Cost-effectiveness of a multidimensional post-discharge disease management program for heart failure patients-economic evaluation along a one-year observation period.

OBJECTIVE: This study aimed to assess the cost-effectiveness of the telemedically assisted post-discharge management program (DMP) HerzMobil Tirol (HMT) for heart failure (HF) patients in clinical practice in Austria. METHODS: We conducted a cost-effectiveness analysis along a retrospective cohort study (2016-2019) of HMT with a propensity score matched cohort of 251 individuals in the HMT and 257 in the usual care (UC) group and a 1-year follow-up. We calculated the effectiveness (hospital-free survival, hospital-free life-years gained, and number of avoided rehospitalizations), costs (HMT, rehospitalizations), and the incremental cost-effectiveness ratio (ICER). We performed a nonparametric sensitivity analysis with bootstrap sampling and sensitivity analyses on costs of HF rehospitalizations and on costs per disease-related diagnosis (DRG) score for rehospitalizations. RESULTS: Base-case analysis showed that HMT resulted in an average of 42 additional hospital-free days, 40 additional days alive, and 0.12 avoided hospitalizations per patient-year compared with UC during follow-up. The average HMT costs were EUR 1916 per person. Mean rehospitalization costs were EUR 5551 in HMT and EUR 6943 in UC. The ICER of HMT compared to UC was EUR 4773 per life-year gained outside the hospital. In a sensitivity analysis, HMT was cost-saving when "non-HF related costs" related to the DMP were replaced with average costs. CONCLUSIONS: The economic evaluation along the cohort study showed that the HerzMobil Tirol is very cost-effective compared to UC and cost-saving in a sensitivity analysis correcting for "non-HF related costs." These findings promote a widespread adoption of telemedicine-assisted DMP for HF.

Manifestation of migraine in adolescents: Does it change in puberty?

PURPOSE: To analyze the association between pubertal stage, menstrual cycle and migraine attacks in girls with migraine. In addition, headache frequency, accompanying symptoms, duration and onset in relation to the specific phase of the cycle were investigated. METHODS: Girls between 7 and 18 years old, diagnosed with headaches that met "International Classification of Headache Disorders II" diagnostic criteria for migraine without aura, kept a daily headache and menstrual cycle diary over 8 weeks. Ovulatory cycles were identified by weekly progesterone saliva tests. RESULTS: 47 girls participated in the study and were divided into three groups according to Tanner stage and onset of regular menstruation: pre- (n = 16), peri- (n = 19) and post-pubertal (n = 12). A significant difference in migraine frequency was found between pre- and post-pubertal girls (p = 0.005). No significant differences with regard to headache characteristics were detected. Interestingly, a higher frequency of attacks in follicular phase occurred compared to luteal phase in peri- and post-pubertal girls (p = 0.030). CONCLUSION: During puberty, migraine patterns in girls change to a typical adult pattern of migraine in a stepwise manner not clearly related to menarche. The first sign of this transition phase could be the higher frequency of migraine attacks in post-pubertal girls.

[Comparison of two optical biometric devices for intraocular lens calculation]. / Vergleich zweier optischer Biometriegeräte zur Kunstlinsenberechnung.

BACKGROUND: Modern cataract surgery not only consists of a minimally invasive lens extraction but also of the implantation of a suitable intraocular lens. OBJECTIVE: The aim of this prospective trial was a comparison of the predicted refractive error of two optical biometers, the IOLMaster 500 and LenStar LS 900 for intraocular lens power calculation in cataract surgery. MATERIAL AND METHODS: This was a prospective, analytical, comparative, non-masked study. A total of 86 eyes of 86 patients were examined and measured with both instruments before and after uneventful cataract surgery. Primary outcome measures were the differences of the predicted refractive error of both instruments. The predicted refractive error was calculated with different formulas. The results were compared to each other, to the desired target refraction as well as to the postoperative spherical equivalent. RESULTS: The mean differences in predicted refractive error of both instruments varied between 0.9 ± 0.19 (standard deviation) diopters (D) and 0.18 ± 0.30 D depending on the chosen formula. The IOLMaster 500 predicted less difference to the desired target refraction as well as to the spherical equivalent than the LenStar LS 900 with nearly all formulas. CONCLUSION: Both devices generated reproducible exact data with only a small deviation from the desired target refraction and from the postoperative spherical equivalent. There were statistically significant differences based on the chosen a­constants as well as the utilized measurement methods of both instruments.

Publications by Scandinavian university Departments of Anaesthesiology from 2001 to 2015.

BACKGROUND: This study assessed the contribution made to research by Scandinavian university Departments of Anaesthesiology and their distribution among those departments. METHODS: We committed a PubMed search for all publications originating from Scandinavian university Departments of Anaesthesiology between 2001 and 2015. Articles were assigned to their author's affiliated university department and to 3 time periods 2001-2005, 2006-2010 and 2011-2015. The number of publications, original articles and citations were analysed. RESULTS: The 23 Scandinavian university Departments of Anaesthesiology published 5190 articles between 2001 and 2015, which make up 91.5% from all anaesthesiology research originating from Scandinavia. Of these 1760 (33.9%) were classified as original articles. The number of publications increased in the observed periods (from 1305 in 2001-2005 to 2452 in 2010-2015), but the share of original articles decreased (from 40% to 31%). Finnish university Departments of Anaesthesiology had the largest share of original articles. The university department of Copenhagen was the most productive Department of Anaesthesiology in terms of number of publications (n = 1187) and citation rate of original articles (median 24 citations per original article). Publications from Bergen scored the highest impact (median 19 citations per publication). CONCLUSIONS: The number of publications from Scandinavian university Departments of Anaesthesiology increased between 2001 and 2015, but the share of original articles decreased. Copenhagen was the most productive university Department of Anaesthesiology based on the number of publications and citations of original articles. Finnish university Departments of Anaesthesiology led in the share of original articles out of all publications.

Do complement factor H 402Y and C7 M allotypes predispose to (typical) haemolytic uraemic syndrome?

Typical haemolytic uraemic syndrome (HUS) is mainly caused by infections with enterohaemorrhagic Escherichia coli, whereas in atypical, nonbacteria-associated HUS, complement plays a dominant role. Recently, complement has also been shown to be involved in typical HUS. In this study, mostly weakly significant associations with homozygosities of complement allotype C7 M and inversely with factor H 402H were found, suggesting that 402Y and C7 M allotypes predispose to (typical) haemolytic uraemic syndrome.