scholarly journals A Functional Threshold for Long-Term Use of Hand and Arm Function Can Be Determined: Predictions From a Computational Model and Supporting Data From the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial

2009 ◽  
Vol 89 (12) ◽  
pp. 1327-1336 ◽  
Author(s):  
Nicolas Schweighofer ◽  
Cheol E. Han ◽  
Steven L. Wolf ◽  
Michael A. Arbib ◽  
Carolee J. Winstein
Keyword(s):  
Controlled Trial ◽  
Hand Function ◽  
Cost Effective ◽  
Phase Iii ◽  
Future Research ◽  
Therapy Evaluation ◽  
Effective Interventions ◽  
Term Change ◽  
Number Of Patients

Background Although spontaneous use of the more-affected arm and hand after stroke is an important determinant of participation and quality of life, a number of patients exhibit decreases in use following rehabilitative therapy. A previous neurocomputational model predicted that if the dose of therapy is sufficient to bring performance above a certain threshold, training can be stopped. Objective The aim of this study was to test the hypothesis that there exists a threshold for function of the paretic arm and hand after therapy. If function is above this threshold, spontaneous use will increase in the months following therapy. In contrast, if function is below this threshold, spontaneous use will decrease. Methods New computer simulations are presented showing that changes in arm use following therapy depend on a performance threshold. This prediction was tested by reanalyzing the data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) trial, a phase III randomized controlled trial in which participants received constraint-induced movement therapy for 2 weeks and were tested both 1 week and 1 year after therapy. Results The results demonstrate that arm and hand function measured immediately after therapy predicts, on average, the long-term change of arm use. Above a functional threshold, use improves. Below this threshold, use decreases. Limitations The reanalysis of the EXCITE trial data provides a “group” threshold above which a majority of patients, but not all, improve spontaneously. A goal of future research is to provide the means to assess when patients reach their individual threshold. Conclusion Understanding of the causal and nonlinear relationship between limb function and daily use is important for the future development of cost-effective interventions and prevention of “rehabilitation in vain.”

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.

The cost-effectiveness of atezolizumab in first-line for metastatic triple negative breast cancer is heavily linked to PD-L1 level

2021 ◽  
pp. 107815522110194
Author(s):  
Jacopo Giuliani ◽  
Beatrice Mantoan ◽  
Andrea Bonetti
Keyword(s):  
Breast Cancer ◽  
Triple Negative ◽  
Controlled Trial ◽  
Metastatic Breast ◽  
Cost Effective ◽  
Phase Iii ◽  
Line Treatment ◽  
First Line ◽  
Pivotal Phase ◽  
First Line Treatment

The present analysis was conducted to assess the pharmacological costs of atezolizumab as first-line treatment in triple negative metastatic breast cancer (mBC). Pivotal phase III randomized controlled trial (RCT) was considered. Nine hundred and two patients were included. Differences in costs between the 2 arms (atezolizumab plus nabpaclitaxel versus placebo plus nab-paclitaxel) was 17 398 €, with a cost of 7564 €per month of OS-gain in the overall population and 2485 €per month of OS-gain in PD-L1-positive (≥1) population. Combining pharmacological costs of drugs with the measure of efficacy represented by the OS, atezolizumab could be considered cost-effective in first-line treatment for triple-negative mBC only in PD-L1-positive population, but a reduction of costs is mandatory.

Cultivating Resilience During the COVID-19 Pandemic: A Socioecological Perspective

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ning Zhang ◽  
Shujuan Yang ◽  
Peng Jia
Keyword(s):  
Cost Effective ◽  
Future Research ◽  
Annual Review ◽  
Publication Date ◽  
Physical And Mental Health ◽  
Pandemic Preparedness ◽  
Predicting Factors ◽  
Effective Interventions ◽  
Interdisciplinary Framework ◽  
The Individual

The coronavirus disease 2019 (COVID-19) pandemic poses wide-ranging impacts on the physical and mental health of people around the world, increasing attention from both researchers and practitioners on the topic of resilience. In this article, we review previous research on resilience from the past several decades, focusing on how to cultivate resilience during emerging situations such as the COVID-19 pandemic at the individual, organizational, community, and national levels from a socioecological perspective. Although previous research has greatly enriched our understanding of the conceptualization, predicting factors, processes, and consequences of resilience from a variety of disciplines and levels, future research is needed to gain a deeper and comprehensive understanding of resilience, including developing an integrative and interdisciplinary framework for cultivating resilience, developing an understanding of resilience from a life span perspective, and developing scalable and cost-effective interventions for enhancing resilience and improving pandemic preparedness. Expected final online publication date for the Annual Review of Psychology, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

2016 ◽  
Vol 73 (1) ◽  
Author(s):  
A. Corrado ◽  
T. Renda ◽  
S. Bertini
Keyword(s):  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Future Research ◽  
Chronic Obstructive ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Copd Patients ◽  
Number Of Patients ◽  
Long Term Oxygen Therapy

Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO255%. In fact no evidence supports the use of LTOT in COPD patients with moderate hypoxemia (55<PaO2<65 mmHg), and in those with decreased oxygen saturation (SO2<90%) during exercise or sleep. Furthermore, it is generally accepted without evidence that LTOT in clinical practice is warranted in other forms of chronic respiratory failure not due to COPD when arterial blood gas criteria match those established for COPD patients. The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.

scholarly journals Prevalence of Vitamin D Deficiency and Its Relationship with Clinical Outcomes in Patients with Fibromyalgia: a Systematic Review of the Literature

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Omar M. E. Ali
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Patient Flow ◽  
Controlled Trial ◽  
Cost Effective ◽  
Therapeutic Benefit ◽  
Vitamin D Supplementation ◽  
Effective Interventions ◽  
Randomised Controlled ◽  
And Control

Abstract Fibromyalgia is a debilitating chronic condition which poses a therapeutic challenge to the clinician. With a large backlog in patient flow subsequent to the COVID-19 pandemic and rising numbers of patients with post-acute sequelae of COVID-19 (PASC) presenting with fibromyalgia-like clinical features, there is an increasingly pressing need to identify broad cost-effective interventions. Low levels of vitamin D have previously been reported in patients with fibromyalgia, though any causative link has been difficult to establish. A systematic literature review on the association between vitamin D deficiency and fibromyalgia was performed examining retrospective evidence both for and against an association between vitamin D deficiency (VDD) and fibromyalgia and evaluating the therapeutic benefit from supplementation. A group of six studies were selected based on relevance, use of controls, quality of research and citations. Four primary studies assessing the prevalence of VDD in fibromyalgia patients versus controls were evaluated with a total 3,496 subjects. Three included females only and one larger study assessed males. Two (n = 313) concluded the presence of a statistically significant association, and two (n = 161) found none. Two randomised controlled trials assessing the effect of vitamin D supplementation in a total of 80 subjects found conflicting results, with pain reduction in one and none in the other. It is likely there exists an association between VDD deficiency and fibromyalgia in a large subset of patients, although establishing primary causation is difficult. There is a need for larger randomised controlled trial designs with more effective comparison with healthy subjects and control for confounding factors. Given VDD is a major problem in the general population, we recommend supplementation be recommended by healthcare professionals to fibromyalgia patients for the purpose of maintaining bone health given their potentially increased susceptibility to developing deficiency and its sequelae.

scholarly journals Future Directions for Research on Residential Segregation and Inequality in China

2021 ◽  
pp. 329-361
Author(s):  
Gwilym Pryce
Keyword(s):  
Research Methods ◽  
Residential Segregation ◽  
Policy Development ◽  
Future Research ◽  
Policy Planning ◽  
Future Directions ◽  
Geographical Separation ◽  
Term Change ◽  
Future Policy

AbstractThis chapter summarises some of the key findings and themes of the book and considers their implications for future research on inequality and segregation in China. I highlight four priority areas. First, there is a need for more research on the dynamics of residential segregation. I argue that the real story of segregation is revealed in the factors and processes that drive long-term change. Second, I emphasise the need for more research on the spatial foundations of inequality—how inequality leads to the geographical separation of rich and poor and how this segregation mediates and reinforces almost every aspect of inequality. Third, I consider the relational and psychological impacts of inequality and the imperative for them to be included in the calculus of policy planning. Fourth, I consider the implications of the Causal Revolution in research methods and argue that they potentially offer the prospect of achieving a scientific approach to policy development and evaluation. I conclude with some reflections on the implications of our findings for future policy directions in China.

The economic benefits of rehabilitation for neurological conditions

2020 ◽  
pp. 23-30
Author(s):  
Rory J. O’Connor
Keyword(s):  
Psychological Functioning ◽  
Cost Effective ◽  
Economic Benefits ◽  
Economic Evaluations ◽  
Healthcare Intervention ◽  
Effective Interventions ◽  
Neurological Conditions ◽  
Economic Analyses

Rehabilitation programmes are highly cost-effective interventions that restore people’s independence, dignity, and quality of life. In the past there was an impression that they appeared expensive, which resulted in a lack of enthusiasm to develop them by funding bodies and commissioners. However, the evidence demonstrating the long-term cost-effectiveness of rehabilitation is robust. Many people with long-term neurological conditions will live for many years after the onset of the condition and investment in their physical and psychological functioning early on will, over that person’s lifetime, will result in substantial savings. Nevertheless, calculating economic evaluations can be complicated and the correct measure must be chosen to identify the change produced by the rehabilitation intervention. These data must then be handled appropriately, and any ancillary costs included. The economic impact of the rehabilitation programme is wider than a purely healthcare intervention and will include potential earnings and reduced costs to social care. The economic analyses will also include housing, education, and vocational outcomes, and the effect of the long-term condition on family members who may have a caring role.

scholarly journals What if we combine Quit and win and individual approach to help smokers quit at the community level?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Kovacevic ◽  
D Zombori
Keyword(s):  
Sex Education ◽  
Financial Incentives ◽  
Local Community ◽  
Smoking Status ◽  
Economic Status ◽  
Cost Effective ◽  
Social Characteristics ◽  
Individual Approach ◽  
Effective Interventions

Abstract Issue Tobacco eventually kills up to a half of its users. Helping smokers who wish to quit is one of the six cost effective interventions listed by World Bank to decrease smoking harm. Tobacco Control Scale in 2016, shows diversity in approaches and coverage to help smokers quit across Europe. Comprehensive interventions are most effective. Combining contest, financial incentives, individual approach and triggers (start of Lent or other) could be implemented in other settings. Description of the problem Contest to motivate smokers for a quit attempt and individual help provided, has been conducted yearly since 2015 in a local community in Pozega-Slavonia County in Croatia. Data on all participants from 2015 through 2018 contests were collected by questionnaires and long term smoking status (6 months) evaluated by phone interviewing. Statistical analysis was conducted in SPSS. The objective was to determine how effective in helping smokers quit is a novel combination of evidence-based approaches “Quit and win” and individual support in local setting and to establish certain smokers characteristics as possible predictors of outcome. Results Data for 153 participants were collected. There were more (54%) male participants. Participants mean age was 35.8 years (range 18-67). Short term (30 day) abstinence rate was 73.9% (113/153) and out of those 34.1% (31/91) abstained long term (6 months). Long term follow-up was 80.5% (91/113). Overall, long term quit rate was 23.7% (31/131). There were no statistically significant differences in short and long term quit rates depending on age, sex, education, employment or socio-economic status, pack-year measure or personal success estimates. Lessons Comprehensive contest approach was found to be effective in helping smokers quit. Interest for implementation was shown by several counties and cities in Croatia. Effectiveness regardless of personal and social characteristics of contestants shows potential in different settings. Key messages Comprehensive interventions that include contest, financial incentives, individual approach and triggers in smoking cessation helped one in four involved smokers to quit. This approach has potential for implementation in diverse local communities as no difference in quit rates in different sex, age or socioeconomic groups were detected.

scholarly journals Physiotherapy and low back pain - part 1 outcomes research in the quest for evidence

2002 ◽  
Vol 58 (3) ◽  
Author(s):  
L. D. Bardin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Practice ◽  
Outcome Measures ◽  
Outcomes Research ◽  
Controlled Trial ◽  
Cost Effective ◽  
Low Back ◽  
Major Health Problem ◽  
Effective Interventions

Low back pain (LBP) is one of the most common and costlyconditions treated by physiotherapists and is acknowledged as a major health problem. Much published research on LBP is of poor design and  optimal outcome measures are not selected for LBP patients. Effective and cost-effective interventions for LBP, particularly chronic LBP, need to be identified using appropriate, valid, reliable and responsive measures of  outcome.  These outcome measures should reflect the biopsychosocial model necessary for evaluating the broad impact of LBP, in particular chronic LBP, on a patient’s life. Outcomes research is a feasible and affordable analysis of clinical practice as it occurs, and provides an opportunity to evaluate the effectiveness of interventions for LBP. This is in contrast to a randomised, controlled trial (RCT) that evaluates efficacy under controlled conditions that often do not reflect clinical practice. Using a battery of outcome measures appropriate for measuring change in the LBP population, outcomes research has the potential to identify effective and cost-effective interventions, promote and influence further research, and contribute to the demand for evidence-based practice.

Phase III, placebo-controlled trial (SUCCEED) evaluating ridaforolimus as maintenance therapy in advanced sarcoma patients following clinical benefit from prior standard cytotoxic chemotherapy: Long-term (≥ 24 months) overall survival results.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10010-10010 ◽  
Author(s):  
Jean-Yves Blay ◽  
Sant P. Chawla ◽  
Isabelle Ray-Coquard ◽  
Axel Le Cesne ◽  
Arthur P. Staddon ◽  
...  
Keyword(s):  
Overall Survival ◽  
Maintenance Therapy ◽  
Controlled Trial ◽  
Mammalian Target Of Rapamycin ◽  
Progression Free Survival ◽  
Mtor Inhibitors ◽  
Phase Iii ◽  
Clinical Activity ◽  
Prior Chemotherapy

10010 Background: The mammalian target of rapamycin (mTOR) regulates cell growth and proliferation and is abnormally activated in many sarcomas. Ridaforolimus, an oral mTOR inhibitor, demonstrated clinical activity in previous nonrandomized trials in advanced sarcomas following failure of prior chemotherapy. Methods: An international, multicenter, placebo-controlled, phase 3 trial was conducted to evaluate maintenance therapy with ridaforolimus in patients with metastatic soft-tissue or bone sarcomas who achieved disease control from prior chemotherapy. Patients were randomized (1:1) to receive oral ridaforolimus (40 mg) or placebo once daily for 5 days each week. The primary endpoint was progression-free survival (PFS); secondary endpoints included overall survival (OS) and safety and tolerability. For OS, patients were to be followed at 3-month intervals for at least 24 months and up to 60 months after randomization. Results: 702 of 711 randomized patients received treatment. At the time of the data cutoff for OS (386 deaths), patients in the study population had been followed for at least 15 months. Median OS was 93.3 weeks with ridaforolimus vs 83.4 weeks with placebo (hazard ratio [HR]=0.88; 95% confidence interval [CI]: 0.72, 1.08; P=0.23). Ridaforolimus significantly improved PFS vs placebo (HR=0.72; 95% CI: 0.61, 0.85; P=0.0001; median PFS: 17.7 weeks vs 14.6 weeks); PFS improved across all prespecified baseline characteristics. As expected from the class of mTOR inhibitors, the most common adverse events with ridaforolimus were stomatitis, thrombocytopenia, noninfectious pneumonitis, hypertriglyceridemia, hyperglycemia, infections, and rash. Conclusions: Oral ridaforolimus was generally well-tolerated and significantly improved PFS in metastatic sarcoma patients with benefit from prior chemotherapy, offering an effective treatment alternative to surveillance alone. Results of a long-term OS analysis (prespecified to occur at 67% mortality, 24 months minimum follow-up) in the intent-to-treat population will be available in early 2012.

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