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Intervention thresholds

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https://www.readbyqxmd.com/read/27913943/the-cost-effectiveness-of-interventions-targeting-lifestyle-change-for-the-prevention-of-diabetes-in-a-swedish-primary-care-and-community-based-prevention-program
#1
Anne Neumann, Lars Lindholm, Margareta Norberg, Olaf Schoffer, Stefanie J Klug, Fredrik Norström
BACKGROUND: Policymakers need to know the cost-effectiveness of interventions to prevent type 2 diabetes (T2D). The objective of this study was to estimate the cost-effectiveness of a T2D prevention initiative targeting weight reduction, increased physical activity and healthier diet in persons in pre-diabetic states by comparing a hypothetical intervention versus no intervention in a Swedish setting. METHODS: A Markov model was used to study the cost-effectiveness of a T2D prevention program based on lifestyle change versus a control group where no prevention was applied...
December 2, 2016: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
https://www.readbyqxmd.com/read/27910086/higher-vs-lower-haemoglobin-threshold-for-transfusion-in-septic-shock-subgroup-analyses-of-the-triss-trial
#2
S L Rygård, L B Holst, J Wetterslev, P I Johansson, A Perner
BACKGROUND: Using a restrictive transfusion strategy appears to be safe in sepsis, but there may be subgroups of patients who benefit from transfusion at a higher haemoglobin level. We explored if subgroups of patients with septic shock and anaemia had better outcome when transfused at a higher vs. a lower haemoglobin threshold. METHODS: In post-hoc analyses of the full trial population of 998 patients from the Transfusion Requirements in Septic Shock (TRISS) trial, we investigated the intervention effect on 90-day mortality in patients with severe comorbidity (chronic lung disease, haematological malignancy or metastatic cancer), in patients who had undergone surgery (elective or acute) and in patients with septic shock as defined by the new consensus definition: lactate above 2 mmol/l and the need for vasopressors to maintain a mean arterial pressure above 65 mmHg...
December 2, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27909944/using-an-analysis-of-behavior-change-to-inform-effective-digital-intervention-design-how-did-the-primit-website-change-hand-hygiene-behavior-across-8993-users
#3
B Ainsworth, M Steele, B Stuart, J Joseph, S Miller, L Morrison, P Little, L Yardley
BACKGROUND: In designing digital interventions for healthcare, it is important to understand not just whether interventions work but also how and for whom-including whether individual intervention components have different effects, whether a certain usage threshold is required to change behavior in each intervention and whether usage differs across population subgroups. PURPOSE: We investigated these questions using data from a large trial of the digital PRimary care trial of a website based Infection control intervention to Modify Influenza-like illness and respiratory tract infection Transmission) (PRIMIT) intervention, which aimed to reduce respiratory tract infections (RTIs) by increasing hand hygiene behavior...
December 1, 2016: Annals of Behavioral Medicine: a Publication of the Society of Behavioral Medicine
https://www.readbyqxmd.com/read/27909453/the-effect-of-high-frequency-repetitive-transcranial-magnetic-stimulation-on-occupational-stress-among-health-care-workers-a-pilot-study
#4
Young In Kim, Sun Mi Kim, Hyungjin Kim, Doug Hyun Han
OBJECTIVE: Repetitive transcranial magnetic stimulation (rTMS) was approved by the Food and Drug Administration to alleviate symptoms of treatment-resistant depression. This study aimed to evaluate the effectiveness of rTMS treatment on alleviating occupational stress by evaluating clinical symptoms and quantitative electroencephalography (QEEG). METHODS: Twenty-four health care workers were randomized to receive 12 sessions of active or sham rTMS delivered to the left dorsolateral prefrontal cortex (DLPFC)...
November 2016: Psychiatry Investigation
https://www.readbyqxmd.com/read/27907264/the-legacy-of-large-regime-shifts-in-shallow-lakes
#5
Joy M Ramstack Hobbs, William O Hobbs, Mark B Edlund, Kyle D Zimmer, Kevin M Theissen, Natalie Hoidal, Leah M Domine, Mark A Hanson, Brian R Herwig, James B Cotner
Ecological shifts in shallow lakes from clear-water macrophyte-dominated to turbid-water phytoplankton-dominated are generally thought of as rapid short-term transitions. Diatom remains in sediment records from shallow lakes in the Prairie Pothole Region of North America provide new evidence that the long-term ecological stability of these lakes is defined by the legacy of large regime shifts. We examine the modern and historical stability of 11 shallow lakes. Currently, four of the lakes are in a clear-water state, three are consistently turbid-water, and four have been observed to change state from year to year (transitional)...
December 2016: Ecological Applications: a Publication of the Ecological Society of America
https://www.readbyqxmd.com/read/27905881/bone-morphogenetic-protein-2-mediated-pain-and-inflammation-in-a-rat-model-of-posterolateral-arthrodesis
#6
Kendall Mitchell, Jill P Shah, Clifton L Dalgard, Lyubov V Tsytsikova, Ashley C Tipton, Anton E Dmitriev, Aviva J Symes
BACKGROUND: Bone morphogenetic protein-2 (BMP-2) is a pleiotropic, secreted molecule with diverse effects. The potent ability of BMP-2 to stimulate bone growth prompted its widespread clinical use for arthrodesis (spine fusion). However, elevated post-operative pain in patients treated with BMP-2 has been increasingly reported. Determining whether BMP-2 induces pain directly or whether it induces neuroinflammation, which could lower the threshold for pain, is important for developing therapeutic interventions...
December 1, 2016: BMC Neuroscience
https://www.readbyqxmd.com/read/27905693/revisiting-the-cost-effectiveness-of-screening-65-year-old-men-for-abdominal-aortic-aneurysm-based-on-data-from-an-implemented-screening-programme
#7
Jakob Hager, Martin Henriksson, Per Carlsson, Toste Länne, Fredrik Lundgren
BACKGROUND: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related, as well as all- cause mortality. However, follow-up from implemented screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men is cost-effective based on contemporary data on prevalence and attendance rates from an ongoing AAA screening programme...
December 1, 2016: International Angiology: a Journal of the International Union of Angiology
https://www.readbyqxmd.com/read/27905265/learning-together-part-2-training-costs-and-health-gain-a-cost-analysis
#8
Katherine Cullen, Wendy Riches, Chloe Macaulay, John Spicer
: Learning Together is a complex educational intervention aimed at improving health outcomes for children and young people. There is an additional cost as two doctors are seeing patients together for a longer appointment than a standard general practice (GP) appointment. Our approach combines the impact of the training clinics on activity in South London in 2014-15 with health gain, using NICE guidance and standards to allow comparison of training options. METHODS: Activity data was collected from Training Practices hosting Learning Together...
December 1, 2016: Education for Primary Care
https://www.readbyqxmd.com/read/27905020/laparoscopic-versus-open-cholecystectomy-a-cost-effectiveness-analysis-at-rwanda-military-hospital
#9
Allison Silverstein, Ainhoa Costas-Chavarri, Mussa R Gakwaya, Joseph Lule, Swagoto Mukhopadhyay, John G Meara, Mark G Shrime
BACKGROUND: Laparoscopic cholecystectomy is first-line treatment for uncomplicated gallstone disease in high-income countries due to benefits such as shorter hospital stays, reduced morbidity, more rapid return to work, and lower mortality as well-being considered cost-effective. However, there persists a lack of uptake in low- and middle-income countries. Thus, there is a need to evaluate laparoscopic cholecystectomy in comparison with an open approach in these settings. METHODS: A cost-effectiveness analysis was performed to evaluate laparoscopic and open cholecystectomies at Rwanda Military Hospital (RMH), a tertiary care referral hospital in Rwanda...
November 30, 2016: World Journal of Surgery
https://www.readbyqxmd.com/read/27904632/the-effect-of-reflexology-on-pain-perception-aspects-in-nurses-with-chronic-low-back-pain-in-isfahan
#10
Maryam Eghbali Babadi, Fatemeh Nazari, Reza Safari, Samere Abdoli
BACKGROUND: The most important part in experiencing and recognizing the threshold of pain is the perception of pain. Reflexology is a kind of complementary therapy which is rooted in the beliefs of the community. This study was aimed to determine the effect of reflexology on pain perception aspects in patients with chronic low back pain. MATERIALS AND METHODS: This single-blind clinical trial study was performed on 50 nurses with chronic low back pain, who were selected by convenient sampling and then randomly divided into the case and the control groups...
September 2016: Iranian Journal of Nursing and Midwifery Research
https://www.readbyqxmd.com/read/27901323/safety-of-carotid-revascularization-within-48-hours-of-symptomatic-presentation
#11
Kosmas I Paraskevas, Ian M Loftus
In the last few years, there has been a gradual shift in the recommendations of carotid guidelines towards performance of carotid endarterectomy (CEA) earlier in patients with >70% carotid artery stenosis suffering an ipsilateral transient ischemic attack (TIA)/minor stroke episode. The "6-month" threshold in the early guidelines was subsequently replaced with a "14-day" target. More recently, an even earlier intervention (i.e. "within 48 hours") gains support as the optimal timing for the performance of CEA in patients with symptomatic carotid artery stenosis...
November 30, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27896457/the-value-of-quantitative-sensory-testing-in-spine-research
#12
Anja Tschugg, Wolfgang N Löscher, Sara Lener, Sebastian Hartmann, Matthias Wildauer, Sabrina Neururer, Claudius Thomé
The improvement of pain and functionality is the major goal of a surgical intervention. Thus, the purpose of the present prospective study was to evaluate whether subjective sensory deficits in patients with lumbar radiculopathy caused by a lumbar disc herniation are related to clinical status, using several outcome scores and the quantitative sensory testing (QST) pre- and 12 months postoperatively. We applied the QST in 52 patients with a single lumbar disc herniation treated by lumbar sequestrectomy pre- and 12 months postoperatively...
November 28, 2016: Neurosurgical Review
https://www.readbyqxmd.com/read/27894323/health-related-quality-of-life-and-a-cost-utility-simulation-of-adults-in-the-uk-with-osteogenesis-imperfecta-x-linked-hypophosphatemia-and-fibrous-dysplasia
#13
Lydia Forestier-Zhang, Laura Watts, Alison Turner, Harriet Teare, Jane Kaye, Joe Barrett, Cyrus Cooper, Richard Eastell, Paul Wordsworth, Muhammad K Javaid, Rafael Pinedo-Villanueva
BACKGROUND: Health-related quality of life of adults with osteogenesis imperfecta (OI), fibrous dysplasia (FD) and X-linked hypophosphatemia (XLH) remains poorly described. The aim of this study was to describe the HRQoL of adults with osteogenesis imperfecta, fibrous dysplasia and X-linked hypophophataemia and perform a cost-utility simulation to calculate the maximum cost that a health care system would be willing to pay for a hypothetical treatment of a rare bone disease. RESULTS: Participants completed the EQ-5D-5 L questionnaire between September 2014 and March 2016...
November 28, 2016: Orphanet Journal of Rare Diseases
https://www.readbyqxmd.com/read/27889661/what-explains-the-differences-between-centres-in-the-european-screening-trial-a-simulation-study
#14
Jaakko Nevalainen, Ulf-Håkan Stenman, Teuvo L Tammela, Monique Roobol, Sigrid Carlsson, Kirsi Talala, Fritz H Schröder, Anssi Auvinen
BACKGROUND: The European Randomised study of Screening for Prostate Cancer (ERSPC) is a multicentre, randomised screening trial on men aged 55-69 years at baseline without known prostate cancer (PrCa) at randomisation to an intervention arm invited to screening or to a control arm. The ERSPC has shown a significant 21% reduction in PrCa mortality at 13 years of follow-up. The effect of screening appears to vary across centres, for which several explanations are possible. We set to assess if the apparent differences in PrCa mortality reduction between the centres can be explained by differences in screening protocols...
November 24, 2016: Cancer Epidemiology
https://www.readbyqxmd.com/read/27885585/the-conundrums-of-chronic-kidney-disease-and-aging
#15
REVIEW
Richard J Glassock, Aleksandar Denic, Andrew D Rule
Chronic kidney disease (CKD), as presently defined, is a common disorder. Aging is a nearly universal phenomenon that can affect renal anatomy and function, but at variable rates in individuals. Loss of nephrons and a decline in glomerular filtration rate (GFR) is a characteristic of normal aging, called renal senescence. Using fixed and absolute thresholds for defining CKD on the basis of GFR for all ages may lead to diagnostic uncertainty (a conundrum) in both young and older subjects. This brief review will consider the physiological and anatomical changes of the kidney occurring in the process of normal renal senescence focusing on GFR and will examine the relevance of these observation for the diagnosis of CKD using GFR as the distinguishing parameter...
November 25, 2016: Journal of Nephrology
https://www.readbyqxmd.com/read/27884846/real-world-evidence-studies-into-treatment-adherence-thresholds-for-intervention-and-disparities-in-treatment-in-people-with-type-2-diabetes-in-the-uk
#16
Andrew McGovern, William Hinton, Ana Correa, Neil Munro, Martin Whyte, Simon de Lusignan
PURPOSE: The University of Surrey-Lilly Real World Evidence (RWE) diabetes cohort has been established to provide insights into the management of type 2 diabetes mellitus (T2DM). There are 3 areas of study due to be conducted to provide insights into T2DM management: exploration of medication adherence, thresholds for changing diabetes therapies, and ethnicity-related or socioeconomic-related disparities in management. This paper describes the identification of a cohort of people with T2DM which will be used for these analyses, through a case finding algorithm, and describes the characteristics of the identified cohort...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27884813/development-and-feasibility-testing-of-prompt-care-an-ehealth-system-for-collection-and-use-of-patient-reported-outcome-measures-for-personalized-treatment-and-care-a-study-protocol
#17
Afaf Girgis, Geoff P Delaney, Anthony Arnold, Alexis Andrew Miller, Janelle V Levesque, Nasreen Kaadan, Martin G Carolan, Nicole Cook, Kenneth Masters, Thomas T Tran, Tiffany Sandell, Ivana Durcinoska, Martha Gerges, Sandra Avery, Weng Ng, Stephen Della-Fiorentina, Haryana M Dhillon, Ashley Maher
BACKGROUND: Patient-reported outcome (PRO) measures have been used widely to screen for depression, anxiety, and symptoms in cancer patients. Computer-based applications that collect patients' responses and transfer them to the treating health professional in real time have the potential to improve patient well-being and cancer outcomes. OBJECTIVE: This study will test the feasibility and acceptability of a newly developed eHealth system which facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research...
November 24, 2016: JMIR Research Protocols
https://www.readbyqxmd.com/read/27884360/cost-effectiveness-of-endovascular-femoropopliteal-intervention-using-drug-coated-balloons%C3%A2-versus-standard-percutaneous-transluminal-angioplasty-results-from-the-in-pact%C3%A2-sfa-ii-trial
#18
Adam C Salisbury, Haiyan Li, Katherine R Vilain, Michael R Jaff, Peter A Schneider, John R Laird, David J Cohen
OBJECTIVES: The aim of this study was to evaluate the cost-effectiveness of drug-coated balloon (DCB) angioplasty versus standard percutaneous transluminal angioplasty (PTA). BACKGROUND: Recent trials have reported lower rates of target lesion revascularization with DCB angioplasty versus standard PTA. However, the cost-effectiveness of DCB angioplasty is unknown. METHODS: A prospective economic study was performed alongside the IN.PACT SFA II (IN...
November 28, 2016: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/27884203/a-system-dynamics-model-of-clinical-decision-thresholds-for-the-detection-of-developmental-behavioral-disorders
#19
R Christopher Sheldrick, Dominic J Breuer, Razan Hassan, Kee Chan, Deborah E Polk, James Benneyan
BACKGROUND: Clinical decision-making has been conceptualized as a sequence of two separate processes: assessment of patients' functioning and application of a decision threshold to determine whether the evidence is sufficient to justify a given decision. A range of factors, including use of evidence-based screening instruments, has the potential to influence either or both processes. However, implementation studies seldom specify or assess the mechanism by which screening is hypothesized to influence clinical decision-making, thus limiting their ability to address unexpected findings regarding clinicians' behavior...
November 25, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27883239/individually-dosed-omalizumab-an-effective-treatment-for-severe-peanut-allergy
#20
J Brandström, M Vetander, G Lilja, S G O Johansson, A-C Sundqvist, F Kalm, C Nilsson, A Nopp
BACKGROUND: Treatment with omalizumab has shown a positive effect on food allergies, but no dosages are established. Basophil allergen threshold sensitivity (CD-sens) can be used to objectively measure omalizumab treatment efficacy and correlates with the outcome of Double Blind Placebo Controlled Food Challenge to peanut. OBJECTIVE: To evaluate if individualized omalizumab treatment monitored by CD-sens could be an effective intervention for suppression of allergic reactions to peanut...
November 24, 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
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