Optimizing the embryo transfer technique

The technique of embryo transfer is very crucial and great attention and time should be given to this step. In order to optimize the embryo transfer technique, several precautions should be taken. The first and most important is to avoid the initiation of uterine contractility. This can be achieved by the use of soft catheters, gentle manipulation and by avoiding touching the fundus. Secondly, proper evaluation of the uterine cavity and utero-cervical angulation is very important, and can be achieved by performing dummy embryo transfer and by ultrasound evaluation of the utero-cervical angulation and uterine cavity length. Another important step is the removal of cervical mucus so that it does not stick to the catheter and inadvertently remove the embryo during catheter withdrawal. Finally, one has to be absolutely sure that the embryo transfer catheter has passed the internal cervical os and that the embryos are delivered gently inside the uterine cavity.     

Sensory evaluation of soft drinks with various sweeteners

Forty subjects participated in each of two experiments in which both lemon-line and cola-flavored beverages containing one of six sweeteners--sucrose, sodium saccharin, aspartame, acesulfam-K, and two calcium cyclamate/sodium saccharin blends (10:1 and 3.5:1)--were evaluated on similarity and adjective scales. The similarity data suggest that drinks containing sucrose and aspartame cannot be discriminated from one another in either a lemon-line or cola medium in this experimental design. Sucrose and aspartame were also statistically equivalent on every adjective scale for both lemon-line and cola drinks. On both similarity judgments and adjective scales, acesulfam-K and sodium saccharin were most different from sucrose. The calcium cyclamate/sodium saccharin blends tended to be less similar than aspartame but not as different from sucrose as the acesulfam-K or sodium saccharin sweetened beverages.     

Long-term evaluation of usefulness of skin and incremental challenge tests in patients with history of adverse reaction to local anesthetics

A variety of adverse reactions to local anesthetics has been described, some of which are thought to be allergic. Different protocols of prick and intradermal skin tests as well as subcutaneous challenge tests are used to select a local anesthetic which can safely be used. Their long-term effectiveness has not yet been assessed. Twenty-eight patients with a history of adverse reaction to local anesthetics were evaluated over a 3-year period. Loss of consciousness occurred in eight patients, skin reaction in nine, and vagal symptoms in eight. Various reactions were recorded in the remaining three patients. Rapid spontaneous recovery was the rule, suggesting that immediate allergic reaction and, in particular, anaphylactic reaction were unlikely. Investigation allowed the selection of a tolerated anesthetic in all cases. Reexposure occurred in 19 patients 16–50 months after evaluation and 6.8 ± 5.5 years after the first reaction. No patient presented a second reaction. In conclusion, adverse reactions to local anesthetics seem to be, in most cases, not allergic in nature. Evaluation protocols are effective in selecting an agent susceptible to tolerance, but are time consuming. However, they probably contribute to an important reassurance effect that is likely to increase tolerance to subsequent local anesthetic administration. Simplification of the protocols and better patient selection are proposed.     

某国家级死因监测点漏报调查及死因监测质量评价

目的 了解某国家级死因监测点居民死亡漏报情况,评价死因监测信息系统报告的完整性和准确性。 方法 某国家级死因监测点居民死亡信息来源于泸县3个抽样点。采用随机整群抽样的方法,在泸县抽取3个镇(抽样点)共42个村/社,分别从派出所、社事办、妇幼、村(居委会)等渠道收集抽样点2018—2020年全部人口死亡信息,与“人口死因监测信息管理系统”死亡报告数据进行比较,计算漏报率。对“人口死因监测信息管理系统”中抽样点居民死亡报告卡进行审核,评估死因诊断的可靠性和编码质量。 结果 泸县人群总死亡漏报率为9.38%;2018—2020年,漏报率逐渐下降,分别为18.31%、7.53%、2.16%,年度变化百分比为-11.9%,变化趋势差异有统计学意义(t=-5.175,P＜0.001),抽样点死因诊断可靠性和准确性较高,可靠诊断单位占比81.81%,可靠诊断依据占比75.67%,根本死因编码错误率为0.21%。 结论 泸县死因监测数据质量较好,但仍需进一步降低漏报率,提高死因监测数据的完整性和诊断的可靠性。     

2016—2020年甘肃省食源性疾病暴发事件流行病学调查报告质量评价

目的:评价甘肃省食源性疾病暴发事件流行病学调查报告质量,发现基层流行病学调查过程中存在的问题并提出指导意见。方法:收集2016—2020年甘肃省食源性疾病暴发事件监测系统中,发病人数≥10例的食源性疾病暴发事件的流行病学调查报告,按照相应标准对流行病学调查报告中各项指标进行评价。结果:共收集68起食源性疾病暴发事件的流行病学调查报告。报告普遍存在条理性差、层次混乱不清,虽然书写了相应的指标但内容过于简单且不够规范的问题;报告还存在描述性流行病学调查不够全面、深入,分析流行病学欠缺,食品卫生学调查不充分等问题;仅有50.00%(34/68)的调查查明了致病因子和污染食物,39.71%(27/68)的调查查明了污染原因,14.71%(10/68)的调查找出了完整证据链。结论:甘肃省基层工作人员食源性疾病暴发事件流行病学调查不够深入、细致,病因调查和推断较少,几乎未开展分析流行病学调查,调查报告得出的结论依据不够充分;流行病学调查和调查报告书写质量均需要加强和提高;相关部门应基层流行病学调查队伍建设,对技术人员进行中长期的理论与实践相结合的培训。     

癫痫患者匹兹堡睡眠质量指数量表评分 与多导睡眠监测参数、脑功能状态指标相关性分析

摘 要：目的：评价甘肃省食源性疾病暴发事件流行病学调查报告质量,发现基层流行病学调查过程中存在的问题并提 出指导意见。方法：收集2016—2020年甘肃省食源性疾病暴发事件监测系统中,发病人数≥10例的食源性疾病暴发事件的 流行病学调查报告,按照相应标准对流行病学调查报告中各项指标进行评价。结果：共收集 68起食源性疾病暴发事件的流 行病学调查报告。报告普遍存在条理性差、层次混乱不清,虽然书写了相应的指标但内容过于简单且不够规范的问题;报告 还存在描述性流行病学调查不够全面、深入,分析流行病学欠缺,食品卫生学调查不充分等问题;仅有50.00% （34/68） 的 调查查明了致病因子和污染食物,39.71% （27/68） 的调查查明了污染原因,14.71% （10/68） 的调查找出了完整证据链。结 论：甘肃省基层工作人员食源性疾病暴发事件流行病学调查不够深入、细致,病因调查和推断较少,几乎未开展分析流行病 学调查,调查报告得出的结论依据不够充分;流行病学调查和调查报告书写质量均需要加强和提高;相关部门应基层流行病 学调查队伍建设,对技术人员进行中长期的理论与实践相结合的培训。     

Accounting for Intergenerational Cascade Testing in Economic Evaluations of Clinical Genomics: A Scoping Review

ObjectivesClinical genomics is emerging as a diagnostic tool in the identification of blood relatives at risk of developing heritable diseases. Our objective was to identify how genetic cascade screening has been incorporated into health economic evaluations.MethodsA scoping review was conducted to identify how multiple generations of a family were included in economic evaluations of clinical genomic sequencing, how many and which relatives were included, and uptake rates. Databases were searched for full economic evaluations of genetic interventions that screened multiple generations of families and were in English language, and no restrictions were made for disease or publication type. Data were synthesized using a narrative approach.ResultsTwenty-five studies were included covering a range of diseases in various countries. Markov cohort models were mostly used with hypothetical populations and unsupported by clinical evidence. Cascade testing was either the primary intervention or secondary to the index cases. The number and type of relatives were based on assumptions or identified through population or family records, clinical registry data, or clinical literature. Studies included only immediate family members and the uptake of testing ranged between 20% and 100%. All interventions were reported as cost-effective, and a higher number of relatives was a key driver.ConclusionsSeveral economic evaluations have considered the impacts of cascade testing interventions within clinical genomics. Ideally, models supported with high-quality clinical data are needed and, in their absence, transparent and justifiable assumptions of uptake rates and choices about including relatives. Consideration of more appropriate modeling types is required.     

Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 Explanation and Elaboration: A Report of the ISPOR CHEERS II Good Practices Task Force

Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces the previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, and the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as healthcare, public health, education, and social care). This Explanation and Elaboration Report presents the new CHEERS 2022 28-item checklist with recommendations and explanation and examples for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer-reviewed journals and the peer reviewers and editors assessing them for publication. Nevertheless, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, given that there is an increasing emphasis on transparency in decision making.     

Diagnostics and Treatments of COVID-19: A Living Systematic Review of Economic Evaluations

ObjectivesAs healthcare systems continue to respond to the COVID-19 pandemic, cost-effectiveness evidence will be needed to identify which tests and treatments for COVID-19 offer value for money. We sought to review economic evaluations of diagnostic tests and treatments for COVID-19, critically appraising the methodological approaches used and reporting cost-effectiveness estimates, using a “living” systematic review approach.MethodsKey databases (including MEDLINE, EconLit, Embase) were last searched on July 12, 2021. Gray literature and model repositories were also searched. Only full economic evaluations published in English were included. Studies were quality assessed and data were extracted into standard tables. Results were narratively summarized. The review was completed by 2 reviewers independently, with disagreements resolved through discussion with a senior reviewer.ResultsOverall, 3540 records were identified, with 13 meeting the inclusion criteria. After quality assessment, 6 were excluded because of very severe limitations. Of the 7 studies included, 5 were cost-utility analyses and 2 were cost-effectiveness analyses. All were model-based analyses. A total of 5 evaluated treatments (dexamethasone, remdesivir, hypothetical) and 2 evaluated hypothetical testing strategies. Cost-effectiveness estimates were sensitive to the treatment effect on survival and hospitalization, testing speed and accuracy, disease severity, and price.ConclusionsPresently, there are few economic evaluations for COVID-19 tests and treatments. They suggest treatments that confer a survival benefit and fast diagnostic tests may be cost effective. Nevertheless, studies are subject to major evidence gaps and take inconsistent analytical approaches. The evidence may improve for planned updates of this “living” review.     

Another Step Toward Hepatitis C Elimination: An Economic Evaluation of an Irish National Birth Cohort Testing Program

ObjectivesWe aimed to evaluate the cost-effectiveness of offering once-off birth cohort testing for hepatitis C virus (HCV) to people in Ireland born between 1965 and 1985, the cohort with the highest reported prevalence of undiagnosed chronic HCV infection.MethodsSystematic and opportunistic HCV birth cohort testing programs, implemented over a 4-year timeframe, were compared with the current practice of population risk-based testing only in a closed-cohort decision tree and Markov model hybrid over a lifetime time horizon. Outcomes were expressed in quality-adjusted life-years (QALYs). Costs were presented from the health system’s perspective in 2020 euro (€). Uncertainty was assessed via deterministic, probabilistic, scenario, and threshold analyses.ResultsIn the base case, systematic testing yielded the largest cost and health benefits, followed by opportunistic testing and risk-based testing. Compared with risk-based testing, the incremental cost-effectiveness ratio for opportunistic testing was €14 586 (95% confidence interval €4185-€33 527) per QALY gained. Compared with opportunistic testing, the incremental cost-effectiveness ratio for systematic testing was €16 827 (95% confidence interval €5106-€38 843) per QALY gained. These findings were robust across a range of sensitivity analyses.ConclusionsBoth systematic and opportunistic birth cohort testing would be considered an efficient use of resources, but systematic testing was the optimal strategy at willingness-to-pay threshold values typically used in Ireland. Although cost-effective, any decision to introduce birth cohort testing for HCV (in Ireland or elsewhere) must be balanced with considerations regarding the feasibility and budget impact of implementing a national testing program given high initial costs and resource use.