How Did We Get Here? An Examination of Opioid Addiction from A Historical Perspective

2021 ◽  
Vol 8 (2) ◽  
pp. 54-64
Author(s):  
Ralph Gallo
Keyword(s):  
Historical Perspective ◽  
Treatment Options ◽  
War On Drugs ◽  
Intervention Programs ◽  
Medical Community ◽  
Family Status ◽  
Drug Prescribing ◽  
Richard Nixon ◽  
Criminal Background ◽  
The Cost

America is facing a drug crisis that is rocking the nation at the cost of one trillion dollars since former President Richard Nixon declared war on drugs more than 40 years ago in 1971.  This latest opioid crisis can be identified as the war on drugs 2.0. Research supports that the American public is not interested in fighting the war on drugs; it is interested in creating viable intervention programs that are effective in treating drug addiction and education programs for the drug prescribing medical community. Results revealed statistically significant differences between socioeconomic status and race, family status and criminal background, family status and criminal background related to a drug background, and family status and equally offering drug treatment options.

Pharmacoeconomic Considerations in Treatment Options for Acute Seizures

1998 ◽  
Vol 13 (1_suppl) ◽  
pp. S27-S29 ◽  
Author(s):  
Nina Graves
Keyword(s):  
Treatment Options ◽  
Emergency Department Visits ◽  
Event Management ◽  
Pharmacoeconomic Data ◽  
Acute Seizures ◽  
Rectal Diazepam ◽  
Adverse Event Management ◽  
History Of ◽  
Cluster Seizures ◽  
The Cost

Two pharmacoeconomic studies on the treatment of acute seizures have been conducted. In 1991, Kriel and colleagues surveyed parents of children with a history of cluster seizures, prolonged seizures, or status epilepticus who had been instructed in the use of rectal diazepam. A comparison of data before instruction with data after instruction showed a reduced need for emergency department visits with rectal diazepam. Instruction thus provided a pharmacoeconomic benefit, despite the cost of the product. In 1996, Marchetti and coworkers found that intravenous fosphenytoin was associated with fewer adverse events than intravenous phenytoin. Fosphenytoin thus reduced the need for adverse event management and provided a substantial pharmacoeconomic benefit, despite its higher cost, compared with phenytoin. This study had a number of limitations, however, and hospital pharmacists remain resistant to the use of fosphenytoin. Additional studies may provide more pharmacoeconomic data to support the greater use of fosphenytoin in the treatment of acute pediatric seizures. (J Child Neurol 1998;13(Suppl 1):S27-S29).

scholarly journals Treatment options in moderate and severe depression: decision analysis supporting a clinical guideline

2006 ◽  
Vol 189 (6) ◽  
pp. 494-501 ◽  
Author(s):  
Judit Simon ◽  
Stephen Pilling ◽  
Rachel Burbeck ◽  
David Goldberg
Keyword(s):  
Combination Therapy ◽  
Decision Analysis ◽  
Secondary Care ◽  
Treatment Options ◽  
Severe Depression ◽  
Cost Effective ◽  
Current Evidence ◽  
Resource Utilisation ◽  
Moderate Depression ◽  
The Cost

BackgroundTreatment options for depression include antidepressants, psychological therapy and a combination of the two.AimsTo develop cost-effective clinical guidelines.MethodSystematic literature reviews were used to identify clinical, utility and cost data. A decision analysis was then conducted to compare the benefits and costs of antidepressants with combination therapy for moderate and severe depression in secondary care in the UK.ResultsOver the 15-month analysis period, combination therapy resulted in higher costs and an expected 0.16 increase per person in the probability of remission and no relapse compared with antidepressants. The cost per additional successfully treated patient was £4056 (95% CI 1400–18 300); the cost per quality-adjusted life year gained was £5777 (95% CI 1900–33 800) for severe depression and £14 540 (95% CI 4800–79 400) for moderate depression.ConclusionsCombination therapy is likely to be a cost-effective first-line secondary care treatment for severe depression. Its cost-effectiveness for moderate depression is more uncertain from current evidence. Targeted combination therapy could improve resource utilisation.

scholarly journals Reoperation costs in attempted breast-conserving surgery: a decision analysis

2016 ◽  
Vol 23 (5) ◽  
pp. 314 ◽  
Author(s):  
R. Pataky ◽  
C.R. Baliski
Keyword(s):  
Health Care ◽  
Breast Reconstruction ◽  
Patient Care ◽  
Health Care System ◽  
Early Stage ◽  
Treatment Options ◽  
Breast Conserving Surgery ◽  
Reoperation Rate ◽  
The Cost ◽  
Care System

Background Breast-conserving surgery (bcs) is the preferred surgical approach for most patients with early-stage breast cancer. Frequently, concerns arise about the pathologic margin status, resulting in an average reoperation rate of 23% in Canada. No consensus has been reached about the ideal reoperation rate, although 10% has been suggested as a target. Upon undergoing reoperation, many patients choose mastectomy and breast reconstruction, which add to the morbidity and cost of patient care. We attempted to identify the cost of reoperation after bcs, and the effect that a reduction in the reoperation rate could have on the B.C. health care system.Methods A decision tree was constructed to estimate the average cost per patient undergoing initial bcs with two reoperation frequency scenarios: 23% and 10%. The model included the direct medical costs from the perspective of the B.C. health care system for the most common surgical treatment options, including breast reconstruction and postoperative radiation therapy.Results Costs ranged from a low of $8,225 per patient with definitive bcs [95% confidence interval (ci): $8,061 to $8,383] to a high of $26,026 for reoperation with mastectomy and delayed reconstruction (95% ci: $23,991 to $28,122). If the reoperation rate could be reduced to 10%, the average saving would be $1,055 per patient undergoing attempted bcs (95% ci: $959 to $1,156). If the lower rate were to be achieved in British Columbia, it would translate into a savings of $1.9 million annually.Summary The implementation of initiatives to reduce reoperation after bcs could result in significant savings to the health care system, while potentially improving the quality of patient care.

scholarly journals Superficial venous insufficiency from the infernal to the endothermal

2014 ◽  
Vol 96 (1) ◽  
pp. 5-10 ◽  
Author(s):  
D Carradice
Keyword(s):  
Gold Standard ◽  
Venous Insufficiency ◽  
Varicose Veins ◽  
Treatment Options ◽  
Resource Limitation ◽  
Skin Damage ◽  
The Common ◽  
Modern Treatment ◽  
The Cost ◽  
Superficial Venous Insufficiency

This review presents the common diseases associated with superficial venous insufficiency of the leg. These include varicose veins, swelling, skin damage and ulceration. The benefits and rationale behind treatment are discussed, followed by the historical advances from ancient mortality and prayer to the modern endovenous revolution. Finally, an overview of modern treatment options will discuss the evidence supporting the gold standard of endothermal ablation and the cost effectiveness of treatment at this time of challenging resource limitation.

scholarly journals A Brief Review of Severe Asthma

2021 ◽  
Vol 6 (2) ◽  
pp. 4-12
Author(s):  
Muhammad Amin Ibrahim ◽  
Ahmad Izuanuddin Ismail ◽  
Mohammed Fauzi Abdul Rani
Keyword(s):  
Severe Asthma ◽  
Treatment Options ◽  
Oral Steroid ◽  
Inhaler Technique ◽  
Inhaled Corticosteroid ◽  
Asthma Care ◽  
Asthmatic Patients ◽  
Appropriate Treatment ◽  
Considerable Morbidity ◽  
The Cost

Severe asthma describes an asthma condition that requires a substantial amount of inhaled corticosteroid and bronchodilators to keep it under control including the frequent additional need for oral steroid to avoid exacerbations. The incidence of severe asthma in Malaysia is unknown but data elsewhere shows that it is around 5 to 10 % of asthmatics. This category of asthmatic patients has considerable morbidity, is disproportionate cost-wise to the number of sufferers and requires specialised and focused care. The management of severe asthma should be undertaken at a severe asthma clinic led by a physician with a special interest in its management. The diagnosis needs confirmation, comorbidities identified and triggering factors addressed. Inhaler technique and compliance are major contributing issues and must be addressed at all consultation opportunities. Once the diagnosis of severe asthma is confirmed, the disease needs phenotyping to plan for the most appropriate treatment, termed as a personalised approach to severe asthma care. The advances in biologics have changed the landscape of treatment of this disease but in Malaysia especially, there are many limitations namely the cost. This article briefly explores the current understanding of severe asthma, the assessment including phenotyping and possible treatment options.

scholarly journals Larotrectinib (Vitrakvi)

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Reimbursement Team
Keyword(s):  
Gene Fusion ◽  
Treatment Options ◽  
Single Agent ◽  
Locally Advanced ◽  
Acquired Resistance ◽  
Resistance Mutation ◽  
Solid Tumours ◽  
The Cost ◽  
Tyrosine Receptor Kinase ◽  
Public Drug

CADTH recommends that Vitrakvi be reimbursed by public drug plans for treating adult and pediatric patients with locally advanced or metastatic solid tumours who have a neurotrophic tyrosine receptor kinase (NTRK) gene fusion without a known acquired resistance mutation, or where surgical resection is likely to result in severe morbidity and have no satisfactory treatment options, but only if certain conditions are met. Vitrakvi should only be covered to treat patients with advanced solid tumours who have an NTRK gene fusion, who have previously failed on all standard treatments for their current tumour site, and who will be able to tolerate the treatment. Vitrakvi should only be reimbursed as single-agent therapy if it is prescribed by a clinician with expertise in the use of antineoplastic drugs and if the cost of Vitrakvi is reduced.

Corruption, Transparency, and E-Government

2011 ◽  
pp. 271-282
Author(s):  
Herwig Ostermann ◽  
Roland Staudinger
Keyword(s):  
International Development ◽  
Historical Perspective ◽  
Capital Inflows ◽  
Private Capital ◽  
African Countries ◽  
Political Issue ◽  
Transparency International ◽  
Economic Progress ◽  
Red Tape ◽  
The Cost

Regarded from a historical perspective, the appearance of corruption is not a new phenomenon at all. It can be traced back to the ancient civilizations of China, Egypt, Greece, India, Israel, and Rome, which all provide evidence of widespread illegality and corruption. In spite of its long history, corruption increasingly became a political issue in the 1990s: corruption scandals contributed substantially to the resignation of governments in Ecuador, Brazil, India, and Italy and unsettled well-established ruling parties in Japan and Mexico (Lash, 2004; Sen, 1999). According to Sen (1999), “the prevalence of corruption is rightly regarded as one of the major stumbling blocks in the path to successful economic progress, for example in many Asian and African countries” (p. 275). Dudley (2000) estimates that 30% of the money spent annually for international development loans are diverted from productive pursuits because of corruption. Additionally, countries perceived as being corrupt suffer from lower (private) capital inflows, as foreign investors are deterred by corruption and its associated phenomena, which include bureaucratic red tape, mismanagement and the lack of secure property rights (Transparency International (TI), 2004). Overall, the cost of corruption represents 5% of the volume of total global output or more than 1.5 trillion dollars a year according to “rough, but conservative” World Bank estimates (United Nations, 2003c). Table 1 aims to illustrate the scale of political corruption by presenting estimates of the funds allegedly embezzled by 10 notorious (but not necessarily the most corrupt) leaders of the last 20 years.

scholarly journals Cost-Effectiveness of Titanium Elastic Nail (TEN) in the Treatment of Forearm Fractures in Children

Medicina ◽  
2020 ◽  
Vol 56 (2) ◽  
pp. 79
Author(s):  
Ovidiu Adam ◽  
Vlad Laurentiu David ◽  
Florin George Horhat ◽  
Eugen Sorin Boia
Keyword(s):  
Closed Reduction ◽  
Diagnosis Related Groups ◽  
Financial Burden ◽  
Treatment Options ◽  
Indirect Costs ◽  
Forearm Fractures ◽  
Titanium Elastic Nail ◽  
Fractures In Children ◽  
Elastic Nail ◽  
The Cost

Background and objectives: There are various methods in the management of forearm fractures in children. Elastic stable intramedullary nailing using Titanium Elastic Nail (TEN) is nowadays employed in diaphysis fractures of children, with clear benefits over other treatment options. However, in the case of TEN versus other treatment methods of forearm fractures in children, cost is an important issue. This report will focus on the cost assessment of using TEN versus other therapeutic means in the treatment of forearm fractures in children. Materials and Methods: We performed a retrospective longitudinal study of 173 consecutive patients with forearm fractures treated in a single institution during 2017. We calculated the cost for each patient by summing up direct costs plus indirect costs, calculated at an aggregate level. Hospital income data were extracted from the Diagnosis Related Groups database. Results: A total of 173 patients with forearm fractures were treated, 44 using TEN, 86 using K-wire, and 46 using closed reduction and cast. There were 66 radius fractures, 1 ulna fracture, and 106 that were both radius and ulna fractures. Mean treatment cost were $632.76 for TEN, $499.50 for K-wire, and $451.30 for closed reduction and cast. Costs for TEN were higher than for K-wire insertion (p = 0.00) and higher than closed reduction and cast ($182.42; p = 0.00). Reimbursement per patient was higher with TEN versus K-wire patients; $497.88 vs. $364.64 /patient (p = 0.00), and higher than for patients treated with closed reduction and cast (p = 0.00). Conclusions: The treatment of upper extremity fractures using TEN was more expensive than the other methods. In Romania, because the reimbursement for TEN is higher as well, there are no differences in the financial burden when treating forearm fractures with TEN versus K-wire. Non-surgical treatment has the lowest cost but also the lowest reimbursement.

Maxillary Ameloblastoma With Pulmonary Metastasis: Management Challenges in Resource-Limited Setting—A Case Report

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S42-S42
Author(s):  
Salvatory Mlaga ◽  
Tupokigwe Brown ◽  
Atuganile Malango ◽  
Karpal Sohal ◽  
Edda Vuhahula
Keyword(s):  
Rare Case ◽  
Treatment Options ◽  
Resource Limited Setting ◽  
Medical Community ◽  
Biological Behavior ◽  
Ki 67 ◽  
Regional Lymph Nodes ◽  
Ct Guided ◽  
Resource Limited ◽  
Limited Setting

Abstract Introduction: Ameloblastoma is a benign odontogenic tumor that may exhibit aggressive biological behavior with local recurrence. It more commonly occurs in the mandible than the maxilla. Rarely, ameloblastoma may metastasize to local regional lymph nodes and/or distant organs, notably lungs, brain, and skin, hence the term metastasizing (malignant) ameloblastoma (MA), in keeping with the WHO definition of MA in its recent classification of odontogenic tumors (2017). Here, we report a rare case of maxillary ameloblastoma that metastasized to the lungs in a 22-year-old African male. Radiological evaluation revealed a massive maxillary tumor that had a local extension to the brain. Chest x-ray and CT scan pointed out metastatic mass to the lungs. Histology of the tumor mass revealed it to be follicular ameloblastoma with aggressive behavior shown by abnormal mitoses and further characterization by immunohistochemical reactivity to Ki-67. CT-guided fine-needle aspiration cytology of the lung mass showed microscopic features of ameloblastoma bearing resemblance to the primary jaw tumor. Socioeconomic constraints on the patient’s side and limited medical resources necessitated planning that served the purpose of proper diagnosis and treatment options. In this paper, we discuss the clinical behavior, differential diagnosis, and challenges faced by clinicians in managing metastatic ameloblastoma in a resource-limited setting. Conclusively, reporting this rare case and first of its kind in our locality raises awareness, hence reducing misdiagnosis of primary tumor in sites other than the jaw, while also sharing our experience of managing metastasizing ameloblastoma in a resource-limited setting to the larger medical community.

scholarly journals Molecular and Immunological Characterization of Biliary Tract Cancers: A Paradigm Shift Towards a Personalized Medicine

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2190 ◽  
Author(s):  
Ines Malenica ◽  
Matteo Donadon ◽  
Ana Lleo
Keyword(s):  
Biliary Tract ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Ampulla Of Vater ◽  
Current Treatment ◽  
Medical Community ◽  
Small Subset ◽  
Molecular Heterogeneity ◽  
Biliary Tract Cancers

Biliary tract cancers (BTCs) are a group of rare cancers that account for up to 3–5% of cancer patients worldwide. BTCs include cholangiocarcinoma (CCA), gallbladder cancer (GBC), and ampulla of Vater cancer (AVC). They are frequently diagnosed at an advanced stage when the disease is often found disseminated. A late diagnosis highly compromises surgery, the only potentially curative option. Current treatment regimens include a combination of chemotherapeutic drugs gemcitabine with cisplatin that have a limited efficiency since more than 50% of patients relapse in the first year. More recently, an inhibitor of fibroblast growth factor receptor 2 (FGFR2) was approved as a second-line treatment, based on the promising results from the NCT02924376 clinical trial. However, novel secondary treatment options are urgently needed. Recent molecular characterization of CCA and GBC highlighted the molecular heterogeneity, etiology, and epidemiology in BTC development and lead to the classification of the extrahepatic CCA into four types: metabolic, proliferating, mesenchymal, and immune type. Differences in the immune infiltration and tumor microenvironment (TME) have been described as well, showing that only a small subset of BTCs could be classified as an immune “hot” and targeted with the immunotherapeutic drugs. This recent evidence has opened a way to new clinical trials for BTCs, and new drug approvals are highly expected by the medical community.

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