Cost–Utility Analysis of Paclitaxel in Combination with Cisplatin for Patients with Advanced Ovarian Cancer

The standard treatment for patients with advanced ovarian cancer (AOC) has been cyclophosphamide and cisplatin (CP). Recently, the results of a large randomized comparative trial demonstrated that the combination of paclitaxel and cisplatin (TP) provided a progression-free survival benefit of 5 months. In this study, a cost–utility analysis was performed from a Canadian health care system perspective to estimate the incremental cost-effectiveness of the TP combination. Twelve AOC patients who received treatment with TP were matched for age and disease stage on a 1-to-2 basis with a CP control. Total hospital resource consumption was then collected for all patients. Treatment preferences were estimated from a cohort of 20 patients and 40 healthy female volunteers using the time trade-off technique. The outcomes were then generated through a decision-analytic model. First-line treatment costs with TP were approximately fourfold greater on a per-cycle basis than the CP alternative (Can$1911 vs Can$459). When progression-free survival benefit and patient treatment preferences were incorporated into the analysis, the results of the decision model revealed an incremental cost between Can$12,000 and Can$24,000 per quality-adjusted progression-free year with the TP protocol. Even though the TP combination has a considerably higher drug acquisition cost, the results of the current analysis suggest that this new chemotherapy regimen does provide patients with substantial quality-adjusted progression-free survival benefit at a reasonable cost to the Canadian health care system.     

Effects of vasopressin on water and NaCl transport across the in vitro perfused medullary thick ascending limb of Henle's loop of mouse,rat, and rabbit kidneys

Direct tubular effects of arginine vasopressin (AVP) on water and NaCl transport across the medullary thick ascending limb of Henle (MAL) were examined by the in vitro perfusion of isolated nephron fragments of mice, rats, and rabbits. Osmotic water permeability of the MAL of mice and rats was low and remained unchanged with 2 mU/ml AVP added to the bath. A dose-dependent increase in transepithelial electrical potential difference (PD) with AVP was observed in the mouse MAL when the ambient medium was isotonic. A similar result was also obtained when 2×10^–4 mol/l dibutyryl adenosine 3,5-cyclic-monophosphate was added to the bath. In this preparation, AVP also caused an increase in the unidirectional Cl efflux from 323±45 to 398±61 pmoles·mm^–1 ·min^–1 (n=6,P<0.05). In contrast, under similar condition, we could not demonstrate any effect of AVP on PD, Cl efflux, or net Na flux in the rat MAL and on PD and Cl efflux in the rabbit MAL. Both PD and Cl efflux in the rat MAL were unaffected by AVP when the perfusate was made hypotonic. However, when the ambient medium was made hypertonic by adding NaCl and urea, a significant increase in PD was observed. In addition, we confirmed that AVP stimulated adenylate cyclase activity in the MAL as well as in the collecting tubule of mice and rats. We conclude that AVP stimulates Cl transport across the MAL of mice and rats by activating adenylate cyclase-cyclic AMP system. However, this effect of AVP may quantitatively vary among species.     

地奥心血康对心肌缺血再灌犬心肌细胞膜Na~＋，K~＋—ATP酶活性与LPO含量

１６只成年杂种犬复制心肌缺血再灌模型。分为地奥心血康治疗组（ＤＡＸＸＫＧ）和生理盐水对照组（ＮＳＣＧ）。差速离心分离心肌细胞质膜，无机磷法测定心肌细胞膜Ｎａ￣＋，Ｋ￣＋－ＡＴＰ酶活性，荧光法测定心肌细胞膜与血清脂质过氧化物（ＬＰＯ）含量。结果表明：（１）ＤＡＸＸＫＧＮａ￣＋，Ｋ￣＋－ＡＴＰ酶活性明显高于ＮＳＣＧ（Ｐ＜０．０１）；（２）血清ＬＰＯ含量，随着再灌时间延长，ＮＳＣＧ呈上升趋势，ＤＡＸＸＫＧ略下降，再灌２４０ｍｉｎ两组比较差异显著（Ｐ＜０．０１）；心肌细胞膜ＬＰＯ含量，ＤＡＸＸＫＧ低于ＮＳＣＧ（Ｐ＜０．０５）；（３）心肌细胞膜Ｎａ￣＋，Ｋ￣＋－ＡＴＰ酶活性与ＬＰＯ含量呈明显负相关（ｒ＝－０．８３，Ｐ＜０．０１）。这些结果提示ＤＡＸＸＫ可通过抗脂质过氧化而实现其保护心肌细胞膜的效应。     

体外培育牛黄与天然牛黄指纹图谱的比较研究

目的：研究、比较体外培育牛黄与天然牛黄的指纹图谱。方法：利用TOFMS、HPIEJMS技术研究、比较体外培育牛黄与天然牛黄中肽类、胆汁酸类和胆红素类3类成分的指纹图谱。结果：体外培育牛黄与天然牛黄3类成分的指纹基本一致，但各成分间的相对含量有差异。结论：10批体外培育牛黄的指纹图谱有较好的一致性，说明体外培育牛黄的质量稳定。4批天然牛黄的指纹图谱，尤其是胆汁酸类成分的指纹图谱差异明显，说明天然牛黄由于来源不同，导致质量不够稳定.     

When people with dementia are perceived as witches. Consequences for patients and nurse education in South Africa

Aims and Objectives

To explore and describe the link between culture and dementia care with the focus on the influence of the belief in dementia as witchcraft and people with dementia as witches.

Background

In South Africa, especially in townships and rural areas, dementia is often perceived as connected to witchcraft rather than to disease. Persons labelled as witches—mostly older women—may be bullied, ostracised, beaten, stoned, burned, even killed.

Method

One strand of findings from a larger international study is presented with in‐depth qualitative interviews of one close family member and seven nurses caring for patients with severe dementia in nursing homes in Tshwane in South Africa. A hermeneutic analytic approach was used.

Results

Two main themes are found, namely “Belief in witchcraft causing fear of persons with dementia” and “Need of knowledge and education.” Fear of and violence towards people with dementia are based on the belief that they are witches. Some of the nurses had also held this belief until they started working with patients with dementia. There is a great need for education both among healthcare workers and the populace.

Discussion

The “witch” belief prevents seeking professional help. As nursing homes tend to be private and expensive, professional dementia care is virtually unattainable for the poor. Dementia needs a more prominent place in nursing curricula. Nurses as educators need to know the local culture and language to be accepted in the various communities. They need to visit families affected by dementia, give awareness talks in churches, schools and clinics and facilitate support groups for carers of people with dementia in the local language.

Conclusion

Improved nurses’ education in gerontology and geriatric care is needed. Trained specialist nurses may work as mediators and help eradicate the witchcraft beliefs connected to severe dementia.