scholarly journals Need for evidence on long-term prognosis of PD+HD: a commentary

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mototsugu Tanaka ◽  
Naobumi Mise
Keyword(s):  
High Risk Patient ◽  
Cost Effective ◽  
Effective Treatment Option ◽  
Hospitalization Rates ◽  
Appropriate Treatment ◽  
Risk Of Mortality ◽  
Cost Effective Treatment ◽  
Long Term Prognosis ◽  
End Stage

AbstractCombination therapy with peritoneal dialysis and hemodialysis (PD+HD) is an alternative dialysis method for patients with end-stage kidney disease (ESKD). The complementary use of once-weekly HD expedites to achieve adequate dialysis and enables to prolong PD duration. Although PD+HD has been widely employed among Japanese PD patients, it is much less common outside Japan. Clinical evidences are still not enough, especially in long-term prognosis and appropriate treatment duration, suitable patients, and generalizability. A retrospective cohort study by Chung et al. (BMC Nephrol 21:348, 2020) compared the risk of mortality and hospitalization between PD patients who were transferred to PD+HD and those who were transferred to HD in Taiwan. Because the mortality and hospitalization rates did not differ between the groups, the authors concluded that, PD+HD may be a rational and cost-effective treatment option. It should be noted that the effects of PD+HD on long-term prognosis are still unknown due to too-short PD+HD duration. However, the study identified the high-risk patient population and showed the generalizability of PD+HD. PD+HD is a treatment of choice in patients with ESKD who prefer PD lifestyles even after decline in residual kidney function.

Physical and Psychological Benefits of Written Emotional Expression

2015 ◽  
Vol 20 (4) ◽  
pp. 242-251 ◽  
Author(s):  
Éva Kállay
Keyword(s):  
Mental Health ◽  
Expressive Writing ◽  
Mental Health Problems ◽  
Cost Effective ◽  
Health Problems ◽  
Future Research ◽  
Psychological Benefits ◽  
Cost Effective Treatment ◽  
Meta Analyses

Abstract. The last several decades have witnessed a substantial increase in the number of individuals suffering from both diagnosable and subsyndromal mental health problems. Consequently, the development of cost-effective treatment methods, accessible to large populations suffering from different forms of mental health problems, became imperative. A very promising intervention is the method of expressive writing (EW), which may be used in both clinically diagnosable cases and subthreshold symptomatology. This method, in which people express their feelings and thoughts related to stressful situations in writing, has been found to improve participants’ long-term psychological, physiological, behavioral, and social functioning. Based on a thorough analysis and synthesis of the published literature (also including most recent meta-analyses), the present paper presents the expressive writing method, its short- and long-term, intra-and interpersonal effects, different situations and conditions in which it has been proven to be effective, the most important mechanisms implied in the process of recovery, advantages, disadvantages, and possible pitfalls of the method, as well as variants of the original technique and future research directions.

scholarly journals The Cost-effectiveness of Celecoxib versus Non-steroidal Anti-inflammatory Drugs plus Proton-pump Inhibitors for Treating Osteoarthritis in Algeria

10.36469/9865 ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 184-199 ◽  
Author(s):  
Nadir Hammoumraoui ◽  
Sid Ahmed Kherraf ◽  
Joaquin Mould-Quevedo ◽  
Tarek A. Ismail
Keyword(s):  
Cost Effectiveness ◽  
Adverse Events ◽  
Proton Pump ◽  
Cost Effective ◽  
Private Clinic ◽  
Effective Treatment Option ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Cyclooxygenase-2 inhibitors such as celecoxib are as effective as non-selective non-steroidal anti-inflammatory drugs (ns-NSAIDs) in the treatment of osteoarthritis (OA), have fewer gastrointestinal side effects, but are more expensive. Objective: To evaluate the incremental cost-effectiveness ratio (ICER) of celecoxib versus ns-NSAIDs, with/without proton-pump inhibitor (PPI) co-therapy, for treating OA in Algeria. Methods: The National Institute for Health and Clinical Excellence (NICE) health economic model from UK, updated with relative risks of adverse events using CONDOR trial data, was adapted for costeffectiveness analysis in OA patients aged ≥65 years. Patients could initiate treatment with celecoxib or ns-NSAIDs with/without omeprazole. Conditional probabilities were obtained from published clinical trials; effectiveness measure was quality-adjusted life years (QALYs) gained/patient. The analysis was conducted from a healthcare payer’s perspective. The average daily treatment costs and frequencies of resource use for adverse events were based on data collected in August 2011 from a private clinic located in Cheraga, Algiers, Algeria. Probabilistic sensitivity analysis (PSA) was performed to construct cost-effectiveness acceptability curves (CEACs). Results: QALYs gained/patient over a 6-month horizon were higher with celecoxib (0.368) and celecoxib+PPI (0.40) versus comparators. The lowest expected cost/patient was associated with ibuprofen (US$134.76 versus US$175.67 with celecoxib+PPI, and US$177.57 with celecoxib). Celecoxib+PPI was the most cost-effective drug treatment, with an ICER of US$584.43, versus ibuprofen. Treatment with celecoxib alone showed an ICER of US$1,530.56 versus diclofenac+PPI. These ICERs are <1 gross domestic product per capita in Algeria (US$7,500). Over 1-year, 3-year and 5-year horizons, celecoxib with/without PPI co-therapy showed higher QALYs/patient versus comparators, and decreasing ICERs. The ICER of celecoxib+PPI was lower than that of comparators over all time horizons. These findings were confirmed with CEACs generated via PSA. Conclusion: Using data from a single private clinic in Cheraga, Algiers, Algeria, and after considering new adverse event risks, we showed that celecoxib with/without PPI co therapy is more cost-effective than ns-NSAID+PPI for treating OA patients aged ≥65 years. Celecoxib+PPI remains dominant over a 5-year horizon, making it the most cost-effective treatment option for medium- and long-term use.

Acupuncture's Place within Mainstream Medicine

1997 ◽  
Vol 15 (2) ◽  
pp. 104-107 ◽  
Author(s):  
Keyword(s):  
Bladder Dysfunction ◽  
Cost Effective ◽  
Discussion Paper ◽  
Effective Treatment Option ◽  
Medical Practitioners ◽  
Mainstream Medicine ◽  
Cost Effective Treatment ◽  
Pain Clinics ◽  
Medical Acupuncture ◽  
Needle Stimulation

This is a discussion paper reviewing the evidence for acupuncture in the fields of its current Western medical use. It is proven by controlled trials to be effective in pain relief, for dysmenorrhoea, and in nausea and vomiting. It has been found clinically useful in a wide variety of other areas including allergy bladder dysfunction, drug dependency and stroke. There is an increasing body of evidence that acupuncture is a cost-effective treatment option, and its use has become widespread in pain clinics, hospital rheumatology and physiotherapy departments, and in general practice. Medical acupuncture is now based firmly on modern physiological principles, and an understanding of the opioid and other neurotransmitters involved in needle stimulation has made clinically useful acupuncture practice readily accessible to medical practitioners.

Abstract 3772: Alternate Listing Transplantation is a Cost-Effective Treatment for End-Stage Heart Failure Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mark J Russo ◽  
Jonathan M Chen ◽  
Kimberly N Hong ◽  
Michael Argenziano ◽  
Ryan R Davies ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Cost Model ◽  
Case Series ◽  
Cost Effective ◽  
Intention To Treat ◽  
Cost Effective Treatment ◽  
Number Of Patients ◽  
Transplant Candidates ◽  
End Stage

BACKGROUND: In order to offer the benefit of heart transplantation to a greater number of patients some centers match high-risk recipients (HR) with non-standard or ”marginal” donors (MD) in a strategy known as Alternate Listing Transplantation (ALT). However, pairing sicker recipients with lower quality donor organs remains both clinically and ethically controversial. The purpose of this study was to determine the cost-effectiveness of this strategy. METHODS: The United Network of Organ Sharing provided deidentified patient-level data. UNOS data was used to determine clinical outcomes, including waiting time, post-transplant survival, length of stay, re-hospitalizations, episodes of rejection, and infection, based on all adult heart transplant candidates (age [gt] 18 yo) and listed between 1995–2005 (n=35,049). Through a systematic literature review of randomized controlled trials and case series that estimated related costs, a cost model (see Table ) using an intention-to-treat assumption was developed to calculate the incremental cost-effectiveness ratio (ICER) for HR candidates who subsequently received marginal donor hearts (HTR) compared with candidates who were not transplanted (NTXP). High-risk recipient criteria included age [gt] 65yo, retransplantation, HepC+, HIV+, CrCl <30 ml/min, DM with PVD, DM with Crcl <40 ml/min. MD criteria included age [gt] 55yo, DM, HIV+, HepC+, EF<45%, and donor:recipient weight <0.7. RESULTS: Median survival from listing was 0.55 yrs and 5.1 yrs in the HTR and NTXP groups, respectively. The estimated ICER was $66,645($34,046–$127,491) ICER varied by HR recipient criteria. CONCLUSIONS: The ICER for ALT falls at the upper limits acceptability for being cost-effective. However, stratified analysis by HR group suggests that this strategy is not appropriate for all groups. Cost Model Assumptions

E-Governance

2011 ◽  
pp. 1-27
Author(s):  
Srinivas Bhogle
Keyword(s):  
Web Services ◽  
Case Studies ◽  
Computer Networks ◽  
Cost Effective ◽  
Communication Technologies ◽  
Illustrative Case ◽  
Digital Information ◽  
Human Race ◽  
Long Term Prognosis

E-governance uses Internet and communication technologies to automate governance in innovative ways, so that it becomes more efficient, more cost-effective, and empowers the human race even more. E-governance exercises are being attempted for more than a decade now, but have so far achieved only mixed success. The long-term prognosis for e-governance, however, remains extremely positive. The emergence of Web-services technologies, the continually proliferating computer networks, and the irreversible migration towards digital information strongly confirm the view that e-governance is here to stay. The eventual success of any e-governance project is intimately linked to the methodology used, and to that complex mesh between men, machines, and mindsets. We explain the “what,” “why,” and “how” of e-governance. We also talk of e-governance concerns, and discuss a few illustrative case studies.

The Ethics of Infant Dialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 505-509 ◽  
Author(s):  
Timothy E. Bunchman
Keyword(s):  
Standard Of Care ◽  
Health Care Team ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Number Of Factors ◽  
Long Term Prognosis ◽  
Infant Dialysis ◽  
Stage Renal Disease ◽  
End Stage

The proper treatment of an infant with end-stage renal disease depends upon a number of factors including parental willingness to take on the task, experience of the health-care team, local and regional resources, and society's willingness to accept this support as a standard of care. Whereas the abilityto keep infants aliveon peritoneal dialysis (PD) is obtainable, it is not without physical, financial, as well as emotional cost. In order for a family to agree to take on such a task, an understanding of the risks and long-term prognosis should be offered. This “informed consent” is difficult to obtain in such a highly charged situation when emotions often dictate choice independently of logic. Long-term outcome of infants on PD has improved over time, yet is still fraught with complications. Options of treatment or nontreatment are explored.

scholarly journals Clinical impact of sarcopenia assessment in patients with hepatocellular carcinoma undergoing treatments

2020 ◽  
Vol 55 (10) ◽  
pp. 927-943 ◽  
Author(s):  
Giovanni Marasco ◽  
Matteo Serenari ◽  
Matteo Renzulli ◽  
Luigina Vanessa Alemanni ◽  
Benedetta Rossini ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Skeletal Muscle ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Appropriate Treatment ◽  
Risk Of Mortality ◽  
Short And Long Term ◽  
Poor Outcomes ◽  
And Function

Abstract Changes in body composition are associated with poor outcomes in cancer patients including hepatocellular carcinoma (HCC). Sarcopenia, defined as the loss of skeletal muscle mass, quality and function, has been associated with a higher rate of complications and recurrences in patients with cirrhosis and HCC. The assessment of patient general status before HCC treatment, including the presence of sarcopenia, is a key-point for achieving therapy tolerability and to avoid short- and long-term complications leading to poor patients’ survival. Thus, we aimed to review the current literature evaluating the role of sarcopenia assessment related to HCC treatments and to critically provide the clinicians with the most recent and valuable evidence. As a result, sarcopenia can be predictive of poor outcomes in patients undergoing liver resection, transplantation and systemic therapies, offering the chance to clinicians to improve the muscular status of these patients, especially those with high-grade sarcopenia at high risk of mortality. Further studies are needed to clarify the predictive value of sarcopenia in other HCC treatment settings and to evaluate its role as an additional staging tool for identifying the most appropriate treatment. Besides, interventional studies aiming at increasing the skeletal muscle mass for reducing complications and increasing the survival in patients with HCC are needed.

Allograft Augmentation of Hamstring Autograft for Younger Patients Undergoing Anterior Cruciate Ligament Reconstruction: Clinical and Cost-Effectiveness Analyses

2016 ◽  
Vol 45 (4) ◽  
pp. 892-899 ◽  
Author(s):  
Cale A. Jacobs ◽  
Jeremy M. Burnham ◽  
Eric C. Makhni ◽  
Chaitu S. Malempati ◽  
Eric C. Swart ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Cost Effective ◽  
Effective Treatment Option ◽  
Younger Patients ◽  
Cost Effective Treatment ◽  
Anterior Cruciate ◽  
Graft Diameter ◽  
Return To Activity

Background: Younger patients and those with smaller hamstring autograft diameters have been shown to be at significantly greater risk of graft failure after anterior cruciate ligament (ACL) reconstruction. To date, there is no information in the literature about the clinical success and/or cost-effectiveness of increasing graft diameter by augmenting with semitendinosus allograft tissue for younger patients. Hypothesis: Hybrid hamstring grafts are a cost-effective treatment option because of a reduced rate of graft failure. Study Design: Cohort study (economic and decision analysis); Level of evidence, 3. Methods: We retrospectively identified patients younger than 18 years who had undergone ACL reconstruction by a single surgeon between 2010 and 2015. During this period, the operating surgeon’s graft selection algorithm included the use of bone–patellar tendon–bone (BTB) autografts for the majority of patients younger than 18 years. However, hamstring autografts (hamstring) or hybrid hamstring autografts with allograft augment (hybrid) were used in skeletally immature patients and in those whom the surgeon felt might have greater difficulty with postoperative rehabilitation after BTB graft harvest. Patient demographics, graft type, graft diameter, the time the patient was cleared to return to activity, and the need for secondary surgical procedures were compared between the hamstring and hybrid groups. The clinical results were then used to assess the potential cost-effectiveness of hybrid grafts in this select group of young patients with an ACL injury or reconstruction. Results: This study comprised 88 patients (hamstring group, n = 46; hybrid group, n = 42). The 2 groups did not differ in terms of age, sex, timing of return to activity, or prevalence of skeletally immature patients. Graft diameters were significantly smaller in the hamstring group (7.8 vs 9.9 mm; P < .001), which corresponded with a significantly greater rate of graft failure (13 of 46 [28.3%] vs 5 of 42 [11.9%]; P = .049). As a result of the reduced revision rate, the hybrid graft demonstrated incremental cost savings of US$2765 compared with the hamstring graft, and the hybrid graft was the preferred strategy in 89% of cases. Conclusion: Driven by increased graft diameters and the reduced risk of revision, hybrid grafts appear to be a more cost-effective treatment option in a subset of younger patients with an ACL injury.

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