The Cost-Effectiveness of an Advanced Hybrid Closed-Loop System in People with Type 1 Diabetes: a Health Economic Analysis in Sweden.

INTRODUCTION: Swedish National Diabetes Registry data show a correlation of improved glycemic control in people with type 1 diabetes (T1D) with increased use of diabetes technologies over the past 25 years. However, novel technologies are often associated with a high initial outlay. The aim of the present study was to evaluate the long-term cost-effectiveness of the advanced hybrid closed-loop (AHCL) MiniMed 780G system versus intermittently scanned continuous glucose monitoring (isCGM) plus self-injection of multiple daily insulin (MDI) or continuous subcutaneous insulin infusion (CSII) in people with T1D in Sweden. METHODS: Outcomes were projected over patients' lifetimes using the IQVIA CORE Diabetes Model (v9.0). Clinical data, including changes in glycated hemoglobin (HbA1c) and hypoglycemia rates, were sourced from observational studies and a randomized crossover trial. Modeled patients were assumed to receive the treatments for their lifetimes, with HbA1c kept constant following the application of treatment effects. Costs were accounted from a societal perspective and expressed in Swedish krona (SEK). Utilities and days off work estimates were taken from published sources. RESULTS: The MiniMed 780G system was associated with an improvement in life expectancy of 0.16 years and an improvement in quality-adjusted life expectancy of 1.95 quality-adjusted life years (QALYs) versus isCGM plus MDI or CSII. These clinical benefits were due to a reduced incidence and a delayed time to onset of diabetes-related complications. Combined costs were estimated to be SEK 727,408 (EUR 72,741) higher with MiniMed 780G, with treatment costs partially offset by direct cost savings from the avoidance of diabetes-related complications and indirect cost savings from the avoidance of lost workplace productivity. The MiniMed 780G system was associated with an incremental cost-effectiveness ratio of SEK 373,700 per QALY gained. CONCLUSIONS: Based on a willingness-to-pay threshold of SEK 500,000 per QALY gained, the MiniMed 780G system was projected to be cost-effective versus isCGM plus MDI or CSII for the treatment of T1D in Sweden.

A hermeneutic approach to the characteristics of mental health nursing practice.

Mental health nursing (MHN) takes a non-reductionist view of the human being, based on a hermeneutic and interdisciplinary perspective. MHN is dependent on the development of hermeneutic knowledge for understanding the deeper meaning of, for example, encountering a patient with emotional pain. The aim of this study was to provide a philosophical discussion about the characteristics of MHN practice. The hermeneutic approach was used to expand the philosophical discussion of MHN. In order to explore the consequences for MHN practice, previous relevant research within the discipline of MHN was used, exemplified by patients suffering from emotional pain. Two themes emerged: A reflective way of being and working and Relationships as a foundation for change and improvements. Four themes emerged related to the practice of the nurse: Desire for confirmation and trust, The vulnerable human being, The difficulties involved in responsibility and The power of self-development, authenticity and freedom. MHN must be open to changing some of the negative images of past interdisciplinary discussions in order to provide high quality care and support to the suffering patient. The hermeneutic approach is one way to help nurses who work in the context of mental health to understand and use their intuition and empathy to empower patients, thus providing hope and future possibilities.

Emotional pain: surviving mental health problems related to childhood experiences.

Emotional pain is described as intense by women who suffer from borderline personality disorder (BPD), and a high prevalence of reported childhood abuse was found in the literature and in research. The aim of this study was to explore the experiences of women suffering from BPD with focus on emotional pain related to childhood. An explorative design was used. Data were collected from in-depth interviews consisting of women suffering from BPD (n = 13) and an interpretive content analysis was used to analyse the text. The findings revealed two main themes: 'Power' and 'Assessment of vulnerability'. The main theme 'Power' resulted in two categories: 'Surviving the feeling of being forced' and 'Surviving the feeling of having to assume responsibility'. The other main theme 'Assessment of vulnerability' had two categories: 'Surviving the feeling of being victimized' and 'Surviving the feeling of not being loved'. The findings suggest that nursing care need to develop an understanding of how these women endure their emotional pain, and try to survive as fighting spirits and how struggling became their way of life.

The adoption of smoke-free hospital campuses in the United States.

BACKGROUND: The adoption of a smoke-free hospital campus policy is often a highly publicised local event. National media coverage suggests that the trend towards adopting these policies is growing, and this publicity can frequently lead hospital administrators to consider the adoption of such policies within their own institutions. Little is actually known, however, about the prevalence of these policies or their impact. OBJECTIVES: To determine the national prevalence of smoke-free hospital campus policies and the relation between these policies and performance on nationally standardised measures for smoking cessation counselling in US hospitals. METHODS: 4494 Joint Commission-accredited hospitals were invited to complete a web-based questionnaire assessing current smoking policies and future plans. Smoking cessation counselling rates were assessed through nationally standardised measures. RESULTS: The 1916 hospitals responding to the survey (43%) were statistically similar to non-responders with respect to performance measure rates, smoking policies and demographic characteristics. Approximately 45% of responders reported an existing smoke-free hospital campus policy. With respect to demographics, higher proportions of smoke-free campus policies were reported in non-teaching and non-profit hospitals. Smoke-free campus hospitals were also more likely to provide smoking cessation counselling to patients with acute myocardial infarction, heart failure and pneumonia who smoke (p<0.001). CONCLUSIONS: By February 2008, 45% of US hospitals (up from approximately 3% in 1992) had adopted a smoke-free campus policy; another 15% reported actively pursuing the adoption of such a policy. By the end of 2009, it is likely that the majority of US hospitals will have a smoke-free campus.

Pet owners' attitudes and behaviours related to smoking and second-hand smoke: a pilot study.

BACKGROUND: Although research indicates that second-hand smoke (SHS) harms both human and animal health, data on the percentage of pet owners who smoke or allow smoking in their homes are not readily available. OBJECTIVE: To investigate pet owners' smoking behaviour and policies on smoking in their homes, and the potential for educational interventions to motivate change in pet owners' smoking behaviour. METHODS: A web-based survey was used with 3293 adult pet owners. The main outcome measures were smoking behaviour of pet owners and their cohabitants; policies on smoking in pet owners' homes; and impact of information about the dangers of pet exposure to SHS on pet owners' smoking intentions. RESULTS: Of respondents, 21% were current smokers and 27% of participants lived with at least one smoker. Pet owners who smoke reported that information on the dangers of pet exposure to SHS would motivate them to try to quit smoking (28.4%) and ask the people with whom they live to quit smoking (8.7%) or not to smoke indoors (14.2%). Moreover, non-smoking pet owners who live with smokers said that they would ask the people with whom they live to quit (16.4%) or not smoke indoors (24.2%) if given this information. About 40% of current smokers and 24% of non-smokers living with smokers indicated that they would be interested in receiving information on smoking, quitting, or SHS. CONCLUSIONS: Educational campaigns informing pet owners of the risks of SHS exposure for pets could motivate some owners to quit smoking. It could also motivate these owners and non-smoking owners who cohabit with smokers make their homes smoke-free.

Clearing the airways: advocacy and regulation for smoke-free airlines.

OBJECTIVE: To examine the advocacy and regulatory history surrounding bans on smoking in commercial airliners. METHODS: Review of historical documents, popular press articles, and other sources to trace the timeline of events leading up to the US ban on smoking in airliners and subsequent efforts by airlines and other nations. RESULTS: In early years, efforts by flight attendants and health advocates to make commercial airliners smoke-free were not productive. Advocacy efforts between 1969 and 1984 resulted in maintenance of the status quo, with modest exceptions (creation of smoking and non-smoking sections of aircraft, and a ban on cigar and pipe smoking). Several breakthrough events in the mid 1980s, however, led to an abrupt turnaround in regulatory efforts. The first watershed event was the publication in 1986 of the National Academy of Science's report on the airliner cabin environment, which recommended banning smoking on all commercial flights. Subsequently, following concerted lobbying efforts by health advocates, Congress passed legislation banning smoking on US domestic flights of less than two hours, which became effective in 1988. The law was made permanent and extended to flights of less than six hours in 1990. This landmark legislation propelled the adoption of similar rules internationally, both by airlines and their industry's governing bodies. Though the tobacco industry succeeded in stalling efforts to create smoke-free airways, it was ultimately unable to muster sufficient grassroots support or scientific evidence to convince the general public or policymakers that smoking should continue to be allowed on airlines. CONCLUSIONS: The movement to ban smoking in aircraft represents a case study in effective advocacy for smoke-free workplaces. Health advocates, with crucial assistance from flight attendants, used an incremental advocacy process to push for smoking and non-smoking sections on US commercial flights, then for smoking bans on short domestic flights, and finally for completely smoke-free domestic and international flights. Through the course of the battle, advocates from all quarters of tobacco control presented a unified message, exhibited remarkable focus on an attainable goal, and effectively leveraged their relationships with champions in both government and the private sector.

Gastric uptake of Tc-99m MDP in a child treated with isotretinoin.

The side effects of prolonged isotretinoin therapy include progressive calcification of ligamentous and tendon insertions, premature fusion of epiphyses, and modeling abnormalities of long bones. Increased calcification of gastric mucosa has been reported only in animal studies, but not in humans. A case of a child who was treated with isotretinoin for 26 months for a dermatologic disorder and who showed abnormal gastric uptake of 99m-Tc MDP on a bone scan is reported.

Impetigo herpetiformis associated with hypocalcemia of congenital rickets.

A 30-year-old woman with congenital rickets and autosomal recessive ichthyosis developed impetigo herpetiformis in the second trimester of her first pregnancy. This condition was temporally related to her discontinuation of vitamin D supplements and subsequent hypocalcemia. No associated systemic symptoms were observed, and a healthy baby was delivered prematurely at 34 weeks' gestation. This report supports the association between hypocalcemia and impetigo herpetiformis and raises theoretical questions regarding a relationship between vitamin D metabolism and various epidermal hyperproliferative states.

Experiences of postoperative chylothorax in children.

Eight cases of postoperative chylothorax in children are discussed. The age of the patients varied between 5 hours and 18 months. Chylothorax was diagnosed between 3 and 14 days after operation. In 6 cases chylothorax was certainly due to damage to the thoracic duct, or other big lymph vessels in the lungs or mediastinum. These patients had no typical pulmonary changes before chylothorax developed. In 2 cases there was probably no damage to the lymph vessels, but the venous pressure in the upper part of the body was elevated by constriction of the superior caval vein. The anatomical prerequisites for chylothorax in these cases is discussed. In these patients, before chylothorax, pulmonary changes appeared in the radiograph interpreted as widened lymph vessels and caused by altered lymph flow at the periphery. If pulmonary changes of this kind appear in patients with elevation of pressure in the superior caval vein, this may be a sign that chylothorax may develop. The importance of early diagnosis is stressed. Drainage of the pleura with continuous suction has proved to be the therapy of choice. Direct operation has not been necessary in any of our cases.