Cost-utility Analysis of Navigate, a Treatment Decision Aid for Men with Prostate Cancer and Their Partners, in Comparison to Usual Care.

BACKGROUND AND OBJECTIVE: Evidence on the cost effectiveness of decision aids to guide management decisions for men with prostate cancer is limited. We examined the cost utility of the Navigate online decision aid for men with prostate cancer in comparison to usual care (no decision aid). METHODS: A Markov model with a 10-yr time horizon was constructed from a government health care perspective. Data from the Navigate trial (n = 302) and relevant published studies were used for model inputs. Incremental costs and quality-adjusted life-years (QALYs) were calculated for the two strategies. One-way and probabilistic sensitivity analyses were undertaken to address model uncertainty. KEY FINDINGS AND LIMITATIONS: On average, the Navigate strategy was estimated to cost AU$8899 (95% uncertainty interval [UI] AU$7509-AU$10438) and produce 7.08 QALYs (95% UI 6.73-7.36) in comparison to AU$9559 (95% UI AU$8177-AU$11017) and 7.03 QALYs (95% UI 6.67-7.31) or usual care. The Navigate strategy dominated usual care as it produced cost-savings and higher QALYs, although differences for both outcomes were small over 10 yr. The likelihood of Navigate being cost effective at a conventionally acceptable threshold of AU$50000 per QALY gained was 99.7%. This study is limited by the availability, quality, and choice of the data used in the model. CONCLUSIONS AND CLINICAL IMPLICATIONS: Use of an online decision aid for men with prostate cancer appears to be cost effective relative to usual care in Australia, driven by the higher acceptance and uptake of active surveillance. Wider implementation of decision aids may better inform men diagnosed with prostate cancer about their management options. PATIENT SUMMARY: We looked at the cost effectiveness of an online decision aid for guiding Australian men with prostate cancer in choosing a management option. We found that this decision aid was cost effective, mainly because more men chose active surveillance. Decision aids that inform patients about their management options should be more widely used in health care.

From Diagnosis to Fertility: Optimizing Treatment of Adenomyosis for Reproductive Health.

Adenomyosis is a benign gynecologic disorder that had previously not been well studied or understood. However, it is now become a more common diagnosis with long-standing implications especially for fertility. In this literature review, the pathophysiology and diagnosis along with management options for uterine preservation and fertility along with more definitive options are reviewed. While there is a better understanding of adenomyosis, there is still more research that is needed to fully elucidate the best ways of management for patients especially in those seeking fertility.

Assessing the perception of Parkinson's disease in Al-Ahsa, Saudi Arabia among the visitors of a public campaign: before and after survey.

Introduction: Insufficient knowledge and beliefs hinder the early diagnosis and provision of adequate treatment and care for PD patients, causing socio-economic burdens. Raising public awareness and understanding the knowledge gap is crucial for effective educational programs and early detection. This study aims to assess the perception of Parkinson's disease (PD) among visitors of a public campaign conducted to raise PD awareness and knowledge to facilitate early detection and management. Methods: A before-and-after study was conducted from May to June 2023, to assess the perception of PD among a public PD campaign visitors in Al-Ahsa, Saudi Arabia. The campaign included educational booths discussing PD symptoms, causes, diagnosis, management, and support. Participants completed a self-administered online questionnaire before and after the campaign. The data were analyzed using SPSS. Results: The study included 48 eligible individuals. The mean knowledge score was significantly enhanced following the campaign, rising from 12 to 17.77 points (p < 0.05). The symptoms of PD that showed a significant difference were slow movement, tremors, depression, memory problems, and sleep problems. The campaign had a beneficial effect on participants' general understanding of PD. Discussion: The study showed that public awareness campaigns successfully raised community awareness of PD. Participants' knowledge improved after the campaign, highlighting its positive effect. Further research could explore measuring the continuity of awareness over a longer period and its impact on improving patients' lives and could expand the sample size.

Buruli ulcer in Africa: Geographical distribution, ecology, risk factors, diagnosis, and indigenous plant treatment options - A comprehensive review.

Buruli ulcer (BU), a neglected tropical disease (NTD), is an infection of the skin and subcutaneous tissue caused by Mycobacterium ulcerans. The disease has been documented in many South American, Asian, and Western Pacific countries and is widespread throughout much of Africa, especially in West and Central Africa. In rural areas with scarce medical care, BU is a devastating disease that can leave patients permanently disabled and socially stigmatized. Mycobacterium ulcerans is thought to produce a mycolactone toxin, which results in necrosis of the afflicted tissue and may be involved in the etiology of BU. Initially, patients may notice a painless nodule or plaque on their skin; as the disease progresses, however, it may spread to other parts of the body, including the muscles and bones. Clinical signs, microbial culture, and histological analysis of afflicted tissue all contribute to a diagnosis of BU. Though antibiotic treatment and surgical removal of infected tissue are necessary for BU management, plant-derived medicine could be an alternative in areas with limited access to conventional medicine. Herein we reviewed the geographical distribution, socioeconomic, risk factors, diagnosis, biology and ecology of the pathogen. Complex environmental, socioeconomic, and genetic factors that influence BU are discussed. Further, our review highlights future research areas needed to develop strategies to manage the disease through the use of indigenous African plants.

Manejo de embarazos únicos con diagnóstico antenatal de vasa previa / Management of singleton pregnancies with prenatal diagnosis of vasa previa

Introducción: vasa previa (VP) corresponde al paso de los vasos umbilicales por las membranas amnióticas, sin protección de gelatina de Wharton o placenta, antes de la presentación fetal, sobre el orificio cervical interno. Pese a su baja incidencia, el diagnóstico prenatal es relevante por las graves consecuencias que puede tener esta patología en caso de no ser diagnosticada. El objetivo de esta revisión es presentar la evidencia disponible para el manejo de embarazadas con diagnóstico antenatal de VP. Materiales y métodos: analizamos todos los estudios publicados (prospectivos, retrospectivos y reporte de casos) entre los años 1999 y 2023, con diagnóstico VP en embarazo único, reportando la edad gestacional de interrupción y el resultado neonatal. Resultados: incluimos 19 investigaciones (18 en la búsqueda primera y una adicional por relevancia). Las pacientes con manejo intrahospitalario desde las 34 semanas tuvieron mayor latencia al parto, mejores resultados neonatales y menor tasa de cesárea de urgencia que las pacientes con manejo ambulatorio. La edad gestacional de interrupción es variable entre los estudios, sin embargo, no se evidenció beneficio de interrupción a las 34 semanas comparado con manejo expectante hasta las 37 semanas de edad gestacional. Conclusión: existiría beneficio de hospitalización entre las 32-34 semanas en mujeres con diagnóstico de VP, siendo razonable la interrupción cercana a las 37 semanas por cesárea electiva.

Introduction: vasa previa (VP) corresponds to the passage of the umbilical vessels through the amniotic membranes, without the protection of Wharton's gelatin or placenta, in front of the fetal presentation, over the internal cervical os. Despite its low incidence, prenatal diagnosis is relevant due to the severe consequences of this pathology if the diagnosis is missed. This review presents the available evidence for pregnant women's management with an antenatal diagnosis of VP. Materials and methods: we analyzed all the studies published (prospective, retrospective, and case reports) between 1999 and 2023, with a diagnosis of VP in a single pregnancy, reporting gestational age at delivery and neonatal outcome. Results: We included 19 investigations (18 in the first search and another for relevance). Patients with in-hospital management from 34 weeks had a more extended latency period until delivery, better neonatal outcomes, and a lower rate of emergency cesarean section than patients with outpatient management. The gestational age at birth is variable between the studies; however, no benefit of delivery at 34 weeks was evidenced compared with expectant management until 37 weeks of gestational age. Conclusion: there would be a benefit of hospitalization between 32-34 weeks in women diagnosed with VP, being reasonable to schedule the delivery close to 37 weeks by elective cesarean section.

Management of Chronic Patella Tendon Tear with Heterotopic Ossifications: A Case Report and Pictorial Review of Various Techniques in Contemporary Practice.

Purpose: To review reliable techniques for reconstructing or repairing chronic patella tendon tears and describe the unique case report of chronic patellar tendon tear with heterotopic ossification (HO). Case description: A 47-year-old male presented with chronic patellar tendon tears with HO, resulting in an inability to extend the right knee fully. Krackow suture repair augmented by autograft semitendinosus and gracilis was employed after debriding intra-substance patella tendon HO and fibrotic tissue. The repair was augmented using a method described by Chen et al. Postoperative recovery was uneventful, and the patient demonstrated an excellent Knee Society Score (86/100) at 6 months of follow-up. Proximal migration of the patella, poor tissue quality, scar tissue formation, and quadriceps atrophy pose unique challenges in managing chronic patellar tendon tears. Conclusion: HO increased the probability of patella baja after the reconstruction. To alleviate that, precise pre-op planning, careful method selection, and proper execution of the selected method are very important. A comprehensive review of 14 different methodologies for managing chronic patellar tendon tears, comprising eight case series and six case reports, was conducted. The selection of an appropriate technique should be based on individual patient characteristics, resource availability, and the surgeon's expertise.

Guiding Patients Through Decision-Making in Management of Sporadic Vestibular Schwannoma.

Decision-making in management of sporadic vestibular schwannoma aims to identify the most appropriate options based on tumor characteristics, symptoms, health, and goals for each patient. Advances in knowledge of tumor natural history, improvements in radiation techniques, and achievements in neurologic preservation with microsurgery have shifted emphasis toward maximizing quality of life using a personalized approach. To empower patients to make informed decisions, we present a framework to help match patient values and priorities with reasonable expectations from modern management options. Introduced herein are practical examples of communication strategies and decision aids to support shared decision-making in modern practice.

Post-Harvest Insect Pests and Their Management Practices for Major Food and Export Crops in East Africa: An Ethiopian Case Study.

Ethiopian subsistence farmers traditionally store their grain harvests, leaving them open to storage pests and fungi that can cause contamination of major staple crops. Applying the most effective strategy requires a precise understanding of the insect species, infestation rates, storage losses, and storage conditions in the various types of farmers' grain stores. This study did a complete literature analysis on post-harvest pest and management measures with a focus on Ethiopia. The most frequent insect pests of stored cereals in this study were weevils (Sitophilus spp.), the lesser grain borer (Rhyzopertha dominica), rust-red flour beetle (Tribolium sp.), sawtoothed grain beetle (Oryzaephilus sp.), grain beetle (Cryptolestes spp.), Indian meal moth (Plodia interpunctella), and Angoumois grain moth (Sitotroga cerealella). Flour beetles (Tribolium spp.), sawtoothed beetles (Oryzaephilus sp.), flat grain beetles (Cryptolestes pusillus), and some moths have been identified as common stored product pests of stored oil seed, while bruchid beetles (Callosobruchus chinensis) and the moths were reported for pulses. Additionally, the storage pests in Ethiopia under varied conditions caused storage losses of 9-64.5%, 13-95%, 36.9-51.9%, and 2-94.7% in maize, sorghum, chickpeas, and sesame, respectively. To reduce the losses incurred, preventative measures can be taken before infestations or as soon as infestations are discovered. A variety of pest population monitoring systems for harvested products and retailers have been developed and recommended. In this context, reducing post-harvest grain losses is an urgent concern for improving food accessibility and availability for many smallholder farmers in Ethiopia and ensuring the nation's long-term food security.

Microplastics in soil and freshwater: Understanding sources, distribution, potential impacts, and regulations for management.

Plastic debris is a complex and persistent environmental contaminant that has received a high amount of attention in the last few years. Understanding the sources, transport, fate, occurrence, and health risks of microplastics (MPs) in the environment is essential as millions of tons of plastic are manufactured and released into the environment. There is a high possibility that MPs will accumulate and retain within continental environments and have effects on the environment and human health. This review elucidates the outcomes of studies related to the prevalence, transport, fate, and health risks of MPs in soil and freshwater environments. The review shows that the sources of MPs are diverse and extensive and their occurrence, transport, fate, and health risks in the environment are affected by their physico-chemical characteristics and by natural factors. Implemented legislation or regulatory plans to reduce MPs contamination of the environment have been reviewed in this study. Moreover, management options are presented.

Uncommon Ectopic Pregnancies-Challenges in the Management.

Background: The risk factors for ectopic pregnancy are on the rise. Despite the progress (availability of serum ßhCG, USG and MRI), there are diagnostic and therapeutic challenges in the management. Up to 50% of ectopic pregnancies go undetected. Furthermore, cases seen as emergency with hemodynamic instability need urgent intervention with simultaneous arrangement of transport, blood transfusion and at times multidisciplinary team involvement. This is more challenging in a setting where resources are limited. Objective: To evaluate the outcome of women presenting with uncommon ectopic pregnancies as life-threatening emergency. Challenges encountered in diagnosis, pre-operative evaluation, decision for surgery and the procedure are presented. Patients and Methods: This is a series of twelve cases of uncommon ectopic pregnancies belonging to eight different types. These were managed under the first author during the period 2001 to 2019. Subjects were analyzed retrospectively. Results: Diagnostic dilemma was faced in majority of the cases even with the use of ultrasonography. All the conceptions were spontaneous. Emergency surgical interventions were made on the basis of clinical evaluation. Five cases presented with massive hemoperitoneum. Blood transfusion was needed in nine cases. There was no mortality. One woman (case 4), with abdominal pregnancy, went home with a live baby, after the second laparotomy. Conclusion: Uncommon ectopic pregnancies are life-threatening conditions. Clinical acumen and an alert mind are of superior value in diagnosis. Investigations are supportive. Early diagnosis and intervention are lifesaving.

Impact of Climate Change on Dryland Agricultural Systems: A Review of Current Status, Potentials, and Further Work Need.

Dryland agricultural system is under threat due to climate extremes and unsustainable management. Understanding of climate change impact is important to design adaptation options for dry land agricultural systems. Thus, the present review was conducted with the objectives to identify gaps and suggest technology-based intervention that can support dry land farming under changing climate. Careful management of the available agricultural resources in the region is a current need, as it will play crucial role in the coming decades to ensure food security, reduce poverty, hunger, and malnutrition. Technology based regional collaborative interventions among Universities, Institutions, Growers, Companies etc. for water conservation, supplemental irrigation, foliar sprays, integrated nutrient management, resilient crops-based cropping systems, artificial intelligence, and precision agriculture (modeling and remote sensing) are needed to support agriculture of the region. Different process-based models have been used in different regions around the world to quantify the impacts of climate change at field, regional, and national scales to design management options for dryland cropping systems. Modeling include water and nutrient management, ideotype designing, modification in tillage practices, application of cover crops, insect, and disease management. However, diversification in the mixed and integrated crop and livestock farming system is needed to have profitable, sustainable business. The main focus in this work is to recommend different agro-adaptation measures to be part of policies for sustainable agricultural production systems in future.

Method's corner: Allergist's guide to network meta-analysis.

Network meta-analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta-analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care.

Patterns and Drivers of Rodent Abundance across a South African Multi-Use Landscape.

South Africa's decentralized approach to conservation entails that wildlife outside formally protected areas inhabit complex multi-use landscapes, where private wildlife business (ecotourism and/or hunting) co-exist in a human-dominated landscape matrix. Under decentralized conservation, wildlife is perceived to benefit from increased amount of available habitat, however it is crucial to understand how distinct management priorities and associated landscape modifications impact noncharismatic taxa, such as small mammals. We conducted extensive ink-tracking-tunnel surveys to estimate heterogeneity in rodent distribution and investigate the effect of different environmental factors on abundance patterns of two size-based rodent groups (small- and medium-sized species), across three adjacent management contexts in NE KwaZulu-Natal, South Africa: a private ecotourism game reserve, mixed farms and traditional communal areas (consisting of small clusters of houses interspersed with grazing areas and seminatural vegetation). Our hypotheses were formulated regarding the (1) area typology, (2) vegetation structure, (3) ungulate pressure and (4) human disturbance. Using a boosted-regression-tree approach, we found considerable differences between rodent groups' abundance and distribution, and the underlying environmental factors. The mean relative abundance of medium-sized species did not differ across the three management contexts, but small species mean relative abundance was higher in the game reserves, confirming an influence of the area typology on their abundance. Variation in rodent relative abundance was negatively correlated with human disturbance and ungulate presence. Rodent abundance seems to be influenced by environmental gradients that are directly linked to varying management priorities across land uses, meaning that these communities might not benefit uniformly by the increased amount of habitat promoted by the commercial wildlife industry.

Choosing the best for preventing the worst: A structured analysis of the selection of risk management options in REACH restriction dossiers.

Under the European chemicals legislation REACH (Registration, Evaluation, Authorisation and restriction of CHemicals), the use of chemicals posing an unacceptable risk for humans and the environment can be restricted. This requires that regulatory authorities of EU member states, or the European Chemicals Agency on request of the Commission, submit a restriction proposal in which they suggest one or multiple risk management options (RMOs). The options are recommended to be evaluated in a socio-economic analysis (SEA) using defined criteria. This paper explores the drivers of the selection of the preferred RMO in 32 restriction dossiers. Applying principal component analysis reveals that the selection of the preferred RMO, and the evaluation of possible trade-offs between alternative RMOs, is determined by criteria characterizing a measure's effectiveness and practicality, in particular its risk reduction capacity (R) and proportionality. A logistic regression using quantitative estimates provided in SEA suggests that the probability for an RMO to be selected is the higher the higher its R and the lower the costs of the restriction. Based on our analysis we conclude that the selection process of RMOs in REACH restriction dossiers could be strengthened by defining a limited but unambiguous set of criteria, conducting a score-based evaluation as a default, and by defining transparent decision rules.

Potential of invasive watermilfoil (Myriophyllum spp.) to remediate eutrophic waterbodies with organic and inorganic pollutants.

Watermilfoil (Myriophyllum) is one of the world's most troublesome invasive aquatic weeds. Although current management practices may inhibit its expansion, it also impacts not only the quality of water but habitat deterioration. Therefore, the need for developing highly efficient and low-cost biotechnologies with resource recovery into the agriculture field as a complementary management strategy cannot be overstated. Here, we reviewe the scientific/grey literature to offer readers a precise and panoramic view of the invasive watermilfoil ecology, regional problems, impacts, ecosystem services, and management. In this regard, an in-depth review aimed to assess the potential for reducing non-point source inorganic and organic pollutants using invasive watermilfoil, with the sustainable approaches, while offering other services and mitigating ecological trade-offs is presented. Global distributions, growth, and current progress on the management and utilization of invasive watermilfoil biomass are summarized to develop the aim, which is to convey challenges during the implementation of large-scale weed use. In short, pollutant assimilation in plant and bacterial communities linked to this weed considerably contribute to the reduction and degradation of pollutants from both natural and artificial systems. Although several considerations in recycling and reusing biomass need to be considered, the potential reuse of the harvested material for livestock feed, compost and direct use in farming systems offer an additional strategy to achieve sustainable ecosystem restoration. Further research and development may focus on a more detailed economic modeling approach that integrates the costs (worker's wage, harvesting, transportation, and energy consumption), legal and regulatory barriers, health risks and ecosystem service benefits (biodiversity improvement, and pollutant removal) to holistically evaluate the economic, environmental, and societal value of reusing and recycling this waste material.

Nitrate contamination of groundwater in the Lower Volta River Basin of Ghana: Sources and related human health risks.

A significant population within the Lower Volta River Basin of Ghana relies solely on untreated groundwater (GW) and surface water (SW) for various purposes. However, negative practices associated with increasing human activities pose threats to particularly GW quality in the basin. Using NO3- as a proxy, this study mainly focused on the status of GW contamination, origins of NO3- and potential human health risks through integrated hydrochemistry, correlation analysis, isotopes (15N, δ18O), Bayesian and USEPA human health risk models. Slightly acidic to alkaline GW and SW environments were observed. Electrical conductivity (EC) values above 1000 µS/cm were recorded in 45% of the GW with a maximum of 19370 µS/cm. NO3- in GW ranged from 0.12 to 733 mg/L with average 59.6 mg/L and positively correlated with K+, Ca2+, Mg2+, Cl-, Na+ and EC. In SW, a maximum of 5.3 mg/L of NO3- was observed. Largely, 75% of the GW exceeded local background NO3- value of 2.1 mg/L, while 35% were above the WHO recommended value of 50 mg/L. Bivariate and correlation relationships elucidated human contributions to sources of NO3-, Cl-, SO42- and K+ to GW in the basin. From NO3-/Cl- ratio, 43% of the GW and 21% of SW were affected by effluents and agrochemicals. Values for δ15N-NO3- and δ18O-NO3- ranged from +4.2‰ to +27.5‰ and +4.5‰ to +19.9‰ for GW, and from +3.8‰ to +14.0‰ and +10.7‰ to +25.2‰ for SW. Manure, septic effluents and mineralized fertilizers are sources of NO3- contamination of water in the basin. The Bayesian model apportioned 80% of GW NO3- contamination to sewage/manure. Hazard index indicated 70%, 50% and 48% medium to high-risk levels for infants, children and adults respectively, with 79% high-risk of SW NO2- contamination to infants. Immediate measures for GW and SW quality protection are recommended.

A structured literature review of interventions used in the management of nonalcoholic steatohepatitis (NASH).

Nonalcoholic steatohepatitis (NASH) is a chronic, progressive disease, that can advance to fibrosis, cirrhosis, and hepatocellular carcinoma. Despite being a leading cause of liver transplantation, there are no approved pharmacological treatments. Our aim was to identify literature on management options in NASH. Our structured review of interventions treating NASH patients from English language publications between 1 January 2007 and 25 September 2017 elicited 48 eligible references. Lifestyle management was identified as the mainstay of NASH therapy. Vitamin E and pioglitazone reported reductions in steatosis; however, although recommended for some, no therapies are indicated in NASH. Multiple investigational treatments reported efficacy in mild-to-moderate fibrosis in Phase II/III NASH trials. Lifestyle management, although the focus of clinical guidelines, is insufficient for patients progressing to advanced fibrosis. With no clear guidelines for patients requiring interventions beyond lifestyle modification, long-term outcomes data are needed, particularly in patients with moderate-to-severe fibrosis.

Extramammary Paget's Disease.

Extramammary Paget disease (EMPD) is a rare cutaneous malignancy most commonly affecting the genitals, perineum, and perianal area of the elderly. Despite its rarity, to those impacted, the disease and its treatment can have a tremendous impact on quality of life. Commonly confined to the epidermis, EMPD can be invasive, associated with contiguous extension or upward pagetoid spread of underlying malignancy or with distant synchronous malignancy. Because of its association with other cancers, formal evaluation is warranted. Treatment varies widely and evidence-based approaches are lacking. The authors review the workup and management options for the patient with EMPD.

Triple-Valve Endocarditis in a Diabetic Patient: Case Report and Literature Review.

BACKGROUND: Despite major advancements since its first description in the 19th century, infective endocarditis remains a significant medical challenge. Although commonly involving a single valve, multiple valve involvement may occur, complicating matters even further. Triplevalve endocarditis is a very rare phenomenon. Poorly studied and described only a handful of times in the literature, little is known about the optimal therapeutic and management options in dealing with this complex entity. CONCLUSION: In this paper we describe the case of a 48-year-old male who was diagnosed with triple-valve endocarditis and provide a review of the literature to delineate what is already known and improve our understanding of this rare phenomenon.

Guiding the Child's Teeth with Class III Dental Malocclusion into Correct Occlusion: A Clinician's Parenting.

Pediatric dentists are often the first ones to be consulted for the presence of an anterior cross bite in the primary dentition. The condition requires an early interception to avoid progressive dentoalveolar and skeletal changes. The management, however, poses unique challenges in terms of young age of the child, correct choice of appliance and unpredictability of the response to treatment due to inability to ascertain the inherent growth potential. It is very important therefore for the specialist, to be able to recognize the early signs of a developing class III malocclusion tendency and also know the basic details of successful management of such cases. The following article describes the appropriateness of appliance choice for a case of incisor cross bite in primary dentition using different appliances based on their varied clinical presentations.