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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.
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
995.
996.
Remy-Jardin M; Duyck P; Remy J; Petyt L; Wurtz A; Mensier E; Copin MC; Riquet M 《Radiology》1995,196(2):387
997.
MARK R. STEIN M.D. Maj MC USA CARLTON K. THOMPSON Jr. M.D. Maj MC USA †JOHN E. SAWICKI M.D. Maj MC USA ‡ANTHONY J. MARTEL M.D. Maj MC USA ‡ 《The American journal of gastroenterology》1974,62(5):435-439
Esophageal stricture may occur as a late complication of the Stevens-Johnson syndrome. Our patient suffered multiple complications, including bilateral blindness and developed significant dysphagia two months after the onset of the Stevens-Johnson syndrome. Early radiologic and endoscopic documentation of the stricture of the distal esophagus led to the initiation of treatment with esophageal dilatation. A program of esophageal dilatation and antacid therapy was successful in relieving the dysphagia and in returning the patient to her normal diet. With early diagnosis and treatment of esophageal stricture surgical intervention may be avoided. 相似文献
998.
Clyde A. Helms M.D. Gregory S. Chapman CPT USAF MC James H. Wild LTC USAF MC 《Skeletal radiology》1981,7(1):55-58
Two cases of Charcot-like joints in patients with pseudogout who were otherwise neurologically intact are presented. The arthropathy of pseudogout should include Charcot-like joints and it is emphasized that an apparent Charcot joint should raise the question of pseudogout. 相似文献
999.
1000.
Jacob G. Robison MD Capt USAF MC Thomas W. Pollock MD Maj USAF MC 《American journal of surgery》1980,140(6):783-786
Computed tomographic scanning of the abdomen in 50 patients evaluated for suspected intraabdominal abscess resulted in an overall accuracy of 92 percent. It proved the most accurate diagnostic tool in determining the presence of intraabdominal abscess. Computed tomography of the abdomen is a useful diagnostic adjunct to clinical judgment and may assist in localizing intraabdominal abscesses and planning early surgical intervention. 相似文献