An Evaluation of Managing and Educating Patients on the Risk of Glucocorticoid-Induced Osteoporosis

OBJECTIVE: To assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis. METHODS: Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet. RESULTS: The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [-6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant. CONCLUSIONS: Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients.     

An Economic Evaluation of Sacubitril/Valsartan for Heart Failure Patients in the Netherlands

Background

In September 2014, the PARADIGM-HF trial showed the heart failure drug combination sacubitril/valsartan to be superior to enalapril for patients with a reduced ejection fraction.

Medical Nutrition Therapy for Patients with Osteoporosis

Osteoporosis is a disease of bone fragility that afflicts more than 25 million Americans and costs the economy of the United States approximately $13.8 billion per year. In addition to direct economic costs, osteoporosis frequently costs patients their independence and a decrease in quality of life. Patients with osteoporosis, particularly those with hip fractures, are often older, malnourished persons in need of nutrition assessment and intervention. Such intervention in persons with hip fractures has been shown to be effective in reducing medical costs by decreasing hospital stays and morbidity. We review here a working practice of care at our osteoporosis research center for the medical nutrition therapy of patients with osteoporosis. Medical nutrition therapy includes an evaluation of the patient's health history, social status, and nutrient intake. On the basis of the assessment, a nutrition care plan can be developed and implemented with the goals of improving clinical outcomes and the quality of life for patients and saving health care dollars. J Am Diet Assoc. 1997:97:414–417.     

An Economic Evaluation of Valsartan for Post-MI Patients in the UK Who Are Not Suitable for Treatment with ACE Inhibitors

Objectives:  The overall objective of this study was to estimate the costs and outcomes associated with treatment with valsartan for post-myocardial infarction (post-MI) patients with left ventricular systolic dysfunction, heart failure, or both, who are not suitable for treatment with angiotensin-converting enzyme (ACE) inhibitors, compared to placebo.
Methods:  A Markov model, using data drawn from the Valsartan in Acute Myocardial Infarction (VALIANT) trial and other trials, was developed to predict the future health pathways, resource use, and costs for patients who have recently experienced an MI. Patients received either valsartan (mean dose 247 mg) or placebo. Cost data were drawn from national databases and published literature, although health outcome utility weights were derived from existing studies. Patient outcomes were modeled for 10 years, and incremental cost-effective ratios were calculated for valsartan compared with placebo.
Results:  Over a period of 10 years, a cohort of 1000 patients treated with valsartan experienced 147 fewer cardiovascular deaths, 37 fewer nonfatal MIs, and 95 fewer cases of heart failure than a cohort who received placebo. The incremental cost of valsartan, compared with placebo, was £2680 per patient, although the incremental effectiveness of valsartan was 0.5021 quality-adjusted life-years (QALYs) gained per patient. Therefore, the incremental cost per QALY for treatment with valsartan was £5338. When analysis was undertaken using life-years rather than QALYs, the cost per life-year gained was £4672.
Conclusions:  For patients who are not suitable for treatment with ACE inhibitors, valsartan is a viable and cost-effective treatment for their management after an MI.     

Development and Validation of a Markov Microsimulation Model for the Economic Evaluation of Treatments in Osteoporosis

Objective:  Markov models are increasingly used in economic evaluations of treatments for osteoporosis. Most of the existing evaluations are cohort-based Markov models missing comprehensive memory management and versatility. In this article, we describe and validate an original Markov microsimulation model to accurately assess the cost-effectiveness of prevention and treatment of osteoporosis.
Methods:  We developed a Markov microsimulation model with a lifetime horizon and a direct health-care cost perspective. The patient history was recorded and was used in calculations of transition probabilities, utilities, and costs. To test the internal consistency of the model, we carried out an example calculation for alendronate therapy. Then, external consistency was investigated by comparing absolute lifetime risk of fracture estimates with epidemiologic data.
Results:  For women at age 70 years, with a twofold increase in the fracture risk of the average population, the costs per quality-adjusted life-year gained for alendronate therapy versus no treatment were estimated at €9105 and €15,325, respectively, under full and realistic adherence assumptions. All the sensitivity analyses in terms of model parameters and modeling assumptions were coherent with expected conclusions and absolute lifetime risk of fracture estimates were within the range of previous estimates, which confirmed both internal and external consistency of the model.
Conclusion:  Microsimulation models present some major advantages over cohort-based models, increasing the reliability of the results and being largely compatible with the existing state of the art, evidence-based literature. The developed model appears to be a valid model for use in economic evaluations in osteoporosis.     

An Economic Evaluation of Two Ototopical Treatments for Acute Otitis Media in Tympanostomy Tube Patients

OBJECTIVE: The goal of this research was to determine the cost-effectiveness of ciprofloxacin 0.3%/dexamethasone 0.1% (CD) otic suspension versus ofloxacin 0.3% otic solution (OFX) for treatment of acute otitis media in tympanostomy tube patients. METHODS: A decision-analytic model was used to emulate the ototopical treatment of acute otitis media in patients with tympanostomy tubes. The economic outcome was the cost per otorrhea-free day (OFD) achieved per episode of care. Three tiers of antimicrobial therapy were modeled, with each successive tier representing the retreatment of clinical failures from the preceding tier. First-tier therapy compared CD and OFX using outcome measures obtained from a randomized clinical trial (n = 599). Second-tier therapy modeled the use of amoxicillin/clavulanate (ACA) using outcome measures obtained from a physician survey and medical literature. Third-tier therapy was modeled as pathogen-specific and curative. It could follow one of three pathways: 1) intramuscular ceftriaxone; 2) oral fluconazole; or 3) hospitalization for intravenous antibiotics. Third-tier outcomes were based on a physician survey. Cost data were obtained from standard references and presented from a payer perspective. RESULTS: The expected therapeutic costs were 249.40 dollars for the CD pathway and 265.44 dollars for the OFX pathway. The estimated number of OFDs per episode of care was 25.88 for the CD pathway and 23.86 for the OFX pathway. The cost-effectiveness ratios for CD and OFX therapies were 9.64 dollars and 11.13 dollars per OFD, respectively. CONCLUSION: CD is both more effective and less costly than OFX for the treatment of acute otitis media in patients with tympanostomy tubes.     

Economic Evaluation of Individualized Nutritional Support for Hospitalized Patients with Chronic Heart Failure

Background Malnutrition is a highly prevalent risk factor in hospitalized patients with chronic heart failure (CHF). A recent randomized trial found lower mortality and improved health outcomes when CHF patients with nutritional risk received individualized nutritional treatment. Objective To estimate the cost-effectiveness of individualized nutritional support in hospitalized patients with CHF. Methods This analysis used data from CHF patients at risk of malnutrition (N = 645) who were part of the Effect of Early Nutritional Therapy on Frailty, Functional Outcomes and Recovery of Undernourished Medical Inpatients Trial (EFFORT). Study patients with CHF were randomized into (i) an intervention group (individualized nutritional support to reach energy, protein, and micronutrient goals) or (ii) a control group (receiving standard hospital food). We used a Markov model with daily cycles (over a 6-month interval) to estimate hospital costs and health outcomes in the comparator groups, thus modeling cost-effectiveness ratios of nutritional interventions. Results With nutritional support, the modeled total additional cost over the 6-month interval was 15,159 Swiss Francs (SF). With an additional 5.77 life days, the overall incremental cost-effectiveness ratio for nutritional support vs. no nutritional support was 2625 SF per life day gained. In terms of complications, patients receiving nutritional support had a cost savings of 6214 SF and an additional 4.11 life days without complications, yielding an incremental cost-effectiveness ratio for avoided complications of 1513 SF per life day gained. Conclusions On the basis of a Markov model, this economic analysis found that in-hospital nutritional support for CHF patients increased life expectancy at an acceptable incremental cost-effectiveness ratio.     

An Economic Evaluation of Triptan Products for Migraine

OBJECTIVE: A composite outcome measure in migraine treatment assessment is useful to clinical decision-makers and payers as it can provide a more accurate reflection of effectiveness and allows for more complete modeling of economic value. The objective of this study was to compare the total triptan cost to treat 100 migraine patient attacks and the cost per successfully treated patient (CPSTP) for six marketed triptans using a composite measure of effectiveness, the "successfully treated" migraine (defined as requiring only one triptan dose to treat one migraine attack during a 24-h period). METHODS: This analysis was conducted from the perspective of the payer. Clinical data were abstracted from a rigorous, published meta-analysis. Two-hour response and pain-free response were used in conjunction with the recurrence rate reported in the meta-analysis to calculate the number of doses used by treatment successes and failures. The average wholesale price per dose was then used to calculate total triptan cost. RESULTS: Of the nine oral triptan doses compared, eletriptan 40 mg was associated with both the lowest total triptan cost for treating 100 migraine attacks ($1560) and with the lowest CPSTP ($56.39). CONCLUSIONS: The relative CPSTP rankings for migraine therapies are dependent on the definition of treatment success and relative pricing. The results of this study support the use of eletriptan for the treatment of acute migraine based on the model assumptions. This study can be used to assist in formulary considerations and offers a model that can be adapted by health-care decision-makers.     

松质骨定量超声检测评估骨质疏松症

在超声诊断技术领域，定量超声密度检测理论已发展了十余年，宽带超声衰减（BUA）和超声声速（SOS）是用定量超声（OUS）进行骨质疏松症诊断的最重要的两项参数。本文利用超声插玉取代式脉冲传输理论推导出测量SOS和BUA参数的相关公式。介绍了松质骨定量超声骨密度诊断系统的组成及其功能实现，提出该项技术与传统技术相比的优势。     

An Economic Analysis of Psychotherapy for Borderline Personality Disorder Patients

BACKGROUND: BPD is a serious mental illness in which psychotherapy has been shown to improve patient outcomes and reduce the use of health services. In most studies of psychotherapy, lower use of health services has been taken to imply lower health service costs. However, the costs of psychotherapy can offset any cost savings due to reduced use of other health services. AIMS OF THE STUDY: To estimate the net costs of health service use in a group of BPD patients receiving intensive psychotherapy. METHODS: Data on use of inpatient hospital, emergency hospital, ambulatory care, diagnostic tests and medications were collected for the twelve months before psychotherapy and the twelve months after the completion of treatment. Cost estimates were developed using standardised unit costs. RESULTS: There was a saving of approximately $670,000 in health service use over the thirty patients compared to a cost of $130,000 for psychotherapy, giving a net cost saving of $18,000 per patient. Most of this was due to reduced hospital admissions. Cost saving was higher in those patients who were high users of hospital services. Sensitivity analyses were performed; overall, the findings consistently show a reduction in the cost of health services used. DISCUSSION: The group studied consisted of 30 patients and comprised a before/after design. Therefore it does not overcome criticisms of other work in this area, that is of observational studies and small sample sizes. Nonetheless, the results were based on detailed costing of service use, using conservative assumptions and subject to sensitivity analysis. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The use of intensive psychotherapy in BPD patients who are high users of health services, particularly those who have had multiple hospital admissions, is probably warranted until more evidence is available. IMPLICATIONS FOR HEALTH POLICIES: There is little rigorous evidence on the effectiveness and cost-effectiveness of psychotherapy. BPD patients appear to generate high service costs so it is important to establish effective and cost-effective modes of treatment. IMPLICATIONS FOR FURTHER RESEARCH: Further research is warranted to establish accurate patterns of service use in BPD patients, and to identify those groups who will most benefit from intensive psychotherapy. erans.     

肾综合症出血热76例早期实验检测结果分析

肾综合症出血热 (REHF)早期诊断及治疗对减轻病情、降低病死率至关重要。我们对 1996～ 1998年诊治的 76例REHF患者早期实验检测结果进行分析 ,现报告如下。对象与方法1　对象　 1996～ 1998年 ,我院疑诊REHF患者 119例 ,以发热、头痛、腰痛 1～ 5天就诊 ,做血、尿常规及血液BUN、REHF .IgM检测。依据临床特征并结合实验检测结果 ,按照标准[1 ] 确诊为REHF的有 76例 ,其中男 4 2例 ,女34例 ,年龄 18～ 6 5岁。2　检验方法2 1　REHFIgM检测 :采用山东张店新科生产的ELISA试剂 ,按照说明书操作 ,以WescanMK 2型酶标仪测定 ,O…     

免疫色谱检测法在结核分枝杆菌检测和鉴定的评价

结核病是由结核杆菌感染引起的慢性传染性疾病。近年来，在世界范围内有复活、增加的趋势。如何快速进行检测分枝杆菌，鉴别结核分枝杆菌与其他分枝杆菌，对于结核病的预防和控制上非常重要。我们利用结核杆菌分泌到菌体外的特异性蛋白质MPB64，采用免疫色谱法对9株标准菌株、参考菌株和20株临床标本分离菌株进行鉴定，并将其结果与其他鉴定方法做了研究比较。     

Economic Evaluation of Complete Revascularization for Patients with Multivessel Disease Undergoing Primary Percutaneous Coronary Intervention

Objectives

To determine the cost-effectiveness of complete revascularization at index admission compared with infarct-related artery (IRA) treatment only, in patients with multivessel disease undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction.

骨质疏松症个体化治疗的哲学思考

骨质疏松症是当今人口老龄化社会常见的代谢性骨病,且患病率呈逐年上升趋势。常在老年人尤其是绝经后女性发病。骨质疏松症所表现的慢性疼痛和导致的其他并发症严重影响老年人生活质量,并且增加了大量的相关医疗费用。骨质疏松症个体化治疗是根据患者的具体情况,选择适宜的药物和治疗方案,从而获得最佳的治疗效果。从哲学角度对骨质疏松症个体化治疗的依据、治疗药物的研究和措施进行综合分析。     

Economic Evaluation of Tegaserod vs. Placebo in the Treatment of Patients with Irritable Bowel Syndrome: An Analysis of the TENOR Study

OBJECTIVES: Tegaserod is effective, safe, and well-tolerated in the treatment of patients with irritable bowel syndrome (IBS) with constipation. The aim of this study was to assess, from a payer perspective, the cost-effectiveness of tegaserod in the treatment of IBS patients, based on the TEgaserod in NORdic region (TENOR) trial data. METHODS: Female and male patients (Rome II criteria) were randomized to receive tegaserod 6 mg b.i.d. or placebo for 12 weeks. Patients (247 tegaserod; 238 placebo) completed the EuroQol EQ-5D questionnaire at baseline, Week 4, and Week 12. A 12-week economic study was undertaken to assess the incremental cost-effectiveness ratio (ICER) of tegaserod in terms of cost per quality-adjusted life-year (QALY) gained. Cost-effectiveness acceptability curves were calculated to estimate the probability of tegaserod being cost-effective at different benchmark values of cost per QALY gained. RESULTS: By assuming a daily drug cost to payers of Euro 2, Euro 3, and Euro 4, the ICER of tegaserod ranges between Euro 19,000 and Euro 38,000 per QALY gained, with the percentage of the bootstrap estimates below the willingness to pay level of Euro 50,000 per QALY gained ranging between 90% and 69%. CONCLUSIONS: This study established directly from a randomized controlled clinical trial that tegaserod is cost-effective in the treatment of non-D-IBS patients.     

国产HIV抗体检测试剂盒的评价

本文报作了对目前国产的HIV抗体检测粗筛试剂的评价结果。病毒所生产的IF和IE试剂,及上海生研所生产的ELISA试剂,敏感性为91.2%~96.9%;特异性为94.6%~97.3%。在我国这样的HIV低感染率情况下,这些试剂的阴性预测值可达100%,阳性预测值极低。认为这些试剂都还能满足国内HIV检测粗筛实验的应用。这些试剂的剂型价格,尚须改进。     

ATB Expression微生物分析系统筛查耐甲氧西林葡萄球菌的评价

目的 通过对头孢西丁(FOX)纸片扩散法与ATB Expression微生物分析系统(苯唑西林MIC法)检测耐甲氧西林葡萄球菌(MRS)的比较,对ATB Expression分析系统筛查MRS的准确性和临床适用性进行评估. 方法用FOX纸片扩散法、ATB Expression分析系统检测医院临床送检标本中分离的204株金黄色葡萄球菌和216株凝固酶阴性葡萄球菌. 结果两种方法检测204株金黄色葡萄球菌中MRS阳性率均为84.3%,且两种方法的符合率100%.检测216株凝固酶阴性葡萄球菌的MRS时,FOX纸片法阳性率为83.6%,而仪器检测的阳性率为91.7%,仪器检测的特异性为51.4%. 结论两种方法检测金黄色葡萄球菌的MRS结果相符合;而仪器检测凝固酶阴性葡萄球菌特异性较低,建议辩证灵活运用自动化仪器,在ATB Expression系统检测的同时用FOX纸片法补充和确认MRS检测结果.     

健康管理在中老年骨质疏松患者中的应用

目的探讨健康管理对中老年骨质疏松患者的影响。方法选取兰州石化离退休中心确诊的骨质疏松患者为研究对象,并对其关于骨质疏松健康认知和血钙、血磷、碱性磷酸酶(AKP)和骨密度值等指标进行调查研究。结果经过6个月健康管理,中老年患者对骨质疏松相关知识认知水平形成有了明显提高,健康干预前后血钙、血磷、AKP和骨密度值具有统计学意义。结论对骨质疏松患者进行社区健康管理有助于增强患者的信心,促使患者形成健康行为,从而使病情得以控制,改善患者的生活质量。     

老年骨质疏松患者腰背疼痛的护理

目的探讨骨质疏松疼痛护理对老年骨质疏松患者腰背疼痛的改善效果。方法选取2013年10月—2016年5月收治的骨质疏松患者110例,随机分为2组,常规组进行钙尔奇D片药物治疗和常规护理,观察组在常规组的基础上配合以健康指导、疼痛曲线识别、功能锻炼等疼痛护理,比较2组治疗前后患者的疼痛、生活自理能力、心理状况等变化。结果与治疗前相比,观察组治疗3个月后VAS评分及SCL-90症状评分明显下降(P<0.05),改良Barther评分明显提升(P<0.05)。结论对骨质疏松腰背疼痛患者实施疼痛护理,患者腰背痛感明显减轻,生活自理能力提高,生活质量和心理状况有所改善,效果明显。     

Test of Association for Quantitative Traits in General Pedigrees: The Quantitative Pedigree Disequilibrium Test

Many statistical methods have been proposed in recent years to test for genetic linkage and association between genetic markers and traits of interest through unrelated nuclear families. However, most of these methods are not valid tests of association in the presence of linkage when some of the nuclear families are related. As a result, related nuclear families in large pedigrees cannot be included in a single analysis to test for linkage disequilibrium. Recently, Martin et al. [Am J Hum Genet 67:146–54, 2000] proposed the pedigree disequilibrium test (PDT) to test for linkage and association in general pedigrees for qualitative traits. In this article, we develop a similar quantitative pedigree disequilibrium test (QPDT) to test for linkage and association in general pedigrees for quantitative traits. We apply both the PDT and the QPDT to analyze the sequence data from the seven candidate genes in the simulated data sets in the Genetic Analysis Workshop 12. © 2001 Wiley‐Liss, Inc.