronically ill patients and on gait imbalance in the elderly. PubMed and B-On databases were accessed during March 2018 to carry out an inventory of relevant scientific papers relating PD to Qigong. Fifteen articles were found and analyzed allowing us to highlight that: (1) in addition to medication, Qigong shows potential gains in PD management; (2) there is a stabilizing effect of motor symptoms and positive results in several frequent autonomy symptoms; (3) Qigong is highly accepted by patients, and is a cost-effective treatment that can be self-practiced, improving sleep quality, gait speed, functional mobility and quality of life, thus reducing the risk of falling; (4) Qigong improves muscle hardness, functional ability to walk, hand–eye coordination and balance. Despite the promising results, the limitations and the disparity of experimental designs of the included studies do not allow us to have a conclusive answer to the question whether Qigong benefits the management of PD or not.

Abstract 17655: Cost-effectiveness of Ivabradine as a Treatment for Systolic Chronic Heart Failure in the United States

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anuraag R Kansal ◽  
Martin Cowie ◽  
Adrian Kielhorn ◽  
Stanimira Krotneva ◽  
Ali Taffazzoli ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Effective Treatment ◽  
Cost Effective ◽  
The United States ◽  
Medicare Advantage ◽  
Risk Of Death ◽  
Life Years ◽  
Cost Effective Treatment

Introduction: To compare the long-term clinical, cost and quality of life outcome of ivabradine+ standard of care (SoC) versus SoC and assess the cost-effectiveness of ivabradine as a treatment to systolic chronic HF, a cost effectiveness model was developed from the perspective of US payers. Hypothesis: Ivabradine+SoC is a cost-effective treatment for systolic chronic HF compared to SoC in the US. Methods: A state-transition model was developed modeling the risk of death and HF-, non-HF CV-, and non-CV- related hospitalization and mortality over 10 years in a cohort of patients receiving ivabradine+SoC. As patients experienced more HF and non-HF CV hospitalizations in the model, they were subject to higher future risk of HF and non-HF CV hospitalization and lower quality of life. Hospitalization rates and costs by hospitalization type were taken from US claims data for patients in commercial and Medicare Advantage insurance plans. Mortality, utility inputs, and ivabradine treatment effect were derived from analyses of the pivotal randomized placebo-controlled SHIFT study. Both health and cost outcomes were discounted at 3% per year. One-way and multi-way sensitivity analyses were conducted. Results: In the commercially insured population based on a cost of $4,500 per year for ivabradine, the total costs over 10 years were $355,080 for a patient treated on ivabradine+SoC and $361,516 for a patient on SoC alone. The total lifetime drug cost of ivabradine ($27,201) was more than offset with cost-savings from reduction in hospitalization. Patients on ivabradine+SoC also had better health outcomes with an incremental improvement of 0.21 life-years and 0.24 quality-adjusted life years (QALYs) compared to SoC. Similar incremental health benefit was seen in the Medicare Advantage (0.20 QALYs) population, but the lower cost per hospitalization led to a modest increase in cost ($7,284). The incremental cost-effectiveness ratio was $36,944/QALY in the Medicare Advantage population. Conclusions: The results of this model indicate that ivabradine+SoC may be a less costly and more effective option compared to SoC in the commercial population and a cost-effective treatment option among Medicare Advantage patients.

Superabsorbent Wound Dressing for Management of Patients With Moderate-to-Highly Exuding Chronic Leg Ulcers: An Early Stage Model-Based Benefit–Harm Assessment

2021 ◽  
pp. 153473462110093
Author(s):  
Vladica M. Velickovic ◽  
Jean P. Lembelembe ◽  
Francisco Cegri ◽  
Ivana Binic ◽  
Amr B. Abdelaziz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Early Stage ◽  
Absolute Risk ◽  
Standard Of Care ◽  
Risk Difference ◽  
Wound Dressings ◽  
Leg Ulcers ◽  
Related Quality ◽  
Health Related

The aim of the research is to assess the benefit–harm of superabsorbent polymers wound dressings based on polyacrylate polymers (SAPs) compared with standard of care (SoC) dressing mix for patients with moderate-to-highly exuding hard-to-heal leg ulcers. The SoC dressings mix was composed of other superabsorbents in 29% of cases, antimicrobials 26%, foams 20%, alginates 5%, and other dressings 19% weighted according to their frequency. We have used the decision-analytic modeling method, Markov process, as an adequate analytical solution for medical prognosis. We have combined the systematic literature search to identify the most relevant inputs for the analysis, with available patient-level clinical data concerning benefits of superabsorbent to generate a robust prediction of patient-relevant outcomes, including healing rates and health-related quality of life. Besides, we have qualitatively described adverse events associated with those treatments. Our research indicates that SAPs when compared with SoC dressing mix in a patient with moderate-to-highly excluding leg ulcers are leading to an improved healing rate with an absolute risk difference of 2.20% in 6 months and a relative risk of 1.07 in favor of SAP dressings. The attributable fraction among those exposed to SAP dressings of 6.6%, meaning that 6.6% of the healed ulcers could be attributed to having had the SAP dressing treatment instead of the SoC dressing treatment. Besides, SAP dressings lead to improved quality of life measured as incremental quality-adjusted life weeks (QALWs) of 0.13 QALWs.

scholarly journals “I just wear it and I become normal”: a qualitative study of Tanzanian women’s experiences with long-term vaginal pessary use for stress urinary incontinence

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040009
Author(s):  
Karina Holm Nissen ◽  
Benjamin C Shayo ◽  
Vibeke Rasch ◽  
Gileard G Masenga ◽  
Ditte Søndergaard Linde
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Women’S Experiences ◽  
Women's Experiences ◽  
Vaginal Pessary ◽  
Cost Effective Treatment ◽  
Long Term Treatment

IntroductionPrevious research has shown that vaginal pessaries are a cost-effective treatment for women worldwide suffering from stress urinary incontinence. However, little is known about African women’s experiences with vaginal pessary use. The aim of this study was to understand the experiences of vaginal pessary use among Tanzanian women who had received long-term pessary treatment for stress urinary incontinence.Methods15 semi-structured, individual interviews were conducted over a 2-month period in 2019 with Tanzanian women living in the Kilimanjaro Region who suffered from stress urinary incontinence and who had been using a pessary for at least 18 months. The interview transcripts were analysed using qualitative content analysis.ResultsThe primary motivation for seeking treatment were discomfort from symptoms, social consequences and low quality of life. Perceived benefits from pessary use included improved quality of life with reacquired abilities to perform daily activities, participate in social gatherings, feeling symptom relief and improved sexual relations. Further, some women saw pessary treatment as superior to other locally available treatment options. Perceived barriers for pessary use included shame, husband’s disapproval, limited access to treatment and lack of knowledge among the women as well as healthcare personnel.ConclusionVaginal pessaries are well-perceived as a long-term treatment method among Tanzanian women suffering from stress urinary incontinence. This method may have potential to be implemented large scale in Tanzania if combined with basic health education.

Changes in weight and weight-related quality of life in a multicentre, randomized trial of aripiprazole versus standard of care

2008 ◽  
Vol 23 (8) ◽  
pp. 561-566 ◽  
Author(s):  
Ronette L. Kolotkin ◽  
Patricia K. Corey-Lisle ◽  
Ross D. Crosby ◽  
Hong J. Kan ◽  
Robert D. McQuade
Keyword(s):  
Quality Of Life ◽  
Clinical Symptoms ◽  
Clinical Trial Data ◽  
Standard Of Care ◽  
Random Regression ◽  
Sexual Life ◽  
Baseline Body Mass Index ◽  
Meaningful Change ◽  
Related Quality

AbstractBackgroundThis is a secondary analysis of clinical trial data collected in 12 European countries. We examined changes in weight and weight-related quality of life among community patients with schizophrenia treated with aripiprazole (ARI) versus standard of care (SOC), consisting of other marketed atypical antipsychotics (olanzapine, quetiapine, and risperidone).MethodFive-hundred and fifty-five patients whose clinical symptoms were not optimally controlled and/or experienced tolerability problems with current medication were randomized to ARI (10–30 mg/day) or SOC. Weight and weight-related quality of life (using the IWQOL-Lite) were assessed at baseline, and weeks 8, 18 and 26. Random regression analysis across all time points using all available data was used to compare groups on changes in weight and IWQOL-Lite. Meaningful change from baseline was also assessed.ResultsParticipants were 59.7% male, with a mean age of 38.5 years (SD 10.9) and mean baseline body mass index of 27.2 (SD 5.1). ARI participants lost an average of 1.7% of baseline weight in comparison to a gain of 2.1% by SOC participants (p < 0.0001) at 26 weeks. ARI participants experienced significantly greater increases in physical function, self-esteem, sexual life, and IWQOL-Lite total score. At 26 weeks, 20.7% of ARI participants experienced meaningful improvements in IWQOL-Lite score, versus 13.5% of SOC participants. A clinically meaningful change in weight was also associated with a meaningful change in quality of life (p < 0.001). A potential limitation of this study was its funding by a pharmaceutical company.ConclusionsCompared to standard of care, patients with schizophrenia treated with aripiprazole experienced decreased weight and improved weight-related quality of life over 26 weeks. These changes were both statistically and clinically significant.

scholarly journals Health-Related Quality of Life following Cytoreductive Radical Prostatectomy in Patients with de-novo Oligometastatic Prostate Cancer

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5636
Author(s):  
Michael Chaloupka ◽  
Lina Stoermer ◽  
Maria Apfelbeck ◽  
Alexander Buchner ◽  
Vera Wenter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
De Novo ◽  
Health Related Quality ◽  
Significant Difference ◽  
Related Quality ◽  
Health Related

(1) Background: local treatment of the primary tumor has become a valid therapeutic option in de-novo oligo-metastatic prostate cancer (PC). However, evidence regarding radical prostatectomy (RP) in this setting is still subpar, and the effect of cytoreductive RP on postoperative health-related quality of life (HRQOL) is still unclear. (2) Methods: for the current study, patients with de-novo oligo-metastatic PC (cM1-oligo), defined as ≤5 bone lesions in the preoperative staging, were included, and matched cohorts using the variables age, body-mass index (BMI), and pT-stage were generated. Patient-reported outcome measures (PROMS) were assessed pre- and postoperatively using the validated EORTC-QLQ-C30, IIEF-5, and ICIQ-SF questionnaires. The primary endpoint for univariate and multivariable analysis was good general HRQOL defined by previously validated cut-off values. (3) Results: in total, 1268 patients (n = 84 (7%) cM1-oligo) underwent RP between 2012 and 2020 at one tertiary care center. A matched cohort of 411 patients (n = 79 with oligo-metastatic bone disease (cM1-oligo) and n = 332 patients without clinical indication of metastatic disease (cM0)) was created. The median follow-up was 25mo. There was no significant difference in good general HRQOL rates between cM1-oligo-patients and cM0-patients before RP (45.6% vs. 55.2%, p = 0.186), and at time of follow-up (44% vs. 56%, p = 0.811). Global health status (GHS) worsened significantly in cM0-patients compared to baseline (−5, p = 0.001), whereas GHS did not change significantly in cM1-oligo-patients (+3.2, p = 0.381). In multivariate analysis stratified for good erectile function (IIEF5 > 18; OR 5.722, 95% CI 1.89–17.36, p = 0.002) and continence recovery (OR 1.671, 95% CI 1.03–2.70, p = 0.036), cM1-oligo was not an independent predictive feature for general HRQOL (OR 0.821, 95% CI 0.44–1.53, p = 0.536). (4) Conclusions: in this large contemporary retrospective analysis, we observed no significant difference in HRQOL in patients with the oligometastatic bone disease after cytoreductive radical prostatectomy, when compared to patients with localized disease at time of surgery.

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