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 The syndrome of inappropriate antidiuretic hormone: current and future management options

2010 ◽  
Vol 162 (Suppl1) ◽  
pp. S13-S18 ◽  
Author(s):  
Mark Sherlock ◽  
Chris J Thompson
Keyword(s):  
Antidiuretic Hormone ◽  
Treatment Options ◽  
Fluid Restriction ◽  
Efficacy And Safety ◽  
Electrolyte Abnormality ◽  
Management Options ◽  
Appropriate Treatment ◽  
The Cost ◽  
Underlying Pathophysiology ◽  
Future Management

Hyponatraemia is the commonest electrolyte abnormality, and syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent underlying pathophysiology. Hyponatraemia is associated with significant morbidity and mortality, and as such appropriate treatment is essential. Treatment options for SIADH include fluid restriction, demeclocycline, urea, frusemide and saline infusion, all of which have their limitations. The introduction of the vasopressin-2 receptor antagonists has allowed clinicians to specifically target the underlying pathophysiology of SIADH. Initial studies have shown good efficacy and safety profiles in the treatment of mild to moderate hyponatraemia. However, studies assessing the efficacy and safety of these agents in acute severe symptomatic hyponatraemia are awaited. Furthermore, the cost of these agents at present may limit their use.

scholarly journals The Costs of Implementing the 1999 Canadian Asthma Consensus Guidelines Recommendation of Asthma Education and Spirometry for the Family Physician

2004 ◽  
Vol 11 (5) ◽  
pp. 349-353 ◽  
Author(s):  
Susan P Corrigan ◽  
David L Cecillon ◽  
Don D Sin ◽  
Heather M Sharpe ◽  
Elaine M Andrews ◽  
...  
Keyword(s):  
Family Practice ◽  
Family Physician ◽  
First Year ◽  
Consensus Guidelines ◽  
Asthma Care ◽  
Asthma Education ◽  
Physician Practices ◽  
Asthmatic Patients ◽  
The Family ◽  
The Cost

BACKGROUND:National and international asthma guidelines recommend that patients with asthma be provided with asthma education and spirometry as a component of enhanced asthma care. The cost of implementing these interventions in family physician practices is not known.OBJECTIVE:The objective of the present study was to determine the cost of providing recommended asthma care to adult patients in the family practice setting.METHODS:The present study was conducted using three scenarios of care in family practice. Small, medium and large asthmatic patient populations were used. The incremental costs of implementing enhanced asthma care based on the Canadian Asthma Consensus Guidelines, including the provision of spirometry and asthma education in both group and individual sessions, and the resources required for these interventions were calculated for each scenario.RESULTS:For a physician with 50 asthmatic patients, the cost of providing enhanced asthma care with spirometry and group education sessions was approximately $78 per patient in the first year of implementation. For individual sessions, the cost increased to $100 per patient for the first year. If the physician had 100 asthmatic patients, the per patient cost would decrease; however, the overall cost of the program would be $7,000.CONCLUSIONS:The costs of providing enhanced asthma care are significant. In most cases, physicians are inadequately reimbursed (or not reimbursed) for these interventions. In light of the evidence of the effectiveness of these interventions, health insurance plans should consider adding these services to fee schedules.

scholarly journals Optimal Treatment Strategy for a Tumor Model under Immune Suppression

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Kwang Su Kim ◽  
Giphil Cho ◽  
Il Hyo Jung
Keyword(s):  
Mathematical Model ◽  
T Cells ◽  
Immune Suppression ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Tumor Model ◽  
Optimal Timing ◽  
Appropriate Treatment ◽  
Control Growth ◽  
The Cost

We propose a mathematical model describing tumor-immune interactions under immune suppression. These days evidences indicate that the immune suppression related to cancer contributes to its progression. The mathematical model for tumor-immune interactions would provide a new methodology for more sophisticated treatment options of cancer. To do this we have developed a system of 11 ordinary differential equations including the movement, interaction, and activation of NK cells, CD8+T-cells, CD4+T cells, regulatory T cells, and dendritic cells under the presence of tumor and cytokines and the immune interactions. In addition, we apply two control therapies, immunotherapy and chemotherapy to the model in order to control growth of tumor. Using optimal control theory and numerical simulations, we obtain appropriate treatment strategies according to the ratio of the cost for two therapies, which suggest an optimal timing of each administration for the two types of models, without and with immunosuppressive effects. These results mean that the immune suppression can have an influence on treatment strategies for cancer.

Candida albicans endocarditis involving a normal native aortic valve in an immunocompetent patient

2020 ◽  
Vol 13 (11) ◽  
pp. e236902
Author(s):  
Taha Sheikh ◽  
Jeremy C Tomcho ◽  
Mohammed T Awad ◽  
Syeda Ramsha Zaidi
Keyword(s):  
Candida Albicans ◽  
Mortality Rate ◽  
Aortic Valve ◽  
High Mortality ◽  
Treatment Options ◽  
Immunocompetent Patient ◽  
Fungal Endocarditis ◽  
Appropriate Treatment ◽  
Mechanical Valves ◽  
Serious Infection

Fungal endocarditis, specifically from Candida species, is a rare but serious infection with a high mortality rate. Most cases occur in bioprosthetic or mechanical valves and are uncommon in native, structurally normal valves. When Candida endocarditis is detected and appropriate treatment is initiated earlier, there is an improvement in mortality. While the recommendation is usually to treat with a combination of surgery and antifungal medications, patient comorbidities may limit treatment options.

scholarly journals The effects of a preoperative multidisciplinary conference on outcomes for high-risk patients with challenging surgical treatment options: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masayoshi Koike ◽  
Mie Yoshimura ◽  
Yasushi Mio ◽  
Shoichi Uezono
Keyword(s):  
Patient Safety ◽  
Retrospective Study ◽  
High Risk ◽  
Treatment Plan ◽  
Treatment Options ◽  
High Risk Patients ◽  
Appropriate Treatment ◽  
Risk Patients ◽  
Treatment Plans ◽  
Multidisciplinary Conference

Abstract Background Surgical options for patients vary with age and comorbidities, advances in medical technology and patients’ wishes. This complexity can make it difficult for surgeons to determine appropriate treatment plans independently. At our institution, final decisions regarding treatment for patients are made at multidisciplinary meetings, termed High-Risk Conferences, led by the Patient Safety Committee. Methods In this retrospective study, we assessed the reasons for convening High-Risk Conferences, the final decisions made and treatment outcomes using conference records and patient medical records for conferences conducted at our institution from April 2010 to March 2018. Results A total of 410 High-Risk Conferences were conducted for 406 patients during the study period. The department with the most conferences was cardiovascular surgery (24%), and the reasons for convening conferences included the presence of severe comorbidities (51%), highly difficult surgeries (41%) and nonmedical/personal issues (8%). Treatment changes were made for 49 patients (12%), including surgical modifications for 20 patients and surgery cancellation for 29. The most common surgical modification was procedure reduction (16 patients); 4 deaths were reported. Follow-up was available for 21 patients for whom surgery was cancelled, with 11 deaths reported. Conclusions Given that some change to the treatment plan was made for 12% of the patients discussed at the High-Risk Conferences, we conclude that participants of these conferences did not always agree with the original surgical plan and that the multidisciplinary decision-making process of the conferences served to allow for modifications. Many of the modifications involved reductions in procedures to reflect a more conservative approach, which might have decreased perioperative mortality and the incidence of complications as well as unnecessary surgeries. High-risk patients have complex issues, and it is difficult to verify statistically whether outcomes are associated with changes in course of treatment. Nevertheless, these conferences might be useful from a patient safety perspective and minimize the potential for legal disputes.

Serum inhaled corticosteroid detection for monitoring adherence in severe asthma.

2021 ◽  
Author(s):  
Fahad H. Alahmadi ◽  
Brian Keevil ◽  
Lynn Elsey ◽  
Kate George ◽  
Robert Niven ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Inhaled Corticosteroid

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.

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