3种拉唑类三联疗法治疗幽门螺杆菌感染的成本-效果分析

目的:探讨不同给药方案治疗幽门螺杆菌(Hp)感染的经济学效果。方法:102例Hp感染的消化性溃疡患者随机分为3组,给予奥美拉唑+阿莫西林+胶体果胶铋(A组)、雷贝拉唑+阿莫西林+胶体果胶铋(B组)、泮托拉唑+阿莫西林+胶体果胶铋(C组),采用成本-效果分析法进行评价。结果:A、B、C组的Hp清除率及溃疡愈合率的成本-效果比分别为1027.31、976.79、967.40及921.05、915.77、936.16。结论:B组方案较佳。     

布洛芬对急性上呼吸道感染患儿的退热效果

目的:观察布洛芬混悬液的退热效果.方法:选择有高热症状的急性上呼吸道感染患儿100例,随机分为两组,分别用布洛芬混悬液(56例)和对乙酰氨基酚口服溶液(44例)治疗,记录首次给药后0.5、1.0、1.5、2.0、3.0、4.0、5.0和6.0 h的体温变化.结果:布洛芬组和对乙酰氨基酚组体温降低1.5 ℃所需的平均时间分别为(110±78)min、(119±82)min,比例分别为83.9%和84.1%(P＞0.05).体温恢复正常时间分别为(110±76)min、(124±78)min(P＞0.05),比例分别为87.5%和68.2%(P＜0.05).前2 h两组体温下降相似,在3.0、4.0、5.0和6.0 h布洛芬组平均体温下降大于对乙酰氨基酚组,体温正常化维持时间更长.结论:布洛芬退热疗效优于对乙酰氨基酚.     

三组方案治疗肝硬化上消化道出血的效果分析

目的 评价3组方案治疗肝硬化上消化道出血的疗效、不良反应及成本-效果.方法 对167例肝硬化上消化道出血患者在常规治疗基础上,随机分为3组,分别使用不同的治疗方案(Ⅰ组:小剂量垂体后叶素 硝酸甘油 法莫替丁;Ⅱ组:奥曲肽 法莫替丁;Ⅲ组:奥曲肽 奥美拉唑).现察其疗效及不良反应,并运用药物经济学成本-效果分析方法进行回顾性分析.结果 3组总有效率分别为90.7%,93.0%和98.2%,其差异无显著性意义(P＞0.05).Ⅰ组中13例有轻度副作用,Ⅱ组、Ⅲ组无副作用.3组成本-效果比分别为26.84,14.14和61.47,Ⅰ组明显优于Ⅱ组、Ⅲ组(P＜0.05).结论 3组方案均为肝硬化上消化道出血安全、有效的治疗方法,可根据患者具体情况灵活选用.     

A Novel,Lipid-Free Nanodispersion Formulation of Propofol and Its Characterization

No HeadingPurpose. Propofol is a widely used anesthetic agent with highly desirable fast on and off effects. It is currently formulated as lipid emulsions, which are known to support microbial growth. In this study, a novel, lipid-free nanodispersion formulation of propofol was characterized.Methods. The formulation was evaluated for its physical and chemical stability, in vitro compatibility with red blood cells, and its antimicrobial effectiveness. In vivo pharmacokinetic and pharmacodynamic properties of the formulation were evaluated in rats.Results. Our data suggest that this lipid-free formulation is physically and chemically stable. Compared to the commercial emulsion formulation Diprivan, it causes less hemolysis with red blood cells and has improved antimicrobial activity. In addition, the lipid-free formulation demonstrates similar pharmacological effects to Diprivan in rats.Conclusions. This novel, lipid-free formulation exhibits improved in vitro properties without compromising in vivo effects, therefore representing a promising new alternative for propofol.     

Effectiveness of amoxicillin, azithromycin, cefprozil and clarithromycin in the treatment of acute otitis media in children: a population-based study

Population-based studies may give results different from randomized clinical trials assessing the efficacy of antibiotics.OBJECTIVE: To determine the effectiveness of amoxicillin, azithromycin, cefprozil and clarithromycin in the treatment of acute otitis media (AOM) in children. METHODS: Using Quebec Health Insurance databases (RAMQ), we selected a cohort of children aged < or = 6 years, with a first episode of AOM between 1999 and 2002. The index AOM was defined as a medical service claim with a diagnosis of AOM and an antibiotic dispensation in the following 72 hours. Failures were defined as a new antibiotic dispensation, a hospitalization or outpatient visit for complications related to AOM in the 30 days after the index AOM. Data were analyzed using logistic regression. RESULTS: Overall, 12,693 failures occurred among 60,513 first episodes of AOM. Azithromycin was the only antibiotic that was associated with a decreased risk of failure overall, when compared to amoxicillin (OR 0.88, 95% CI: 0.82, 0.94). However in the first 3 days of treatment (n = 680), azithromycin was more associated with treatment failure (OR 1.6, 95% CI: 1.3, 2.0). Compared to amoxicillin, post-therapy failures (n = 9387) were more likely to occur with cefprozil (OR 1.2, 95%CI: 1.2, 1.3) but were less with azithromycin (OR 0.8 95% CI: 0.8, 0.9). CONCLUSIONS: Azithromycin had the lowest risk of failure 30 days after the onset of treatment but an increased risk of failure during the first few days of treatment. Amoxicillin remains an effective first-line drug for treating first AOM episodes.     

Changes in Attitudes Toward Antiviral Medication: A Comparison of Women Living with HIV/AIDS in the Pre-HAART and HAART Eras

To examine potential changes in attitudes toward antiviral medication since the advent of highly active antiretroviral therapy (HAART), focused interviews were conducted with two samples of women living with HIV/AIDS; one in the pre-HAART era (1994–1996) and a second matched sample in the HAART era (2000–2003). Women in the pre-HAART era held highly negative attitudes toward antiviral medications, perceived them as ineffective with few benefits and viewed side effects as intolerable. In contrast, women in the HAART era were less likely to report negative attitudes, which were balanced by more frequent reports of perceived benefits and more likely to view side effects as temporary and manageable. African American women in both eras were more likely to hold negative attitudes and less likely to perceive benefits than White and Puerto Rican women. These findings suggest that views of antiviral medication have improved since the advent of HAART, but that negative attitudes and side-effect concerns remain which should be addressed in interventions to promote treatment acceptance and adherence.     

The effect of ergonomic interventions in healthcare facilities on musculoskeletal disorders

BACKGROUND: The high incidence of musculoskeletal disorders (MSDs) among healthcare workers suggests that the introduction of ergonomic interventions could be beneficial. While laboratory studies have clearly documented the efficacy of ergonomic devices, few studies have examined their effectiveness in the healthcare workplace. METHODS: This study evaluated a statewide program that provided ergonomic consultation and financial support for purchasing ergonomic devices, which aid in patient handling and lifting. Changes in MSD rates between baseline (1 year pre-intervention) and post-intervention (up to 2 years) periods were examined in 100 work units in 86 healthcare facilities. RESULTS: The median MSD rate decreased from 12.32 to 6.64 per 200,000 employee-hours, a decrease greater than the secular trend for the study period (1999-2003). CONCLUSIONS: This study suggests that ergonomic consultation and financial support for purchasing ergonomic equipment can be an effective intervention to reduce MSDs among healthcare workers.     

Cost-effectiveness analysis for multinational clinical trials

Clinical trials of cost-effectiveness are often conducted in more than one country. The two most common ways of dealing with the multinational nature of the data are either to calculate a pooled estimate or to stratify results by country. Since the between-country heterogeneity in costs is potentially substantial, pooled estimates may be difficult to interpret for any one country. Policy decisions are often made at a national level, and so country-specific results are important. However, country-specific analyses will be based on fewer patients and will often fail to provide adequate precision for statistical analyses.Shrinkage estimation is a compromise between these two methods and has been used successfully in other fields. These estimates are country-specific yet less variable than those derived through a subgroup approach. Univariate and multivariate shrinkage estimators for costs and effects are proposed, then compared with one another and to the traditional methods in a simulation study. The methods are illustrated using data from a multinational trial evaluating the cost-effectiveness of three thrombolytic drug regimens in patients with acute myocardial infarction.     

Estimating Intervention Effectiveness: Synthetic Projection of Field Evaluation Results

In a 46-site, 5-year high-risk youth substance abuse prevention evaluation, effect sizes were adjusted using a meta-analytic regression technique to project potential effectiveness under more optimal research and implementation conditions. Adjusting effect size estimates to control for the impact of comparison group prevention exposure, service intensity, and coherent program implementation raised the mean effectiveness estimate from near zero (.02, SD = .21) to .24 (SD = .18). This finding suggests that adolescent prevention programs can have significant positive effects under optimal, yet obtainable conditions.Editors’ Strategic Implications: The authors present a meta-analytic technique that promises to be an important tool for understanding what works in multi-site community-based prevention settings. Researchers will find this to be a creative approach to model the “noise’’ in implementation that may often overshadow the potential impact of prevention programs.     

A framework for cost-effectiveness analysis from clinical trial data

We present a general Bayesian framework for cost-effectiveness analysis (CEA) from clinical trial data. This framework allows for very flexible modelling of both cost and efficacy related trial data. A common CEA technique is established for this wide class of models through linking mean efficacy and mean cost to the parameters of any given model. Examples are given in which efficacy may be measured as a continuous, binary, ordinal or time-to-event outcome, and in which costs are modelled as distributed normally, log-normally, as a mixture or non-parametrically. A case study is presented, illustrating the methodology and illuminating the role of prior information.