Assuntos
Pesquisa Biomédica/economia , Pesquisa Biomédica/estatística & dados numéricos , Doenças do Sistema Nervoso Central/economia , Neurociências/economia , Neurociências/estatística & dados numéricos , Pesquisa Translacional Biomédica/tendências , Animais , Pesquisa Biomédica/tendências , Doenças do Sistema Nervoso Central/epidemiologia , Ensaios Clínicos como Assunto/economia , Ensaios Clínicos como Assunto/tendências , Indústria Farmacêutica/economia , Indústria Farmacêutica/estatística & dados numéricos , Indústria Farmacêutica/tendências , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Regeneração Nervosa/efeitos dos fármacos , Regeneração Nervosa/fisiologia , Neurociências/organização & administração , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Prevalência , Traumatismos da Medula Espinal/tratamento farmacológico , Traumatismos da Medula Espinal/fisiopatologia , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/terapia , Pesquisa Translacional Biomédica/organização & administraçãoRESUMO
We describe the process of establishing a large database for the investigation of craniotomy infection and the preliminary results of this database. The initial results have been used to generate a cost analysis for craniotomy infection. The craniotomy infections database prospectively registers craniotomy cases taking place in the John Radcliffe Hospital. In order to achieve this, each patient's details are registered at the time of operation and followed up to identify cases of infection. Infection was defined strictly according to Centre for Disease Control criteria and validated by at least two members of clinical staff. The first 10 months of data are presented here which identifies a total of 245 craniotomies and 20 verified craniotomy infections. An overall infection rate of 8% is identified, and the cost incurred by the neurosurgery department as a result of craniotomy infections is estimated at £1 85 660 for the 10-month period studied. This amounts to a cost per case of infection of £9283.
Assuntos
Doenças do Sistema Nervoso Central/economia , Craniotomia/economia , Infecções/economia , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/mortalidade , Custos e Análise de Custo , Craniotomia/efeitos adversos , Craniotomia/mortalidade , Coleta de Dados/economia , Coleta de Dados/métodos , Bases de Dados Factuais , Feminino , Seguimentos , Humanos , Infecções/etiologia , Infecções/mortalidade , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação/economia , Infecção da Ferida Cirúrgica/economiaRESUMO
PURPOSE OF REVIEW: Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice. RECENT FINDINGS: Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects. SUMMARY: Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.
Assuntos
Doenças do Sistema Nervoso Central/reabilitação , Técnicas de Laboratório Clínico/instrumentação , Técnicas de Laboratório Clínico/tendências , Modalidades de Fisioterapia/instrumentação , Modalidades de Fisioterapia/tendências , Atividades Cotidianas , Doenças do Sistema Nervoso Central/economia , Técnicas de Laboratório Clínico/economia , Análise Custo-Benefício/economia , Terapia por Estimulação Elétrica/economia , Terapia por Estimulação Elétrica/instrumentação , Terapia por Estimulação Elétrica/métodos , Custos de Cuidados de Saúde/tendências , Humanos , Avaliação de Resultados em Cuidados de Saúde/economia , Avaliação de Resultados em Cuidados de Saúde/métodos , Modalidades de Fisioterapia/economia , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/tendências , Robótica/economia , Robótica/instrumentação , Robótica/tendênciasRESUMO
BACKGROUND: Orbital and intracranial complications of pediatric acute rhinosinusitis (ARS) are uncommon. With a risk of significant morbidity, hospital utilization and the financial burden of these entities are often high. We sought to assess utilization trends for complicated ARS and elucidate which factors influence cost. METHODOLOGY: Analysis of Kids' Inpatient Database (2006, 2009 and 2012). Children were selected based on diagnosis codes for ARS and grouped as: uncomplicated ARS, orbital complications (OC), or intracranial complications (IC). Patients with IC were subdivided into abscess (ICa), meningitis, or sinus thrombosis. Length of stay (LOS), cost and management information were analysed. Data presented as median [IQR]. RESULTS: A weighted total of 20,775 children were included. OC and IC were observed in 10.9% and 2.7% of these patients. LOS was longer for IC compared to OC (9 [8] v 4 [3]days, pâ¯<â¯0.001). Daily cost for IC was greater than OC ($2861 [4044] v $1683 [1187], pâ¯<â¯0.001), likely due to differences in need for surgery (IC 66.3% v OC 37.1%, pâ¯<â¯0.001). Within the ICa group, patients who received both otolaryngologic (ENT) and neurosurgery, compared to neurosurgery alone, had higher total cost ($41,474 [41,976] v $32,299 [18,235], pâ¯<â¯0.001) but similar LOS (12 [10] v 11 [9] days, pâ¯=â¯0.783). CONCLUSIONS: Children with IC required more surgery than their OC counterparts, resulting in a longer LOS and increased cost. Within the ICa group, the addition of ENT surgery to neurosurgery resulted in higher costs, but with a similar LOS. Considering the increased costs, the additional benefit of ENT surgery to those with children with IC should be investigated further.
Assuntos
Doenças do Sistema Nervoso Central/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Doenças Orbitárias/economia , Rinite/complicações , Sinusite/complicações , Doença Aguda , Adolescente , Abscesso Encefálico/economia , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Doenças do Sistema Nervoso Central/etiologia , Doenças do Sistema Nervoso Central/cirurgia , Criança , Bases de Dados Factuais , Feminino , Humanos , Masculino , Meningite/economia , Meningite/etiologia , Meningite/cirurgia , Procedimentos Neurocirúrgicos/economia , Doenças Orbitárias/etiologia , Doenças Orbitárias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/economia , Trombose dos Seios Intracranianos/economia , Trombose dos Seios Intracranianos/etiologia , Trombose dos Seios Intracranianos/cirurgiaRESUMO
Over the course of a year, more than 20,000 patients in Taiwan require prolonged mechanical ventilation (PMV). Data from the National Health Insurance Research Database for patients between 2005 and 2011 were used to conduct a retrospective analysis on ventilator dependence. The study subjects were PMV patients aged <17 years in Taiwan. A multiple regression model employing general estimating equations was applied to investigate the factors affecting the use of medical resources by children and adolescent PMV patients. A Cox proportional hazard model was incorporated to explore the factors affecting the survival of these patients. Data were collected for a total of 1,019 children and adolescent PMV patients in Taiwan. The results revealed that the average number of outpatient visits per subject was 32.1 times per year, whereas emergency treatments averaged 1.56 times per year per subject and hospitalizations averaged 160.8 days per year per subject. Regarding average annual medical costs, hospitalizations accounted for the largest portion at NT$821,703 per year per subject, followed by outpatient care at NT$123,136 per year per subject and emergency care at NT$3,806 per year per subject. The demographic results indicated that the patients were predominately male (61.24%), with those under 1 year of age accounting for the highest percentage (36.38%). According to the Kaplan-Meier curve, the 1-year and 5-year mortality rates of the patients were approximately 32% and 47%, respectively. The following factors affecting the survival rate were considered: age, the Charlson Comorbidity Index (CCI), diagnosis type necessitating ventilator use, and whether an invasive ventilator was used. This study investigated the use of medical resources and the survival rates of children and adolescent PMV patients. The findings of this study can serve as a reference for the National Health Insurance Administration in promoting its future integrated pilot projects on ventilator dependency.
Assuntos
Respiração Artificial , Insuficiência Respiratória/patologia , Adolescente , Doenças do Sistema Nervoso Central/economia , Doenças do Sistema Nervoso Central/mortalidade , Doenças do Sistema Nervoso Central/patologia , Criança , Pré-Escolar , Feminino , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Masculino , Programas Nacionais de Saúde , Modelos de Riscos Proporcionais , Respiração Artificial/economia , Insuficiência Respiratória/economia , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , TaiwanRESUMO
Low birthweight is costly to sufferers and to society. Primary prevention gives benefits exceeding costs, but many plans to prevent low birthweight, for example improvement in antenatal care, have failed because the intervention is too late. Preconception care is generally necessary. Poor maternal nutrition and infection are the major causes of low birthweight.
Assuntos
Doenças do Sistema Nervoso Central/prevenção & controle , Retardo do Crescimento Fetal/prevenção & controle , Recém-Nascido de Baixo Peso , Deficiência Intelectual/prevenção & controle , Doenças do Sistema Nervoso Central/economia , Doenças do Sistema Nervoso Central/embriologia , Doenças do Sistema Nervoso Central/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Retardo do Crescimento Fetal/complicações , Retardo do Crescimento Fetal/fisiopatologia , Humanos , Recém-Nascido de Baixo Peso/fisiologia , Recém-Nascido , Deficiência Intelectual/economia , Deficiência Intelectual/embriologia , Deficiência Intelectual/epidemiologia , Masculino , Gravidez , Cuidado Pré-Natal , Fatores de RiscoRESUMO
Magnetic resonance imaging offers new and improved diagnostic capabilities in all body parts and organ systems. Examinations can be quicker, safer and less expensive than traditional radiological procedures. The cost/efficiency of magnetic resonance imaging is under active evaluation.
Assuntos
Imageamento por Ressonância Magnética/economia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/economia , Análise Custo-Benefício , Humanos , Angiografia por Ressonância Magnética/economia , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/economiaRESUMO
INTRODUCTION: The incidence in the central nervous system diseases has increased with a growing elderly population. Unfortunately, conventional treatments used to treat the mentioned diseases are frequently ineffective due to the presence of the blood brain barrier. AIM: To illustrate the blood-brain barrier properties that limit drug transport into the brain and the main strategies employed to treat neurologic disorders. DEVELOPMENT: The blood-brain barrier is mainly composed of a specialized microvascular endothelium and of glial cells. It constitutes a valuable tool to separate the central nervous system from the rest of the body. Nevertheless, it also represents an obstacle to the delivery of therapeutic drugs to the brain. CONCLUSIONS: To be effective, drugs must reach their target in the brain. On one hand, therapeutic agents could be designed to be able to cross the blood brain barrier. On the other hand, drug delivery systems could be employed to facilitate the therapeutic agents' entry into the central nervous system. In vivo models of neurological diseases, in addition to in vitro models of the blood brain barrier, have been widely employed for the evaluation of drugs utilized to treat central nervous system diseases.
TITLE: Afecciones neurologicas y barrera hematoencefalica. Limitaciones y estrategias para la liberacion de farmacos al cerebro.Introduccion. La incidencia de enfermedades del sistema nervioso central (SNC) aumenta a causa del envejecimiento de la sociedad. Desgraciadamente, los tratamientos clasicos para tratarlas no resultan efectivos debido a la presencia de la barrera hematoencefalica. Objetivo. Abordar las propiedades de la barrera hematoencefalica que impiden el transporte de los farmacos al cerebro y las principales estrategias para tratar las afecciones neurologicas. Desarrollo. La barrera hematoencefalica esta compuesta principalmente por un endotelio vascular especializado y las celulas de la glia. Esta constituye una herramienta a disposicion del organismo para aislar al SNC del resto del cuerpo. Sin embargo, tambien supone un impedimento para que muchos farmacos alcancen su diana en el cerebro. Conclusiones. Para poder tratar las afecciones neurologicas, los farmacos deben ser capaces de alcanzar el cerebro. Los agentes terapeuticos pueden diseñarse para que sean capaces de atravesar esta barrera, o bien facilitar su entrada mediante el uso de sistemas de liberacion. Para evaluar la efectividad de los tratamientos dirigidos a enfermedades del SNC, se emplean los modelos animales de enfermedades neurologicas asi como modelos in vitro de barrera hematoencefalica.
Assuntos
Barreira Hematoencefálica , Fármacos do Sistema Nervoso Central/farmacocinética , Doenças do Sistema Nervoso Central/tratamento farmacológico , Sistemas de Liberação de Medicamentos , Adulto , Idoso , Idoso de 80 Anos ou mais , Astrócitos/fisiologia , Barreira Hematoencefálica/citologia , Barreira Hematoencefálica/fisiologia , Fármacos do Sistema Nervoso Central/administração & dosagem , Doenças do Sistema Nervoso Central/economia , Doenças do Sistema Nervoso Central/epidemiologia , Portadores de Fármacos , Células Endoteliais/fisiologia , Endotélio Vascular/fisiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neurônios/fisiologia , Pericitos/fisiologia , PrevalênciaAssuntos
Doenças do Sistema Nervoso Central/economia , Efeitos Psicossociais da Doença , Transtornos Mentais/economia , Apoio à Pesquisa como Assunto , Doenças do Sistema Nervoso Central/epidemiologia , Doença Crônica , Humanos , Transtornos Mentais/epidemiologia , Literatura de Revisão como AssuntoAssuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Síndrome da Imunodeficiência Adquirida/diagnóstico , Doenças do Sistema Nervoso Central/diagnóstico , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Leucoencefalopatia Multifocal Progressiva/diagnóstico , Tuberculose Pulmonar/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/economia , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/economia , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/economia , Antituberculosos/administração & dosagem , Antituberculosos/economia , Doenças do Sistema Nervoso Central/tratamento farmacológico , Doenças do Sistema Nervoso Central/economia , Países em Desenvolvimento , Diagnóstico Diferencial , Feminino , Recursos em Saúde , Acessibilidade aos Serviços de Saúde/economia , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/economia , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Leucoencefalopatia Multifocal Progressiva/economia , Masculino , Pobreza , Fatores de Risco , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/economia , Carga ViralAssuntos
Doenças do Sistema Nervoso Central/tratamento farmacológico , Descoberta de Drogas/legislação & jurisprudência , Neurociências/métodos , Pesquisa/legislação & jurisprudência , Doenças do Sistema Nervoso Central/economia , Doenças do Sistema Nervoso Central/metabolismo , Ensaios Clínicos como Assunto , Europa (Continente) , Humanos , Terapia de Alvo MolecularRESUMO
Bovine pericardium has been widely used for grafts in cardiac surgery and seems to have suitable properties for use as a dural graft. We report on the use of solvent-preserved, gamma-sterilized Tutoplast bovine pericardium for dural grafts in 32 patients undergoing cranial and spinal operations with the objective of clinically assessing this material and technique by a retrospective analysis. All available records were reviewed and information regarding the indication for grafting, complications, and outcome were collected and analyzed for all patients. Indications for grafting included tethered cord myelolysis, closure of lumbosacral myeloceles, Chiari decompression, posterior fossa craniotomy, supratentorial craniotomy, and trauma. Outcomes were excellent in 31 patients; the one poor outcome was unrelated to surgical closure. The dural graft was not intended for outcome in any patient. Bovine pericardium was found to be a flexible and easily suturable, safe and cost-effective material for duraplasty. These results confirm the excellent suitability of Tutoplast bovine pericardium for dural substitution.
Assuntos
Bioprótese , Doenças do Sistema Nervoso Central/cirurgia , Dura-Máter/cirurgia , Pericárdio/transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Bovinos , Doenças do Sistema Nervoso Central/economia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Preservação de Tecido/economia , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. DESIGNS AND METHODS: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. MAIN RESULTS: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. CONCLUSIONS: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).
Assuntos
Doenças do Sistema Nervoso Central/diagnóstico , Imageamento por Ressonância Magnética/economia , Adulto , Doenças do Sistema Nervoso Central/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Feminino , Humanos , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/economia , Anos de Vida Ajustados por Qualidade de Vida , Tomografia Computadorizada por Raios X/economiaRESUMO
Because the federal government's diagnosis-related group (DRG) classification system for prospective payment has not been widely applied to hospitalized pediatric patients, we analyzed the effectiveness of one DRG category (central nervous system infections) for a single year at a medium-sized children's hospital to control for patients' severity of illness and for hospital reimbursement. Several independent measures of severity of illness (length of stay, duration of fever, Physiologic Severity Index) showed that patients with bacterial meningitis and those with encephalitis (DRG 20) were more ill than those with aseptic meningitis (DRG 21) (p less than 0.001 for each measure). Cost analysis revealed that the hospital was only partially reimbursed for its charges (shortfall of $95,547) and that patients with Medicaid or no insurance accounted for 22% of discharges but 88% of losses. Reimbursement by DRG would have increased payment for DRG 21 but decreased that for DRG 20. If DRGs were applied to pediatric central nervous system infections and used in a prospective payment system, they would accurately predict disease severity between but not within groups, and significant financial losses for children's hospitals would still occur.