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1.
J Nutr Health Aging ; 25(8): 956-963, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34545914

RESUMEN

BACKGROUND: Different methods have been proposed to study skeletal muscle mass in sarcopenia diagnosis, although all have inherent drawbacks. The aim of this study was to evaluate the utility of muscle ultrasound in muscle assessment by studying its correlation with dual-energy x-ray absorptiometry (DXA) and calf circumference (CC), cut-off values for ultrasound-based detection of low muscle mass, and the correlation with muscle performance. METHODS: Fifty-seven participants older than 70 years, underwent a muscle ultrasound study, DXA, calf circumference (CC) and functional assessment. Ultrasound measurements were taken in the femoral quadriceps (transverse plane) and in the medial gastrocnemius (transverse and longitudinal planes). Muscle function was assessed by gait speed, Short Physical Performance Battery (SPPB) and grip strength. RESULTS: Median age was 78.9 years (IQR 74.9 - 81.9), and 33 were women (57.9%). We found good correlation between muscle thickness of gastrocnemius muscle in transverse and longitudinal plane and appendicular lean mass measured by DXA (r=0.546 and r=0.689 respectively) and good correlations between muscle thickness of gastrocnemius in transverse and longitudinal plane with CC (r=0.651 and r=0.447 respectively). The thickness of gastrocnemius medialis optimal cut-off points for low muscle mass were 18,5mm in the transverse plane (Sensitivity: 77,8%, Specificity: 77,1%), and 17.3mm in the longitudinal plane (Sensitivity: 100%,Specificity: 68.8%). Muscle thickness was also significantly correlated with gait speed, SPPB and grip strength. CONCLUSIONS: Measures of gastrocnemius medialis thickness obtained by ultrasound are reliable and correlate well with DXA and CC values and muscle performance.

2.
Cad Saude Publica ; 37(8): e00076320, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34495091

RESUMEN

In several countries, primary care for pregnant women is performed by obstetric nurses and/or midwives. In Brazil's Supplementary Health System (private health insurance and out-of-pocket care), coverage of prenatal care is mandatory and is performed by medical obstetricians. The objective of this study is to conduct a cost-effectiveness analysis, comparing clinical outcomes and costs associated with the incorporation of prenatal care by obstetric nurses and midwives in the Supplementary Health System, from the perspective of the operator of health plans as the payment source. A decision tree was built, based on data from a Cochrane Collaboration meta-analysis that showed a reduction in the risk of premature birth in the group of normal-risk pregnant women accompanied by obstetric nurses and midwives. The analysis only considered the direct medical costs covered by health plan operators for essential appointments and tests, according to the prevailing Ministry of Health protocol. The study assumed equal unit costs of consultations by medical professionals and applied an increase in the overall cost of prenatal tests associated with medical follow-up, based on data from the literature. Incremental cost-effective ratio was estimated at -BRL 10,038.43 (savings of BRL 10,038.43) per premature birth avoided. This result was consistent with the sensitivity analyses, with savings associated with the substitution ranging from -BRL 2,544.60 to -BRL 31,807.46 per premature death avoided. In conclusion, prenatal care provided by obstetric nurses and midwives was superior to that provided by medical obstetricians for the prevention of premature birth, besides resulting in cost savings.


Asunto(s)
Partería , Enfermeras y Enfermeros , Brasil , Análisis Costo-Beneficio , Femenino , Humanos , Embarazo , Mujeres Embarazadas , Atención Prenatal
3.
Health Aff (Millwood) ; 40(9): 1411-1419, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34495734

RESUMEN

Under the Medicare Advantage (MA) quality bonus payment program, initiated in 2012, MA plans with relatively high quality performance that are located in "double bonus"-eligible counties-metropolitan areas with high MA enrollment and low fee-for-service Medicare spending-receive quality bonuses twice as large as those received by equivalently high-quality plans in double-bonus-ineligible counties. Using national data for 2008-18, we found that double bonuses were not associated with either improvements in plan quality or increased MA enrollment. Additionally, because Black beneficiaries were less likely to reside in eligible counties, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. Our findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. Our study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.


Asunto(s)
Medicare Part C , Anciano , Planes de Aranceles por Servicios , Humanos , Estados Unidos
4.
Comput Biol Med ; 137: 104777, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34492517

RESUMEN

Planning for bone tumor resection surgery is a technically demanding and time-consuming task, reliant on manual positioning of cutting planes (CPs). This work describes an automated approach for generating bone tumor resection plans, where the volume of healthy bone collaterally resected with the tumor is minimized through optimized placement of CPs. Particle swarm optimization calculates the optimal position and orientation of the CPs by introducing a single new CP to an existing resection, then optimizing all CPs to find the global minima. The bone bounded by all CPs is collaterally resected with the tumor. The approach was compared to manual resection plans from an experienced surgeon for 20 tumor cases. It was found that a greater number of CPs reduce the collaterally resected healthy bone, with diminishing returns on this improvement after five CPs. The algorithm-generated resection plan with equivalent number of CPs resulted in a statistically significant improvement over manual plans (paired t-test, p < 0.001). The described approach has potential to improve patient outcomes by reducing loss of healthy bone in tumor surgery while offering a surgeon multiple resection plan options.


Asunto(s)
Neoplasias Óseas , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Humanos , Planificación de la Radioterapia Asistida por Computador
6.
Edumecentro ; 13(3): 81-101, jul.-sept. 2021. tab, graf
Artículo en Español | LILACS | ID: biblio-1278990

RESUMEN

RESUMEN Fundamento: el envejecimiento poblacional caracteriza la sociedad cubana actual, por lo que se hace necesario promover acciones educativas para este grupo etario. Objetivo: elaborar una intervención educativa comunitaria que contribuya a un envejecimiento activo y con calidad de vida en los adultos mayores del Consejo Popular Falcón-Miller. Métodos: se realizó una investigación acción-participación en el Consejo Popular Falcón Miller, del municipio Placetas, Villa Clara, Cuba, entre septiembre 2019-junio 2020. Se emplearon métodos teóricos: histórico-lógico, análisis-síntesis e inductivo-deductivo; empíricos: análisis documental, entrevista a dirigentes locales y cuestionario a adultos mayores; y matemático-estadísticos, para los valores absolutos y relativos. Resultados: se diagnosticaron potencialidades y carencias en el consejo popular para fortalecer la calidad de vida en los adultos mayores que residen en la demarcación, y las necesidades de capacitación de algunos dirigentes locales, por lo que se elaboró una intervención educativa que responde a indicadores de salud, seguridad, participación, información y conocimientos de este grupo social en los diversos ámbitos. Fue valorada por criterios de especialistas. Conclusiones: el sistema de acciones propuesto en la intervención educativa es variado desde una concepción terapéutica, de capacitación y promoción de salud. Está dirigido a estimular la participación y a socializar conocimientos respecto a temáticas importantes para los adultos mayores, a la deconstrucción de estereotipos de vejez, así como a potenciar actividades educativas y de comunicación para aprender a convivir en un ambiente intergeneracional. Fue valorado como muy adecuado para su aplicación por los especialistas.


ABSTRACT Background: population aging characterizes current Cuban society, so it is necessary to promote educational actions for this age group. Objective: to develop a community educational intervention that contributes to active and life quality aging in the elderly of the Falcón-Miller People´s Council. Methods: an action-participation investigation was carried out in the Falcón Miller People´s Council, of the Placetas municipality, Villa Clara, Cuba, from September 2019 to June 2020. Theoretical methods were used: historical-logical, analysis-synthesis and inductive-deductive; empirical: documentary analysis, interview with local leaders and questionnaire for the elderly; and mathematical-statistical, for absolute and relative values. Results: potentialities and shortcomings were diagnosed in the People´s council to strengthen the quality of life in the elderly residing in the demarcation, and the training needs of some local leaders, for which an educational intervention was developed that responds to indicators of health, safety, participation, information and knowledge of this social group in the various fields. It was evaluated by criteria of specialists. Conclusions: the system of actions proposed in the educational intervention is varied from a therapeutic, training and health promotion concept. It is aimed at stimulating participation and socializing knowledge regarding important issues for the elderly, deconstructing old age stereotypes, as well as promoting educational and communication activities to learn to live together in an intergenerational environment. It was valued as very suitable for its application by the specialists.


Asunto(s)
Planes y Programas de Salud , Dinámica Poblacional , Geriatría , Programas de Gobierno , Programas Nacionales de Salud
7.
Sci Transl Med ; 13(605)2021 08 04.
Artículo en Inglés | MEDLINE | ID: mdl-34349034

RESUMEN

Group A streptococcus (GAS) is among the top 10 causes of mortality from an infectious disease, producing mild to invasive life-threatening manifestations. Necrotizing fasciitis (NF) is characterized by a rapid GAS spread into fascial planes followed by extensive tissue destruction. Despite prompt treatments of antibiotic administration and tissue debridement, mortality from NF is still high. Moreover, there is no effective vaccine against GAS, and early diagnosis of NF is problematic because its clinical presentations are not specific. Thus, there is a genuine need for effective treatments against GAS NF. Previously, we reported that GAS induces endoplasmic reticulum (ER) stress to gain asparagine from the host. Here, we demonstrate that GAS-mediated asparagine induction and release occur through the PERK-eIF2α-ATF4 branch of the unfolded protein response. Inhibitors of PERK or integrated stress response (ISR) blocked the formation and release of asparagine by infected mammalian cells, and exogenously added asparagine overcame this inhibition. Moreover, in a murine model of NF, we show that the inhibitors minimized mortality when mice were challenged with a lethal dose of GAS and reduced bacterial counts and lesion size when mice were challenged with a sublethal dose. Immunohistopathology studies demonstrated that PERK/ISR inhibitors protected mice by enabling neutrophil infiltration into GAS-infected fascia and reducing the pro-inflammatory response that causes tissue damage. Inhibitor treatment was also effective in mice when started at 12 hours after infection. We conclude that host metabolic alteration induced by PERK or ISR inhibitors is a promising therapeutic strategy to treat highly invasive GAS infections.


Asunto(s)
Fascitis Necrotizante , Infecciones Estreptocócicas , Animales , Asparagina , Fascitis Necrotizante/tratamiento farmacológico , Ratones , Infecciones Estreptocócicas/tratamiento farmacológico , Streptococcus pyogenes , Respuesta de Proteína Desplegada
8.
Science ; 373(6552): 332-337, 2021 07 16.
Artículo en Inglés | MEDLINE | ID: mdl-34437152

RESUMEN

Changes in the crystal system of an ionic nanocrystal during a cation exchange reaction are unusual yet remain to be systematically investigated. In this study, chemical synthesis and computational modeling demonstrated that the height of hexagonal-prism roxbyite (Cu1.8S) nanocrystals with a distorted hexagonal close-packed sulfide anion (S2-) sublattice determines the final crystal phase of the cation-exchanged products with Co2+ [wurtzite cobalt sulfide (CoS) with hexagonal close-packed S2- and/or cobalt pentlandite (Co9S8) with cubic close-packed S2-]. Thermodynamic instability of exposed planes drives reconstruction of anion frameworks under mild reaction conditions. Other incoming cations (Mn2+, Zn2+, and Ni2+) modulate crystal structure transformation during cation exchange reactions by various means, such as volume, thermodynamic stability, and coordination environment.

9.
Anal Chem ; 93(33): 11532-11539, 2021 08 24.
Artículo en Inglés | MEDLINE | ID: mdl-34375071

RESUMEN

Continued adoption of two-dimensional liquid chromatography (2D-LC) in industrial laboratories will depend on the development of approaches to make method development for 2D-LC more systematic, less tedious, and less reliant on user expertise. In this paper, we build on previous efforts in these directions by describing the use of multifactorial modeling software that can help streamline and simplify the method development process for 2D-LC. Specifically, we have focused on building retention models for second dimension (2D) separations involving variables including gradient time, temperature, organic modifier blending, and buffer concentration using LC simulator (ACD/Labs) software. Multifactorial retention modeling outcomes are illustrated as resolution map planes or cubes that enable straightforward location of 2D conditions that maximize resolution while minimizing analysis time. We also illustrate the practicality of this approach by identifying conditions that yield baseline separation of all compounds co-eluting from a first dimension (1D) separation using a single combination of 2D stationary phase and elution conditions. The multifactorial retention models were found to be very accurate for both the 1D and 2D separations, with differences between experimental and simulated retention times of less than 0.5%. Pharmaceutical applications of this approach for multiple heartcutting 2D-LC were demonstrated using IEC-IEC or achiral RPLC-chiral RPLC for 2D separations of multicomponent mixtures. The framework outlined here should help make 2D-LC method development more systematic and streamline development and optimization for a variety of 2D-LC applications in both industry and academia.


Asunto(s)
Cromatografía Liquida , Simulación por Computador
10.
PLoS One ; 16(8): e0254698, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34383776

RESUMEN

BACKGROUND: Pneumonia is a common and severe complication of abdominal surgery, it is associated with increased length of hospital stay, healthcare costs, and mortality. Further, pulmonary complication rates have risen during the SARS-CoV-2 pandemic. This study explored the potential cost-effectiveness of administering preoperative chlorhexidine mouthwash versus no-mouthwash at reducing postoperative pneumonia among abdominal surgery patients. METHODS: A decision analytic model taking the South African healthcare provider perspective was constructed to compare costs and benefits of mouthwash versus no-mouthwash-surgery at 30 days after abdominal surgery. We assumed two scenarios: (i) the absence of COVID-19; (ii) the presence of COVID-19. Input parameters were collected from published literature including prospective cohort studies and expert opinion. Effectiveness was measured as proportion of pneumonia patients. Deterministic and probabilistic sensitivity analyses were performed to assess the impact of parameter uncertainties. The results of the probabilistic sensitivity analysis were presented using cost-effectiveness planes and cost-effectiveness acceptability curves. RESULTS: In the absence of COVID-19, mouthwash had lower average costs compared to no-mouthwash-surgery, $3,675 (R 63,770) versus $3,958 (R 68,683), and lower proportion of pneumonia patients, 0.029 versus 0.042 (dominance of mouthwash intervention). In the presence of COVID-19, the increase in pneumonia rate due to COVID-19, made mouthwash more dominant as it was more beneficial to reduce pneumonia patients through administering mouthwash. The cost-effectiveness acceptability curves shown that mouthwash surgery is likely to be cost-effective between $0 (R0) and $15,000 (R 260,220) willingness to pay thresholds. CONCLUSIONS: Both the absence and presence of SARS-CoV-2, mouthwash is likely to be cost saving intervention for reducing pneumonia after abdominal surgery. However, the available evidence for the effectiveness of mouthwash was extrapolated from cardiac surgery; there is now an urgent need for a robust clinical trial on the intervention on non-cardiac surgery.


Asunto(s)
Abdomen/cirugía , Clorhexidina/uso terapéutico , Modelos Teóricos , Neumonía/prevención & control , COVID-19 , Análisis Costo-Beneficio , Humanos , Antisépticos Bucales , Pandemias , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Estudios Prospectivos , Sudáfrica
11.
BMC Psychiatry ; 21(1): 402, 2021 08 13.
Artículo en Inglés | MEDLINE | ID: mdl-34389017

RESUMEN

BACKGROUND: Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. METHODS: An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. RESULTS: There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. CONCLUSIONS: The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. TRIAL REGISTRATION: The trial was registered in the Netherlands Trial Register ( NTR3715 ).


Asunto(s)
Enfermedad Coronaria , Trastorno Depresivo Mayor , Diabetes Mellitus Tipo 2 , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/prevención & control , Análisis Costo-Beneficio , Depresión/prevención & control , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Humanos , Atención Primaria de Salud , Años de Vida Ajustados por Calidad de Vida
12.
Sci Rep ; 11(1): 16437, 2021 08 12.
Artículo en Inglés | MEDLINE | ID: mdl-34385563

RESUMEN

Computed tomography in suspected urolithiasis provides information about the presence, location and size of stones. Particularly stone size is a key parameter in treatment decision; however, data on impact of reformatation and measurement strategies is sparse. This study aimed to investigate the influence of different image reformatations, slice thicknesses and window settings on stone size measurements. Reference stone sizes of 47 kidney stones representative for clinically encountered compositions were measured manually using a digital caliper (Man-M). Afterwards stones were placed in a 3D-printed, semi-anthropomorphic phantom, and scanned using a low dose protocol (CTDIvol 2 mGy). Images were reconstructed using hybrid-iterative and model-based iterative reconstruction algorithms (HIR, MBIR) with different slice thicknesses. Two independent readers measured largest stone diameter on axial (2 mm and 5 mm) and multiplanar reformatations (based upon 0.67 mm reconstructions) using different window settings (soft-tissue and bone). Statistics were conducted using ANOVA ± correction for multiple comparisons. Overall stone size in CT was underestimated compared to Man-M (8.8 ± 2.9 vs. 7.7 ± 2.7 mm, p < 0.05), yet closely correlated (r = 0.70). Reconstruction algorithm and slice thickness did not significantly impact measurements (p > 0.05), while image reformatations and window settings did (p < 0.05). CT measurements using multiplanar reformatation with a bone window setting showed closest agreement with Man-M (8.7 ± 3.1 vs. 8.8 ± 2.9 mm, p < 0.05, r = 0.83). Manual CT-based stone size measurements are most accurate using multiplanar image reformatation with a bone window setting, while measurements on axial planes with different slice thicknesses underestimate true stone size. Therefore, this procedure is recommended when impacting treatment decision.

13.
Am J Manag Care ; 27(12 Suppl): S231-S237, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34382759

RESUMEN

A virtual key opinion leader (KOL) and payer discussion was held on December 5, 2020. In attendance were 2 KOLs, both specialists in amyotrophic lateral sclerosis (ALS) at leading clinics in the United States, and 6 managed care executives from US regional health plans. The objective of this panel was to share opinions, ideas, and information around the treatment of ALS with edaravone, gaps in management and guidelines, and potential solutions. The panel concluded that coverage criteria for edaravone may need to be reassessed and treatment guidelines could be revisited to include a determination of place in therapy for edaravone.


Asunto(s)
Esclerosis Amiotrófica Lateral , Esclerosis Amiotrófica Lateral/tratamiento farmacológico , Edaravona , Depuradores de Radicales Libres , Humanos , Programas Controlados de Atención en Salud , Especialización , Estados Unidos
14.
J Vis ; 21(8): 17, 2021 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-34388233

RESUMEN

New visualization approaches are being actively developed aiming to mitigate the effect of vergence-accommodation conflict in stereoscopic augmented reality; however, high interindividual variability in spatial performance makes it difficult to predict user gain. To address this issue, we investigated the effects of consistent and inconsistent binocular and focus cues on perceptual matching in the stereoscopic environment of augmented reality using a head-mounted display that was driven in multifocal and single focal plane modes. Participants matched the distance of a real object with images projected at three viewing distances, concordant with the display focal planes when driven in the multifocal mode. As a result, consistency of depth cues facilitated faster perceptual judgments on spatial relations. Moreover, the individuals with mild binocular and accommodative disorders benefited from the visualization of information on the focal planes corresponding to image planes more than individuals with normal vision, which was reflected in performance accuracy. Because symptoms and complaints may be absent when the functionality of the sensorimotor system is reduced, the results indicate the need for a detailed assessment of visual functions in research on spatial performance. This study highlights that the development of a visualization system that reduces visual stress and improves user performance should be a priority for the successful implementation of augmented reality displays.

15.
Sci Rep ; 11(1): 15574, 2021 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-34341378

RESUMEN

Methods to test the safety of wood material for hygienically sensitive places are indirect, destructive and limited to incomplete microbial recovery via swabbing, brushing and elution-based techniques. Therefore, we chose mCherry Staphylococcus aureus as a model bacterium for solid and porous surface contamination. Confocal spectral laser microscope (CSLM) was employed to characterize and use the autofluorescence of Sessile oak (Quercus petraea), Douglas fir (Pseudotsuga menziesii) and poplar (Populus euramericana alba L.) wood discs cut into transversal (RT) and tangential (LT) planes. The red fluorescent area occupied by bacteria was differentiated from that of wood, which represented the bacterial quantification, survival and bio-distribution on surfaces from one hour to one week after inoculation. More bacteria were present near the surface on LT face wood as compared to RT and they persisted throughout the study period. Furthermore, this innovative methodology identified that S. aureus formed a dense biofilm on melamine but not on oak wood in similar inoculation and growth conditions. Conclusively, the endogenous fluorescence of materials and the model bacterium permitted direct quantification of surface contamination by using CSLM and it is a promising tool for hygienic safety evaluation.

16.
Am J Manag Care ; 27(8): 340-344, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-34460176

RESUMEN

OBJECTIVES: Prior studies have had difficulty predicting which patients will have persistent high utilization past 1 year within the Medicaid population. The objective of this study was to examine the medical diagnoses at the time of enrollment of patients with persistent high health care utilization over 24 months following enrollment in Medicaid managed care in a large integrated care setting. STUDY DESIGN: Retrospective cohort study in a large integrated managed health care system. METHODS: We identified a cohort of high utilizers (top 5% of health care costs in 2014) and extracted their electronic health record data (2014-2016). Differences in baseline characteristics of high utilizers and the general Medicaid population were determined using bivariate analysis. We used multivariable regression to determine the independent association between medical comorbidities and demographics with persistent high health care utilization over the 2 years following enrollment. RESULTS: Compared with the general Medicaid managed care enrollee population, schizophrenia was the only mental health diagnosis at the time of enrollment associated with persistent high health care utilization (risk ratio [RR], 1.50; 95% CI, 1.20-1.86). Additional characteristics associated with persistent high utilization included age between 31 and 50 years (RR, 1.20; 95% CI, 1.02-1.41), dual enrollment in Medicaid and Medicare (RR, 1.26; 95% CI, 1.09-1.45), chronic pain diagnoses (RR, 1.26; 95% CI, 1.04-1.53), and multimorbidity (RR, 1.43; 95% CI, 1.25-1.63). CONCLUSIONS: Among adults newly enrolled in Medicaid managed care, certain diagnoses noted at the time of enrollment into the plan are associated with persistent high health care utilization over the first 2 years, suggesting that targeting early supportive case management to these individuals could optimize care and reduce health care costs.


Asunto(s)
Medicaid , Medicare , Adulto , Anciano , Humanos , Programas Controlados de Atención en Salud , Aceptación de la Atención de Salud , Estudios Retrospectivos , Estados Unidos
17.
Am J Manag Care ; 27(8): e278-e286, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-34460182

RESUMEN

OBJECTIVES: Health systems and provider groups currently lack a systematic mechanism to evaluate the financial implications of value-based alternative payments. We sought to develop a method to prospectively quantify the financial implications, including risk and uncertainty of (1) transitioning from a fee-for-service to an episode-based payment model and (2) modifying episode-specific clinical cost drivers. Finally, we highlight practical applications for the model to help facilitate stakeholder engagement in the transition to value-based payment models. STUDY DESIGN: We created a financial simulation from empirical data to demonstrate the feasibility and potential use cases within the context of a hypothetical episode-based payment model for prostate cancer surgery (prostatectomy). METHODS: We used Monte Carlo simulation methods to predict financial outcomes under various clinical and payment model scenarios for our pilot prostatectomy episode use case. We input patient-level empirical cost, reimbursement, and clinical data for a cohort of 157 patients at our institution into our model to quantify expected financial outcomes (payments, financial margins) and financial risk for stakeholders (payer, hospital, providers) under an episode-based payment model. RESULTS: Compared with the status quo, there is a range of expected financial outcomes for various stakeholders depending on the financial parameters (episode price, shared savings, downside risk, stop-loss) in an episode-based payment model. Modifying clinical cost drivers has a profound impact on these outcomes. Uncertainty is high due to the small number of episodes. CONCLUSIONS: The simulation demonstrates that both financial parameters and clinical cost drivers significantly affect the expected financial outcomes for stakeholders in value-based payment models.


Asunto(s)
Planes de Aranceles por Servicios , Prostatectomía , Estudios de Cohortes , Servicios de Salud , Humanos , Masculino , Estados Unidos
18.
J Mech Behav Biomed Mater ; 123: 104796, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34464901

RESUMEN

Periodontal disease disturbs the supportive tissues around the teeth such as connective tissue, gingival tissue, periodontal ligaments and alveolar bone. Previously, treatment of periodontitis was embattled by repopulating the affected site with cells that has capacity to regenerate damaged tissue by endorsing the perception of guided tissue regeneration but it entails additional surgery owing to non-biodegradability. Biodegradable polymeric nanofibrous scaffold imitating extracellular matrix (ECM) delivering functionalized nanoparticles loaded with therapeutic drug have the ability to support cellular functions thereby enhancing regeneration. Present study explores novel amine functionalized zirconia nanoparticle loaded curcumin incorporated SPEEK nanofibrous scaffolds to address periodontal regeneration. Zirconia - crown of dental therapeutics, its amine functionalization further enhanced the strength and cyto-compatibility. Carbon-Silica NMR (59.9 and 69.8 ppm), FT-IR (3426 cm-1), EDAX and XRD (28.9°, 31.6° and 38.2° pertaining to [-1 1 1], [1 1 1] and [1 2 0] planes) analysis confirmed the effective functionalization of the zirconia nanoparticle with the amine group. Electrospinning was carried out at a voltage of 20 kV and flow rate of 0.05 ml/h. Fabricated nanofibers were highly dense, porous with interconnected fibrous structures that bio-mimic ECM. They exhibited an average diameter of 187 ± 2 nm (SPEEK), 192 ± 2 nm (SPEEK + NH2-ZrO2), and 256 ± 17 nm (SPEEK + NH2-ZrO2+Cur). Extensively discovered anti-bacterial traits of curcumin supplemented the advantage for the treatment of periodontitis. Incorporated materials improve the physico-chemical, mechanical and biological characteristics of nanofibers. FT-IR, EDAX and XRD analysis of the fabricated nanofibrous scaffold demonstrated the effective incorporation of aminated zirconia loaded curcumin. Results of cyto-compatibility analysis of SPEEK + NH2-ZrO2+Cur nanofibrous scaffold depicted a cell viability of 100 ± 1.62%. Results of anti-bacterial assay with zone of inhibition was 6.5 ± 0.5 mm (SPEEK), 7.5 ± 1 mm (SPEEK + NH2-ZrO2), and 8 ± 1 mm (SPEEK + NH2-ZrO2+Cur). Thus, the fabricated bio-material is cyto-compatible, non-toxic and effective against pathogens exploiting higher potential for periodontal regeneration applications.


Asunto(s)
Curcumina , Nanofibras , Curcumina/farmacología , Poliésteres , Espectroscopía Infrarroja por Transformada de Fourier , Ingeniería de Tejidos , Andamios del Tejido , Circonio
19.
Transl Vis Sci Technol ; 10(9): 13, 2021 08 02.
Artículo en Inglés | MEDLINE | ID: mdl-34388238

RESUMEN

Purpose: To investigate crystalline lens tilt and decentration with respect to the corneal vertex (CV) using swept-source optical coherence tomography (SS-OCT) combined with three-dimensional (3D) reconstruction. Methods: Thirty consecutive patients with cataract (30 right eyes) were included in this prospective, observational, pilot case series study. SS-OCT anterior segment images and 3D reconstructions were used for data analysis. Results: The mean distance between the central points of crystalline lens plane and limbus plane was approximately 0.33 ± 0.18 mm. The distance of the center of the limbus plane relative to the CV was approximately 0.31 ± 0.14 mm, which approximated the distance of the center of the crystalline lens plane relative to the CV at 0.33 ± 0.20 mm (P = 0.354). However, the centers of the limbus and crystalline planes were not in the same quadrant in 80% of eyes (24/30). Moreover, the crystalline lens tilted by approximately 4.16° ± 1.97° relative to the CV. Conclusions: The center of the limbus plane was not consistent with that of the crystalline lens plane. The tilt and decentration of the crystalline lens were natural phenomena. Translational Relevance: The SS-OCT technology combined with 3D reconstruction was useful for quantifying the tilt and decentration of the crystalline lens. The definition of angle alpha used for premium IOL screening should be updated.


Asunto(s)
Cristalino , Lentes Intraoculares , Humanos , Imagenología Tridimensional , Cristalino/diagnóstico por imagen , Estudios Prospectivos , Tomografía de Coherencia Óptica
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