Is the UK NICE “Reference Case” Influencing the Practice of Pediatric Quality-Adjusted Life-Year Measurement within Economic Evaluations?

ObjectivesTo report findings from a systematic review, this article sought to address two related questions. First, how has the practice of UK pediatric cost-utility analyses evolved over time, in particular how are health-related outcomes assessed and valued? Second, how do the methods compare to the limited guidance available, in particular, the National Institute for Health and Care Excellence (NICE) reference case(s)?MethodsElectronic searches of MEDLINE, Embase, and Cochrane databases were conducted for the period May 2004 to April 2012 and the Paediatric Economic Database Evaluation database for the period May 2004 to December 2010. Identified studies were screened by three independent reviewers.ResultsForty-three studies were identified, 11 of which elicit utility values through primary research. A discrepancy was identified between the methods used for outcome measurement and valuation and the methods advocated within the NICE reference case. Despite NICE recommending the use of preference-based instruments designed specifically for children, most studies that were identified had used adult measures. In fact, the measurement of quality-adjusted life-years is the aspect of economic evaluation with the greatest amount of variability and the area that most digressed from the NICE reference case.ConclusionsRecommendations stemming from the review are that all studies should specify the age range of childhood and include separate statements of perspective for costs and effects as well as the reallocation of research funding away from systematic review studies toward good quality primary research measuring utilities in children.     

围术期加速康复外科护理对脑胶质瘤病人的影响

目的:探讨围术期加速康复外科护理对脑胶质瘤病人的影响。方法:将神经外科收治的114例脑胶质瘤病人采用住院编号奇偶数排列法将其分为观察组和对照组各57例。对照组病人给予常规围术期护理,观察组病人在对照组的基础上给予加速康复外科护理,比较两组病人术后生活自理能力、生活质量及并发症情况。结果:干预后观察组病人术后生活自理能力评分高于对照组(P<0.05),术后生活质量评分高于对照组(P<0.05),术后并发症总发生率低于对照组(P<0.05)。结论:围术期加速康复外科护理干预可提高脑胶质瘤病人术后生活自理水平,加快病人术后康复进程,改善病人生活质量,对病人取得良好预后具有重要的意义。     

Low perceived service quality in community pharmacy is associated with poor medication adherence

ObjectiveCommunity pharmacists are highly accessible healthcare professionals, whose regular contact with patients provides ongoing opportunities to improve medication safety and promote medication adherence. This study investigates whether patients who experience low service quality in community pharmacies are less adherent to their regular medications.MethodsEight Australian pharmacies were recruited, 5 self-identified as having a price promotion business strategy and 3 with a service-focused business strategy. Patients taking regular prescribed medicines who had previously attended the pharmacy completed e-surveys in-store with measures of perceived service quality (pSQ) and self-reported adherence. Multivariate regression using multilevel modelling with bootstrapping was used to explore the relationships between variables.ResultsSurveys were completed by 319 respondents. Attending pharmacies with a price promotion business strategy was predictive of lower pSQ and poor medication adherence. The between-pharmacy slope of the relationship between pSQ and adherence was 2.25 (with 95 % confidence intervals = 1.50, 2.86) and was highest in pharmacies with lowest pSQ.ConclusionThis study highlights that when patients experience low service quality, in community pharmacies they are more likely to report poor adherence to their regular prescribed medicines.Practice implicationsCommunity pharmacies need to be designed and managed to allow pharmacists to provide high levels of patient-centred care.     

Halos y lentes intraoculares multifocales: origen e interpretación

ObjectiveTo present the theoretical and experimental characterization of the halo in multifocal intraocular lenses (MIOL).MethodThe origin of the halo in a MIOL is the overlaying of 2 or more images. Using geometrical optics, it can be demonstrated that the diameter of each halo depends on the addition of the lens (ΔP), the base power (P^d), and the diameter of the IOL that contributes to the «non-focused» focus. In the image plane that corresponds to the distance focus, the halo diameter (δH^d) is given by: δH^d = d^pn ΔP/P^d, where d^pn is the diameter of the IOL that contributes to the near focus. Analogously, in the near image plane the halo diameter (δHⁿ) is: δHⁿ = d^pd ΔP/P^d, where d^pd is the diameter of the IOL that contributes to the distance focus. Patients perceive halos when they see bright objects over a relatively dark background. In vitro, the halo can be characterized by analyzing the intensity profile of the image of a pinhole that is focused by each of the foci of a MIOL.Results and conclusionsA comparison has been made between the halos induced by different MIOL of the same base power (20D) in an optical bench. As predicted by theory, the larger the addition of the MIOL, the larger the halo diameter. For large pupils and with MIOL with similar aspheric designs and addition (SN6AD3 vs ZMA00), the apodized MIOL has a smaller halo diameter than a non-apodized one in distance vision, while in near vision the size is very similar, but the relative intensity is higher in the apodized MIOL. When comparing lenses with the same diffractive design, but with different spherical-aspheric base design (SN60D3 vs SN6AD3), the halo in distance vision of the spherical MIOL is larger, while in near vision the spherical IOL induces a smaller halo, but with higher intensity due to the spherical aberration of the distance focus in the near image. In the case of a trifocal-diffractive IOL (AT LISA 839MP) the most noticeable characteristic is the double-halo formation due to the 2 non-focused powers.     

Does music perception have an impact on quality of life following cochlear implantation?

Conclusion. Despite the decrease in listening habits, about half of the patients still enjoy music post implantation. Better quality of sound through the implant improves music enjoyment and contributes to achievement of better postoperative quality of life (QOL). Objectives. To evaluate music perception and enjoyment in cochlear implant (CI) users, and to assess their influence on QOL. Materials and methods. Sixty-five post-lingually deaf CI recipients were enrolled in this study. A musical questionnaire evaluated musical background, listening habits, and quality of musical sound through the CI. The validated Glasgow Benefit Inventory (GBI) was used to quantify changes in QOL. Results. Fifty-two patients answered the questionnaires. Listening habits (music enjoyment and hours spent listening to music per week) significantly decreased following implantation when compared with the same parameters before deafness. Nevertheless, 52% of the patients enjoyed music post implantation. The quality of musical sound was rated >50 (0–100 scale) for the adjective pairs ‘like-dislike’, ‘sounds like music-doesn't sound like music’ and ‘natural-mechanical’ by most users. Med-el device users obtained better scores in the adjective pair ‘sounds like music-doesn't sound like music’ than Cochlear device users. Recipients rating higher scores for quality of sound enjoyed music post implantation and had higher total GBI scores than those rating lower scores.