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11.
Josefine Persson Mattias Aronsson Lukas Holmegaard Petra Redfors Kaj Stenlöf Katarina Jood Christina Jern Christian Blomstrand Gunilla Forsberg-Wärleby Lars-Åke Levin 《Quality of life research》2017,26(11):3059-3068
Purpose
The aim of this study was to investigate whether the dependency of midlife stroke survivors had any long-term impact on their spouses’ QALY-weights.Method
Data on stroke survivors, controls, and spouses were collected from the 7-year follow-up of the Sahlgrenska Academy Study on Ischemic Stroke. Health-related quality of life was assessed by the SF-36, and the preference-based health state values were assessed with the SF-6D. Spouses of dependent and independent stroke survivors were categorized according to their scores on the modified Rankin Scale. An ordinary least squares regression analysis was used to evaluate whether the dependency of the stroke survivors had any impact on the spouses’ QALY-weights.Result
Cohabitant dyads of 247 stroke survivors aged <70 at stroke onset and 245 dyads of controls were included in the study. Spouses of dependent stroke survivors (n = 50) reported a significant lower mean QALY-weight of 0.69 in comparison to spouses of independent stroke survivors (n = 197) and spouses of controls, (n = 245) who both reported a mean QALY-weight of 0.77. The results from the regression analysis showed that higher age of the spouse and dependency of the stroke survivor had a negative association with the spouses’ QALY-weights.Conclusion
The QALY-weights for spouses of dependent midlife stroke survivors were significantly reduced compared to spouses of independent midlife stroke survivors. This indicates that the inclusion of spouses’ QALYs in evaluations of early treatment and rehabilitation efforts to reduce stroke patients’ dependency would capture more of the total effect in dyads of stroke survivors.12.
13.
It is important for economic evaluations in healthcare to cover all relevant information. However, many existing evaluations fall short of this goal, as they fail to include all the costs and effects for the relatives of a disabled or sick individual. The objective of this study was to analyse how relatives’ costs and effects could be measured, valued and incorporated into a cost-effectiveness analysis. In this article, we discuss the theories underlying cost-effectiveness analyses in the healthcare arena; the general conclusion is that it is hard to find theoretical arguments for excluding relatives’ costs and effects if a societal perspective is used. We argue that the cost of informal care should be calculated according to the opportunity cost method. To capture relatives’ effects, we construct a new term, the R-QALY weight, which is defined as the effect on relatives’ QALY weight of being related to a disabled or sick individual. We examine methods for measuring, valuing and incorporating the R-QALY weights. One suggested method is to estimate R-QALYs and incorporate them together with the patient’s QALY in the analysis. However, there is no well established method as yet that can create R-QALY weights. One difficulty with measuring R-QALY weights using existing instruments is that these instruments are rarely focused on relative-related aspects. Even if generic quality-of-life instruments do cover some aspects relevant to relatives and caregivers, they may miss important aspects and potential altruistic preferences. A further development and validation of the existing caregiving instruments used for eliciting utility weights would therefore be beneficial for this area, as would further studies on the use of time trade-off or Standard Gamble methods for valuing R-QALY weights. Another potential method is to use the contingent valuation method to find a monetary value for all the relatives’ costs and effects. Because cost-effectiveness analyses are used for decision making, and this is often achieved by comparing different cost-effectiveness ratios, we argue that it is important to find ways of incorporating all relatives’ costs and effects into the analysis. This may not be necessary for every analysis of every intervention, but for treatments where relatives’ costs and effects are substantial there may be some associated influence on the cost-effectiveness ratio. 相似文献
14.
Bjällmark A Larsson M Nowak J Lind B Hayashi SY do Nascimento MM Riella MC Seeberger A Brodin LÅ 《Heart and vessels》2011,26(3):289-297
Cardiovascular disease is the leading cause of death in patients with end-stage renal disease (ESRD). The aim of this study
was to investigate the changes in cardiovascular function induced by a single session of hemodialysis (HD) by the analysis
of cardiovascular dynamics using wave intensity wall analysis (WIWA) and of systolic and diastolic myocardial function using
tissue velocity imaging (TVI). Gray-scale cine loops of the left common carotid artery, conventional echocardiography, and
TVI images of the left ventricle were acquired before and after HD in 45 patients (17 women, mean age 54 years) with ESRD.
The WIWA indexes, W1 and preload-adjusted W1, W2 and preload-adjusted W2, and the TVI variables, isovolumic contraction velocity (IVCV), isovolumic contraction time (IVCT), peak systolic velocity
(PSV), displacement, isovolumic relaxation velocity (IVRV), isovolumic relaxation time (IVRT), peak early diastolic velocity
(E′), and peak late diastolic velocity (A′), were compared before and after HD. The WIWA measurements showed significant increases in W1 (P < 0.05) and preload-adjusted W1 (P < 0.01) after HD. W2 was significantly decreased (P < 0.05) after HD, whereas the change in preload-adjusted W2 was not significant. Systolic velocities, IVCV (P < 0.001) and PSV (P < 0.01), were increased after HD, whereas the AV-plane displacement was decreased (P < 0.01). For the measured diastolic variables, E′ was significantly decreased (P < 0.01) and IVRT was significantly prolonged (P < 0.05), after HD. A few correlations were found between WIWA and TVI variables. The WIWA and TVI measurements indicate that
a single session of HD improves systolic function. The load dependency of the diastolic variables seems to be more pronounced
than for the systolic variables. Preload-adjusted wave intensity indexes may contribute in the assessment of true LV contractility
and relaxation. 相似文献
15.
Wälivaara DÅ Isaksson S Johansson LÅ 《Journal of plastic surgery and hand surgery》2011,45(2):109-112
Implants integrated into bone have revolutionised the retention of total nasal prostheses. However, it may be difficult to identify available sites for placement of the implant after excision. In addition, it is ideal to minimise wide bony exposure after radiotherapy to avoid compromising the blood supply. In this paper we describe a technique for accurate placement of frontal bone and customised zygomatic implants using a computer-designed and fabricated surgical guide with a minimal access flap. 相似文献
16.
17.
Michael Peolsson Britt Larsson Lars-Åke Brodin Björn Gerdle 《BMC musculoskeletal disorders》2008,9(1):1-15
Background
Low back pain is a substantial health problem and has subsequently attracted a considerable amount of research. Clinical trials evaluating the efficacy of a variety of interventions for chronic non-specific low back pain indicate limited effectiveness for most commonly applied interventions and approaches.Discussion
Many clinicians challenge the results of clinical trials as they feel that this lack of effectiveness is at odds with their clinical experience of managing patients with back pain. A common explanation for this discrepancy is the perceived heterogeneity of patients with chronic non-specific low back pain. It is felt that the effects of treatment may be diluted by the application of a single intervention to a complex, heterogeneous group with diverse treatment needs. This argument presupposes that current treatment is effective when applied to the correct patient. An alternative perspective is that the clinical trials are correct and current treatments have limited efficacy. Preoccupation with sub-grouping may stifle engagement with this view and it is important that the sub-grouping paradigm is closely examined. This paper argues that there are numerous problems with the sub-grouping approach and that it may not be an important reason for the disappointing results of clinical trials. We propose instead that current treatment may be ineffective because it has been misdirected. Recent evidence that demonstrates changes within the brain in chronic low back pain sufferers raises the possibility that persistent back pain may be a problem of cortical reorganisation and degeneration. This perspective offers interesting insights into the chronic low back pain experience and suggests alternative models of intervention.Summary
The disappointing results of clinical research are commonly explained by the failure of researchers to adequately attend to sub-grouping of the chronic non-specific low back pain population. Alternatively, current approaches may be ineffective and clinicians and researchers may need to radically rethink the nature of the problem and how it should best be managed. 相似文献18.
19.
Nga NT Hoa DT Målqvist M Persson LÅ Ewald U 《Acta paediatrica (Oslo, Norway : 1992)》2012,101(4):368-373
Aim: To ascertain the causes of neonatal death in a province in northern Vietnam and analyse their distribution over age at death, birth weight and place of delivery. Methods: Verbal autopsy interviews using a questionnaire derived from WHO standard and adapted to Vietnamese conditions was performed on all neonatal deaths occurring in Quang Ninh province from July 2008 to June 2010. Three experienced paediatricians independently reviewed all verbal autopsy records (233) and assigned a main cause of death. In case of disagreement in the allocation of cause of death, a consensus process was initiated to decide on a final cause. Results: Neonatal mortality rate within the study area was 16/1000 (238 neonatal deaths and 14 453 live births) over the study period. Prematurity/low birth‐weight (37.8%), intrapartum‐related neonatal deaths (birth asphyxia, 33.2%), infections (13.0%) and congenital malformation (6.7%) were the four leading causes of death. Four cases of neonatal tetanus were found. Intrapartum‐related deaths dominated in the home delivery group, whereas prematurity was the most prominent cause of death at all facility levels. Most neonatal deaths occurred within the first 24 h after delivery (58.6%). Conclusion: A high proportion of deaths due to prematurity and intrapartum‐related causes, calls for improvements of delivery care and resuscitation practices at health facilities. 相似文献
20.
Susanne Vilhelmsdotter Allander Lars-?ke Marké Bj?rn Wihlen Maria Svensson Carl-Gustaf Elinder Anders Larsson 《Upsala journal of medical sciences》2012,117(3):273-278