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991.
OBJECTIVE: To calculate the cost of heart failure in Belgium, based on an epidemiological model.
METHODS: We applied a state transition model to simulate the disease progression of heart failure over a period of 5 years, taking into account a weighted average of current practice. Costs related to current practice (1996 values) and disease progression were taken from the perspective of the health insurance. Unit costs of ambulatory care were collected through official listings; hospitalization costs for heart failure were collected from a database of 58 hospitals (ICD codes 402, 428, 429). Current practice was obtained through review of 250 patient records in primary care, starting on the day of initiating therapy up to 6 months later, and through expert interviews (2 rounds Delphi method).
RESULTS: The model indicates that the expected cost of treating heart failure in 1996 in Belgium was 318,000 Bef over 5 years, for an average number of life years of 3.59. ACE inhibitors are used in 34% of patients but are mostly applied only in higher NYHA classes (more ill patients), although studies recommend to prescribe those drugs earlier in the disease development, since they can avoid morbidity (hospitalisation) and morality. We calculated that starting earlier with ACE inhibitors and doubling their use would increase the total costs to 351,700 Bef for an extra survival time of 0.07 life years.
CONCLUSIONS: The study showed that state transition models can be applied in the assessment of the management of heart failure. Changes in the management should be expressed in extra costs per extra life year and compared to interventions in other disease areas. 相似文献
METHODS: We applied a state transition model to simulate the disease progression of heart failure over a period of 5 years, taking into account a weighted average of current practice. Costs related to current practice (1996 values) and disease progression were taken from the perspective of the health insurance. Unit costs of ambulatory care were collected through official listings; hospitalization costs for heart failure were collected from a database of 58 hospitals (ICD codes 402, 428, 429). Current practice was obtained through review of 250 patient records in primary care, starting on the day of initiating therapy up to 6 months later, and through expert interviews (2 rounds Delphi method).
RESULTS: The model indicates that the expected cost of treating heart failure in 1996 in Belgium was 318,000 Bef over 5 years, for an average number of life years of 3.59. ACE inhibitors are used in 34% of patients but are mostly applied only in higher NYHA classes (more ill patients), although studies recommend to prescribe those drugs earlier in the disease development, since they can avoid morbidity (hospitalisation) and morality. We calculated that starting earlier with ACE inhibitors and doubling their use would increase the total costs to 351,700 Bef for an extra survival time of 0.07 life years.
CONCLUSIONS: The study showed that state transition models can be applied in the assessment of the management of heart failure. Changes in the management should be expressed in extra costs per extra life year and compared to interventions in other disease areas. 相似文献
992.
Visual pathways for object-oriented action and object recognition: functional anatomy with PET 总被引:8,自引:4,他引:4
Faillenot I; Toni I; Decety J; Gregoire MC; Jeannerod M 《Cerebral cortex (New York, N.Y. : 1991)》1997,7(1):77-85
The purpose of this study was to identify the functional anatomy of the
mechanisms involved in visually guided prehension and in object recognition
in humans. The cerebral blood flow of seven subjects was investigated by
positron emission tomography. Three conditions were performed using the
same set of stimuli. In the 'grasping' condition, subjects were instructed
to accurately grasp the objects. In the 'matching' condition, subjects were
requested to compare the shape of the presented object with that of the
previous one. In the 'pointing' condition (control), subjects pointed
towards the objects. The comparison between grasping and pointing showed a
regional cerebral blood flow (rCBF) increase in the anterior part of the
inferior parietal cortex and part of the posterior parietal cortex. The
comparison between grasping and matching showed an rCBF increase in the
cerebellum, the left frontal cortex around the central sulcus, the mesial
frontal cortex and the left inferior parietal cortex. Finally, the
comparison between matching and pointing showed an rCBF increase in the
right temporal cortex and the right posterior parietal cortex. Thus
object-oriented action and object recognition activate a common posterior
parietal area, suggesting that some kind of within-object spatial analysis
was processed by this area whatever the goal of the task.
相似文献
993.
994.
Rescue of implantation potential in embryos with poor prognosis by assisted zona hatching 总被引:17,自引:7,他引:10
Magli MC; Gianaroli L; Ferraretti AP; Fortini D; Aicardi G; Montanaro N 《Human reproduction (Oxford, England)》1998,13(5):1331-1335
The effect of the assisted zona hatching (AZH) procedure was investigated
on 135 cycles with a poor prognosis of pregnancy due to: (i) maternal age
> or = 38 years (45 cycles); (ii) three or more failed in-vitro
fertilization (IVF) attempts (70 cycles), and (iii) patients possessing
both inclusion criteria (20 cycles). The control groups (113 cycles)
included patients possessing the same characteristics (42, 53 and 18 cycles
respectively) and who did not undergo the AZH procedure. A total of 505
embryos was treated with AZH before transfer, resulting in: 14, 25 and 6
clinical pregnancies. The percentage of clinical pregnancies per cycle was
significantly higher than controls for the first (31 vs 10% in control 1, P
< 0.05) and second groups (36 vs 17% in control 2, P < 0.05). No
significant difference in percentage of clinical pregnancies was found for
the third group (30 vs 6%). Similarly, higher rates of implantation were
obtained (11.5, 15 and 11%) compared to the respective controls (4%, P <
0.02; 6.3%, P < 0.01; and 1.5%). The rate of miscarriage in the AZH
groups was similar to that obtained in the controls (22 vs 21%). Finally,
the morphological analysis of the embryos transferred revealed that the
poor prognosis condition is associated to a significantly slower rate of
development and a higher rate of fragmentation. The present results
indicate that AZH procedure improves pregnancy and implantation rates in
patients with a poor prognosis of pregnancy by facilitating the hatching
process in embryos which would otherwise be trapped inside the zona
pellucida.
相似文献
995.
996.
Colostrum has important anti-infective properties. It may also somehow promote the development of the child's immunological system. Discarding colostrum, as practised in some cultures, could thus have adverse health consequences beyond the neonatal period. To test this hypothesis, the age at breast feeding start of 734 healthy newborns in urban Guinea-Bissau was ascertained. The children were then prospectively followed up to 3 years of age. Eighty nine deaths occurred during the study. The probability of death in the age interval 28 days to 3 years was about 20%. The child's age at breast feeding start had no statistical impact on postneonatal growth or survival. As a single measure, early breast feeding start is not likely to make much difference for the long term growth or survival of children living under material poverty conditions. 相似文献
997.
998.
CYP2D6和GST在白种人晚期肾病中的遗传变异 总被引:1,自引:0,他引:1
目的生物转化酶细胞色素P4502D6(CYP2D6)和谷胱苷肽转移酶-M1(GST-M1)、谷胱苷肽转移酶-T1(GST-T1)共同代谢内源性和外源性毒素,一部分人群由于相应基因变异导致这些酶缺乏表达,我们检测白种人群中晚期肾病(ESRD)病人这些酶的基因多态性是否比健康者有较高的频率.方法从列克星顿及周围地区征募330名晚期肾病病人和303名健康者,均为白种人,给予他们进行CYP2D6和GST-M1和T1基因分型.结果在ESRD病人中CYP2D6和GST-M1和GST-T1以及CYP2D6和GST-M1或GST-T1都缺乏分别为2.1%和4.2%;而在健康者中均为0.3%(P<0.01).结论CYP2D6和GST-M1和/或GST-T1酶缺乏在ESRD病人中有较高的频率,提示这些酶缺乏可以预计慢性肾病进展的可能性. 相似文献
999.
1000.
Remy-Jardin M; Duyck P; Remy J; Petyt L; Wurtz A; Mensier E; Copin MC; Riquet M 《Radiology》1995,196(2):387