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1.
BJOG ; 130(2): 214-221, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36330672

RESUMO

OBJECTIVE: Patients with recurrent endometrial cancer treated with carboplatin and paclitaxel whose disease progresses have few effective treatment options. Based on promising clinical trial data, the anti-programmed cell death 1 (anti-PD-1) antibody dostarlimab was recently granted accelerated approval for endometrial cancer by the US Food and Drug Administration. We developed a decision model to examine the cost-effectiveness of dostarlimab for patients with progressive/recurrent deficient mismatch repair (dMMR) endometrial cancer whose disease has progressed with first-line chemotherapy. DESIGN: Cost-effectiveness study. POPULATION: Hypothetical cohort of 6000 women with progressive/recurrent dMMR endometrial cancer. METHODS: The initial decision point in the Markov model was treatment with dostarlimab, pembrolizumab or pegylated liposomal doxorubicin (PLD). Model probabilities, and cost and utility values were derived with assumptions drawn from published literature. Effectiveness was estimated as average quality-adjusted life years (QALYs) gained. One-way, two-way and probabilistic sensitivity analyses were performed to vary the assumptions across a range of plausible values. MAIN OUTCOME MEASURES: The primary outcome was the incremental cost-effectiveness ratio (ICER). RESULTS: Pegylated liposomal doxorubicin (PLD) was the least costly strategy, at $55,732, followed by dostarlimab ($151,533) and pembrolizumab ($154,597). Based on a willingness-to-pay threshold of $100,000/QALY, PLD was cost-effective compared with dostarlimab, with an ICER of $331,913 per QALY gained for dostarlimab, whereas pembrolizumab was ruled out by extended dominance (less effective, more costly), compared with dostarlimab. In one-way sensitivity analyses, dostarlimab was cost-effective when its cost was reduced to $4905 (52% reduction). These results were robust in a variety of sensitivity analyses. CONCLUSIONS: Dostarlimab is associated with greater survival compared with other treatments for women with recurrent dMMR endometrial cancer. Although the agent is substantially more costly, dostarlimab became cost-effective when its cost was reduced to $5489 per cycle.

3.
Blood Cells Mol Dis ; 98: 102704, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36265282

RESUMO

Lysosomal storage disorders (LSD) are a group of inherited metabolic diseases mainly caused by a deficiency of lysosomal hydrolases, resulting in a gradual accumulation of non-degraded substrates in different tissues causing the characteristic clinical manifestations of such disorders. Confirmatory tests of suspected LSD individuals include enzymatic and genetic testing. A well-oriented clinical suspicion can improve the cost-effectiveness of confirmatory tests and reduce the time expended to achieve the diagnosis. Thus, this work aims to retrospectively study the influence of clinical orientation on the diagnostic yield of enzymatic tests in LSD by retrieving clinical, biochemical, and genetic data obtained from subjects with suspicion of LSD. Our results suggest that the clinical manifestations at the time of diagnosis and the initial clinical suspicion can have a great impact on the diagnostic yield of enzymatic tests, and that clinical orientation performed in specialized clinical departments can contribute to improve it. In addition, the analysis of enzymatic tests as the first step in the diagnostic algorithm can correctly guide subsequent confirmatory genetic tests, in turn increasing their diagnostic yield. In summary, our results suggest that initial clinical suspicion plays a crucial role on the diagnostic yield of confirmatory enzymatic tests in LSD.


Assuntos
Dietilamida do Ácido Lisérgico , Doenças por Armazenamento dos Lisossomos , Humanos , Estudos Retrospectivos , Doenças por Armazenamento dos Lisossomos/diagnóstico , Doenças por Armazenamento dos Lisossomos/genética , Doenças por Armazenamento dos Lisossomos/metabolismo , Lisossomos/metabolismo , Hospitais
4.
Eval Program Plann ; 96: 102188, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36442267

RESUMO

Recently, identifying performance indicators and developing measurement frameworks have become crucial concerns. Our study first sought to analyze service statistics of Primary Health Care (PHC) facilities for the years 2017 and 2018 to develop PHC key performance indicators (KPI).This was then followed by a thorough discussion of these KPIs with staff and service providers. Finally, re-rating these PHC (KPI) changes by analyzing service statistics infographs for 2017 and 2018 relative to 2019. El-Aiat Health District-Giza Governorate and its 15 PHC facilities served as the study's setting. A quasi-experimental intervention design was used based on operation research with quantitative and qualitative data analysis. The pre-test consisted of a mathematical analysis of service and vital statistics for 2017 and 2018 to calculate composite indices and create infographs (simple colored matrices) for these indices. The intervention included two discussion meetings (2 h each). It included reviewing the Performance Knowledge Matrices (infographs) with the service providers for subsequent problem specification, solving, and suggestion extraction to enhance performance. The SWOC (Strengths, Weaknesses, Opportunities, and Challenges) framework was used to analyze the qualitative data extracted from these conversations. Among the identified flaws were a deficiency in the number of physicians and nurses, inadequate training, insufficient work environments, and a lack of moral appreciation and recognition for the staff. The proposed solutions include providing health education services by nurses and follow-up services in certain units via home visits and mobile clinics. Post-test also entailed analyzing service and vital statistics for 2019 and redisplaying KPI infographics. Four of fifteen PHC facilities achieved a positive response based on the staff-suggested info-action-based intervention, according to our findings after comparing data for the pre-intervention and post-intervention periods of 2017-2018 and 2019. We concluded that reviewing the information derived from the "knowledge performance colored matrix" inspired district and PHC service providers to identify their weaknesses (avoided them as much as possible) and their strengths (practiced the solutions they suggested themselves) in the meetings which eventually improved their performance. Ultimately, the outcome scores and impact indicators of the provided PHC services were enhanced.

5.
J Environ Manage ; 326(Pt A): 116680, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36379080

RESUMO

Protected areas play a paramount role in counteracting the negative effects of human activity on the environment. Without good management effectiveness they might not be able to fulfill their mission. The tools for management effectiveness assessments that are currently most widely used struggle to provide sufficient depth of analysis, present the situation with sufficient breadth of indicators, provide necessary objectivity in identifying challenges during the assessment, and suggesting possible paths for improvement. The Integrated Management Effectiveness Tool (IMET), a novel tool for management effectiveness, is introduced in the article. The purpose of the article is to show that IMET offers instruments for a more in-depth analysis when compared to other protected areas management effectiveness assessment methodologies. Furthermore, the article demonstrates how the introduction of instruments that aid in decision-making and encourage a results-oriented approach can be particularly beneficial in enhancing managerial effectiveness. Additionally, it is asserted that IMET enhances planning and monitoring by incorporating the necessary components into a system of Planning, Monitoring, and Evaluation. IMET has been tested in the field. Ten protected areas from Central Africa (CA) were selected and the tool demonstrated good properties in discriminating between well-performing protected areas and those with a room for improvement. The initial results have pointed to challenges in the management effectiveness dimensions of inputs and process that the studied protected areas are facing. In the long-run IMET is expected to support transition from merely routine management to results-oriented management of protected areas.


Assuntos
Conservação dos Recursos Naturais , Humanos , África Central , Conservação dos Recursos Naturais/métodos
6.
Chemosphere ; 312(Pt 1): 137176, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36400198

RESUMO

This study aims to conduct statistical optimization of nZVI synthesis parameters towards the removal efficiency of phosphorus (P) and nitrate (NO3-), considering for the first time the cost-effectiveness index. The detailed statistical analysis was implemented to evaluate the main effects and interactions of eight synthesis parameters, including reductant concentration (RC), reductant delivery rate (RDR), reductant liquid volume (RLV), pH, aging time (AGT), mixing speed (MS), temperature (T), and precursor concentration (PC). Results revealed that the experimental optimization of the synthesis factors improved the removal efficiency of NO3- and P by 27 and 9%, respectively, with respect to that before the optimization. ANOVA statistical results indicated the significance of RP (%) and [Formula: see text] (%) models with F-values of 4.480 × 108 and 23,755.08, respectively. Moreover, the p-values of all the eight main linear effects were less than 0.05 in both two models of RP (%) and [Formula: see text] (%). However, most of the interaction parameters were not statistically significant (higher than 0.05) in the case of [Formula: see text] (%), which is unlike RP (%) where all interaction parameters were statistically significant (less than 0.05). The normal probability plots of factors effects provided significant evidence of the significance of the investigated parameters RC had the highest positive statistically significant effect on RP (%) followed by RLV, RDR, MS and T. In case of [Formula: see text] (%), RLV had the highest positive significant effect, followed by AGT > RDR > pH > T > MS. The cost-effective optimal constraints in this study resulted in the best economically optimized values of the nZVI synthesis parameters in terms of higher reactivity and reduced synthesis cost.

7.
J Environ Sci (China) ; 124: 735-744, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36182178

RESUMO

Fugitive road dust (FRD) contributes a great deal to urban rainwater and air pollution and is commonly controlled by water-sprinkling in most Chinese cities. However, there is a lack of information on its effectiveness. We used the Testing Re-entrained Aerosol Kinetic Emissions from Roads (TRAKER) method to monitor different types of roads in Baoding city before and within 1 hr after water-sprinkling and obtained the road dirtiness index (a) and PM concentration in the road environment (TT*), to evaluate the removal efficiency for PM deposited on the road surface (ηa) and the reduction efficiency for the PM concentration in the road environment (ηPM). The results give that the ηa for three types of roads is ranked: branch road (87%--100%) > major arterial road (80%-83%) > minor arterial road (68%-77%), and the ηPM ranked: minor arterial road (70%) > branch road (46%-58%) > major arterial road (37%-53%). The ηa and ηPM varied non-linearly with time and presented a quadratic curve. The average effective control time (ηa> 0) was 62 min on the major and minor arterial roads, and much longer than 1 hr on branch roads. The ηPM values diminished completely by 72 min on average from the end of sprinkling for the three types of roads. Water-sprinkling can remove PM10 particles from the road surface and reduce their concentration in the road environment more thoroughly than PM2.5. Our findings could be helpful for controlling urban FRD emissions more efficiently and precisely.


Assuntos
Poluentes Atmosféricos , Poeira , Aerossóis , Poluentes Atmosféricos/análise , China , Poeira/análise , Monitoramento Ambiental , Material Particulado/análise , Emissões de Veículos/análise , Água
8.
Ann Lab Med ; 43(1): 73-81, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36045059

RESUMO

Background: BRCA testing is necessary for establishing a management strategy for ovarian cancer. Several BRCA testing strategies, including germline and somatic testing, are implemented in clinical practice in Korea. We aimed to comparatively evaluate their cost-effectiveness from patients' perspective. Methods: We developed a decision model comprising five BRCA testing strategies implemented in Korea: (1) germline testing first, followed by somatic tumor testing for patients without a germline variant; (2) somatic testing first, followed by germline testing for patients with a variant detected by somatic testing; (3) both germline and somatic testing; (4) germline testing alone; and (5) somatic testing alone, with no testing as the comparator. One-way sensitivity analysis was conducted to test the uncertainty of key parameters. Results: Assuming a willingness-to-pay of $20,000 per progression-free life-year gain (PF-LYG), all five strategies were considered cost-effective. Strategy 4 was the most cost-effective option, with an incremental cost-effectiveness ratio (ICER) of $2,547.7 per PF-LYG, followed by strategy 1, with an ICER of $3,978.4 per PF-LYG. Even when the parameter values were varied within the possible range, the ICERs of all strategies did not exceed the willingness-to-pay threshold. Conclusions: Considering the importance of knowing a patient's BRCA gene status, germline testing first, followed by somatic testing, may be a reasonable option.


Assuntos
Neoplasias Ovarianas , Análise Custo-Benefício , Feminino , Células Germinativas/patologia , Humanos , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/patologia , República da Coreia
9.
Thorac Surg Clin ; 33(1): 11-17, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36372528

RESUMO

Robotic-assisted surgery has been widely adopted in the field of thoracic surgery as a safe, minimally invasive approach with distinct technical advantages. With increased utilization, it has become an integral part of training pathways for the next generation of thoracic surgeons. This review article highlights key steps in implementing a robotic thoracic surgery program at an academic center based on institutional experience and the available surgical literature.


Assuntos
Procedimentos Cirúrgicos Robóticos , Robótica , Cirurgiões , Cirurgia Torácica , Procedimentos Cirúrgicos Torácicos , Humanos , Robótica/educação , Procedimentos Cirúrgicos Torácicos/educação
10.
Philos Trans R Soc Lond B Biol Sci ; 378(1867): 20210073, 2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36373920

RESUMO

As interest in restoring tropical forests surges, so does the need for effective methods to ensure success. The framework species method (FSM) restores forest ecosystems by densely planting open sites, close to natural forest, with woody species, indigenous to the reference ecosystem and selected for their ability to accelerate ecological succession. Criteria for selecting framework species include: (i) representative of the reference forest ecosystem, (ii) tolerant of open conditions, (iii) ability to suppress weeds, (iv) attractiveness to seed-dispersing animals and (v) easily propagated. The method is effective where forest remnants and viable populations of seed dispersers remain. The origins and elements of the FSM are discussed. We review its adoption in 12 countries. Adherence to original principles was mostly high, but some misuse of the term was evident. The need for clearer definitions was identified. We place the FSM on a scale of restoration methods, matched with degradation levels and compare its establishment costs with those of other methods. Obstacles to its wider adoption, both technical and socio-economic, are discussed, along with how these might be overcome. Finally, the FSM is more clearly defined to facilitate its use in contributing towards the goals of the UN Decade on Restoration. This article is part of the theme issue 'Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration'.


Assuntos
Ecossistema , Florestas , Animais , Plantas , Madeira , Projetos de Pesquisa , Conservação dos Recursos Naturais , Árvores , Biodiversidade
11.
Sci Total Environ ; 856(Pt 1): 159127, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36181798

RESUMO

Green roof, as a popular low impact development practice, has become important to mitigate adverse impacts of future climate change on urban stormwater. However, there is limited information regarding assessment of the effectiveness of green roofs in response to uncertain future climate change challenges. In this study, the validated model was used to simulate the reduction performance of green roofs on urban catchment outflow and assess their cost-effectiveness in response to design storms under climate change scenarios. Results showed that the median runoff volume of urban catchments increased by 12.5 %-14.6 % and 15.5 %-18.1 % and the median peak flow rate increased by 14.4 %-17.8 % and 17.9 %-22.1 % under SSP2-4.5 and SSP5-8.5 scenarios, respectively. This indicated the variability of runoff volume and peak flow changes for short return storm events caused by climate change was relatively high. Green roof implementation had reasonable mitigation effects on runoff volume and peak flow amplification in urban catchments caused by climate change. The median runoff volume reduction of green roofs for the 1-year storm was 15.2 % under SSP2-4.5 scenario. As rainfall intensity increased, the median runoff volume reduction of green roofs significantly declined to 5.6 % for the 100-year storm. However, the variations of runoff volume and peak flow reduction of green roofs were relatively smaller for longer return periods under climate change scenarios. Runoff reduction percentages of green roofs increased linearly with their implementation cost. The average value of the cost-effectiveness (C/E) index for green roofs was 91.2 %/million $ under base climate condition, and it decreased to 88.9 %/million $ and 88.4 %/million $ for SSP2-4.5 and SSP5-8.5 scenarios, respectively. The C/E values decreased with increasing storm return period, and the values were relatively lower in SSP5-8.5 scenarios. These results could help to understand the potential role of green roofs to mitigate the impacts of future climate change.


Assuntos
Mudança Climática , Movimentos da Água , Hidrologia , Chuva , Análise Custo-Benefício , Conservação dos Recursos Naturais/métodos
12.
J Environ Manage ; 325(Pt A): 116440, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36242970

RESUMO

Ecosystem services-based land management incorporates environmental features and social needs, providing an important opportunity to realize global sustainability goals. Recent decades, the interaction among water-related ecosystem services (ESs) is getting ambiguous during regional vegetation restoration, which entails challenges for coordinating restoration actions, economic resources, and water-soil resources' availability. In this study, we first explored mechanism of trade-offs among five water-related ESs in the Chinese Loess Plateau under vegetation restoration. Given the decreased baseflow and its widespread trade-offs with water quality, we then developed four scenarios aiming at enhancing the baseflow and nutrient retention in a cost-effective way, by engaging a spatially explicit biophysical software tool-the RIOS model. Moreover, we selected four typical watersheds in the Loess Plateau as cases to demonstrate the differentiated information on the budget levels and the activity sites. The results indicated that, a deep mechanism of scale effects of trade-off among ESs was largely related to spatial heterogeneity rather than spatial resolution, which also affected activity portfolios under different ES scenarios. For the entire Loess Plateau, activity of forest maintenance should be concentrated on the cost-effective locations of investment for the enhancement of baseflow and nutrient retention. Under the regular budget scenarios, trade-offs only could be locally alleviated in reality, while dropping the high-cost ES objectives is an advisable strategy for minimizing investment risk. Taking conservation agricultural practices in the plain river basins should be regarded as a priority when budget can be increased. In contrast, an approach of 'governing by non-interference' for typical watersheds of re-vegetation was sensible strategy for avoiding trade-offs aggravation. These findings emphasized interrelation between the mechanism of ESs trade-offs and activity portfolios, which is an important basis for the implementation of conservation activities in real world context, and a rational reference for the simulation of desired ES goals in future studies.


Assuntos
Conservação dos Recursos Naturais , Ecossistema , Conservação dos Recursos Naturais/métodos , Análise Custo-Benefício , Agricultura/métodos , Solo , China
13.
EClinicalMedicine ; 55: 101729, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36386036

RESUMO

Background: Childhood cancer in low-and middle-income countries is a global health priority, however, the perception that treatment is unaffordable has potentially led to scarce investment in resources, contributing to inferior survival. In this study, we analysed real-world data about the cost-effectiveness of treating 8886 children with cancer at a large resource-limited paediatric oncology setting in Egypt, between 2013 and 2017, stratified by cancer type, stage/risk, and disease status. Methods: Childhood cancer costs (USD 2019) were calculated from a health-system perspective, and 5-year overall survival was used to represent clinical effectiveness. We estimated cost-effectiveness as the cost per disability-adjusted life-year (cost/DALY) averted, adjusted for utility decrement for late-effect morbidity and mortality. Findings: For all cancers combined, cost/DALY averted was $1384 (0.5 × GDP/capita), which is very cost-effective according to WHO-CHOICE thresholds. Ratio of cost/DALY averted to GDP/capita varied by cancer type/sub-type and disease severity (range: 0.1-1.6), where it was lowest for Hodgkin lymphoma, and retinoblastoma, and highest for high-risk acute leukaemia, and high-risk neuroblastoma. Treatment was cost-effective (ratio <3 × GDP/capita) for all cancer types/subtypes and risk/stage groups, except for relapsed/refractory acute leukaemia, and relapsed/progressive patients with brain tumours, hepatoblastoma, Ewing sarcoma, and neuroblastoma. Treatment cost-effectiveness was affected by the high costs and inferior survival of advanced-stage/high-risk and relapsed/progressive cancers. Interpretation: Childhood cancer treatment is cost-effective in a resource-limited setting in Egypt, except for some relapsed/progressive cancer groups. We present evidence-based recommendations and lessons to promote high-value in care delivery, with implications on practice and policy. Funding: Egypt Cancer Network; NIHR School for Primary Care Research; ALSAC.

14.
JAAD Int ; 10: 14-24, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36387062

RESUMO

Background: Few data exist on differences in treatment effectiveness and safety in atopic dermatitis patients of different skin types. Objective: To investigate treatment outcomes of dupilumab, methotrexate, and ciclosporin, and morphological phenotypes in atopic dermatitis patients, stratified by Fitzpatrick skin type. Methods: In an observational prospective cohort study, pooling data from the Dutch TREAT (TREatment of ATopic eczema) NL (treatregister.nl) and UK-Irish A-STAR (Atopic eczema Systemic TherApy Register; astar-register.org) registries, data on morphological phenotypes and treatment outcomes were investigated. Results: A total of 235 patients were included (light skin types [LST]: Fitzpatrick skin type 1-3, n = 156 [Ethnicity, White: 94.2%]; dark skin types [DST]: skin type 4-6, n = 68 [Black African/Afro-Caribbean: 25%, South-Asian: 26.5%, and Hispanics: 0%]). DST were younger (19.5 vs 29.0 years; P < .001), more often had follicular eczema (22.1% vs 2.6%; P < .001), higher baseline Eczema Area and Severity Index (EASI) scores (20.1 vs 14.9; P = .009), less allergic contact dermatitis (30.9% vs 47.4%; P = .03), and less previous phototherapy use (39.7% vs 59.0%; P = .008). When comparing DST and LST corrected for covariates including baseline EASI, DST showed greater mean EASI reduction between baseline and 6 months with only dupilumab (16.7 vs 9.7; adjusted P = .032). No differences were found for adverse events for any treatments (P > .05). Limitations: Unblinded, non-randomized. Conclusion: Atopic dermatitis differs in several characteristics between LST and DST. Skin type may influence treatment effectiveness of dupilumab.

15.
BMC Musculoskelet Disord ; 23(1): 308, 2022 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-35361169

RESUMO

BACKGROUND: Calcific tendinitis of the shoulder (CT) is a common disorder with a large disease burden. The initial treatment is with conservative measures. However, when this fails the next step treatment remains unclear. Minimal invasive treatment modalities have emerged. Needle aspiration of the calcific deposits (NACD) and extracorporeal shock wave therapy (ESWT) have both shown good clinical results. Nonetheless, in the current orthopedic literature there are not any studies available that compare both the effectiveness and cost-effectiveness of those two treatment modalities. Therefore, our primary objective is to compare the effectiveness of NACD to ESWT. A secondary objective is to compare the cost-effectiveness of both treatment modalities and workability. METHODS: Following a power calculation using the minimal clinical important difference of our primary outcome (Constant-Murley score, CMS) 140 patients will be included in the study. Enrolment is based upon strict inclusion/ exclusion criteria outlined in the Methods section. Participants will be randomized by computer in two groups (e.g. 70 patients will receive NACD and 70 patients will receive ESWT). The NACD treatment will consist of a sonographically guided removal of the calcific deposits and the ESWT treatment will be a focused ESWT. Both treatments will be conducted according to a standardized protocol, as part of care as usual in our hospital. The primary outcome will be the between group differences in functional outcome (measured with the CMS) between baseline and after 12 months follow-up. Secondary outcomes will be questionnaires regarding the clinical outcome (SST) and quality of life (EQ-5D-5L). Furthermore, NRS pain and cost related questionnaires (iPCQ and ProDisQ) will be collected during follow-up after two months, six months and at final follow-up after 12 months. DISCUSSION: This study will provide more insight regarding treatment for conservative therapy resistant calcific tendinitis of the shoulder by comparing NACD to focused ESWT, which will aid the physician and patient in determining the appropriate treatment plan. TRIAL REGISTRATION: Dutch trial register: NTR7093 registered on 11 March 2018.


Assuntos
Calcinose , Tratamento por Ondas de Choque Extracorpóreas , Tendinopatia , Calcinose/complicações , Calcinose/diagnóstico por imagem , Calcinose/terapia , Tratamento Conservador , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Ombro , Tendinopatia/complicações , Tendinopatia/diagnóstico por imagem , Tendinopatia/terapia , Resultado do Tratamento
17.
Circ Cardiovasc Qual Outcomes ; : e008951, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36453260

RESUMO

BACKGROUND: While clinical guidelines recommend direct-acting oral anticoagulants (DOAC) over warfarin to treat isolated nonvalvular atrial fibrillation, guidelines are silent regarding nonvalvular atrial fibrillation treatment among individuals with cancer, reflecting the paucity of evidence in this setting. We quantified relative risk of ischemic stroke or systemic embolism and major bleeding (primary outcomes), and all-cause and cardiovascular death (secondary outcomes) among older individuals with cancer and nonvalvular atrial fibrillation comparing DOACs and warfarin. METHODS: This retrospective cohort study used Surveillance, Epidemiology, and End Results cancer registry and linked US Medicare data from 2010 through 2016, and included individuals diagnosed with cancer and nonvalvular atrial fibrillation who newly initiated DOAC or warfarin. We used inverse probability of treatment weighting to control confounding. We used competing risk regression for primary outcomes and cardiovascular death, and Cox proportional hazard regression for all-cause death. RESULTS: Among 7675 individuals included in the cohort, 4244 (55.3%) received DOACs and 3431 (44.7%) warfarin. In the inverse probability of treatment weighting analysis, there was no statistically significant difference among DOAC and warfarin users in the risk of ischemic stroke or systemic embolism (1.24 versus 1.19 events per 100 person-years, adjusted hazard ratio 1.41 [95% CI, 0.92-2.14]), major bleeding (3.08 versus 4.49 events per 100 person-years, adjusted hazard ratio 0.90 [95% CI, 0.70-1.17]), and cardiovascular death (1.88 versus 3.14 per 100 person-years, adjusted hazard ratio 0.82 [95% CI, 0.59-0.1.13]). DOAC users had significantly lower risk of all-cause death (7.09 versus 13.3 per 100 person-years, adjusted hazard ratio 0.81 [95% CI, 0.69-0.94]) compared to warfarin users. CONCLUSIONS: Older adults with cancer and atrial fibrillation exposed to DOACs had similar risks of stroke and systemic embolism and major bleeding as those exposed to warfarin. Relative to warfarin, DOAC use was associated with a similar risk of cardiovascular death and a lower risk of all-cause death.

18.
Curr Diabetes Rev ; 2022 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-36453508

RESUMO

BACKGROUND: The role of pharmacists in middle-income countries such as Indonesia is still not optimal. In this study, we developed a program called "Phardiacare," a specific pharmacist-led program for Type 2 diabetes mellitus (T2DM) patients. OBJECTIVE: The objective of this study is to assess the effectiveness of the application of the "Phardiacare" program in improving medication adherence and clinical outcomes in T2DM patients. METHODS: The study was quasi-experimental, with a pretest-posttest design, and was conducted prospectively from July to October 2019 at the Matraman and Jatinegara District Health Center, Jakarta, Indonesia. The study comprised 33 T2DM patients in an intervention group (IG) who received the "Phardiacare" program and 33 patients in a control group (CG). Assessment was performed of HbA1c, FBG, LDL, HDL, total cholesterol, triglycerides, and blood pressure. RESULTS: HbA1c after intervention in the IG was lower than that of the CG (p <0.05). Intra-group mean differences showed improvement in the clinical parameters of FBG, triglycerides, and diastolic blood pressure in the IG (p <0.05), but not in the CG. Other clinical parameters did not show significant improvement. The results of the multivariate analysis showed that the "Phardiacare" program had a 16 times greater effect in reducing levels of HbA1c in the IG [95% CI 3.995:67.113, p <0.001] compared to the CG, even after controlling for confounding variables. CONCLUSION: The "Phardiacare" program was effective in improving patient medication adherence by decreasing HbA1c and FBG, but it did not have a significant effect on LDL, HDL, total cholesterol, and systolic blood pressure. Therefore, the involvement of pharmacists in the management of chronic diseases, especially T2DM, should be considered.

19.
J Comp Eff Res ; 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36453665

RESUMO

In this latest update we discuss the transportability of comparative effectiveness evidence across countries. We highlight results of a survey indicating that European HTA agencies are reluctant to accept real-world data from other countries, review recent benefit assessments indicating a potential softening of a requirement for the use of local real-world data in Germany, and outline a recent review presenting approaches that can correct for a lack of transportability.

20.
Wien Klin Wochenschr ; 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36454302

RESUMO

Ulcerative colitis (UC) is one of the main forms of inflammatory bowel disease (IBD). Despite the widening range of drug treatment options, primary nonresponse, secondary loss of response as well as adverse events call for additional treatment alternatives.Tofacitinib is an oral small-molecule drug of the class of Janus kinase inhibitors which, in the European Union, was approved for the treatment of moderate to severe active UC in August 2018. This position paper, drawn up by the IBD Working Group of the Austrian Society of Gastroenterology and Hepatology, summarizes the mechanism of action, clinical development, marketing authorization status, efficacy and safety of tofacitinib. Also, by providing a synopsis of available data from both pivotal and post-marketing studies, clinical aspects of specific interest are highlighted and discussed.The available body of evidence indicates that tofacitinib is an additional effective medication for the treatment of UC that exhibits a good safety profile. This position paper aims at optimizing the safe and effective use of tofacitinib in daily clinical practice.

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