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https://www.readbyqxmd.com/read/28645935/liver-cirrhosis-in-patients-with-atrial-fibrillation-would-oral-anticoagulation-have-a-net-clinical-benefit-for-stroke-prevention
#1
Ling Kuo, Tze-Fan Chao, Chia-Jen Liu, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Jo-Nan Liao, Fa-Po Chung, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen
BACKGROUND: Patients with liver cirrhosis have been excluded from randomized clinical trials of oral anticoagulation therapy for stroke prevention in atrial fibrillation. We hypothesized that patients with liver cirrhosis would have a positive net clinical benefit for oral anticoagulation when used for stroke prevention in atrial fibrillation. METHODS AND RESULTS: This study used the National Health Insurance Research Database in Taiwan. Among 289 559 atrial fibrillation patients aged ≥20 years, there were 10 336 with liver cirrhosis, and 9056 of them having a CHA2DS2-VASc score ≥2 were divided into 3 groups, that is, no treatment, antiplatelet therapy, and warfarin...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28644772/risk-stratification-for-second-primary-lung-cancer
#2
Summer S Han, Gabriel A Rivera, Martin C Tammemägi, Sylvia K Plevritis, Scarlett L Gomez, Iona Cheng, Heather A Wakelee
Purpose This study estimated the 10-year risk of developing second primary lung cancer (SPLC) among survivors of initial primary lung cancer (IPLC) and evaluated the clinical utility of the risk prediction model for selecting eligibility criteria for screening. Methods SEER data were used to identify a population-based cohort of 20,032 participants diagnosed with IPLC between 1988 and 2003 and who survived ≥ 5 years after the initial diagnosis. We used a proportional subdistribution hazards model to estimate the 10-year risk of developing SPLC among survivors of lung cancer LC in the presence of competing risks...
June 23, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28644057/the-implementation-of-medical-monitoring-programs-following-potentially-hazardous-exposures-a-medico-legal-perspective
#3
David Vearrier, Michael I Greenberg
CONTEXT: Clinical toxicologists may be called upon to determine the appropriateness of medical monitoring following documented or purported exposures to toxicants in the occupational, environmental, and medical settings. METHODS: We searched the MEDLINE database using the Ovid(®) search engine for the following terms cross-referenced to the MeSH database: ("occupational exposures" OR "environmental exposures") AND ("physiologic monitoring" OR "population surveillance")...
June 23, 2017: Clinical Toxicology
https://www.readbyqxmd.com/read/28642784/novel-miscanthus-germplasm-based-value-chains-a-life-cycle-assessment
#4
Moritz Wagner, Andreas Kiesel, Astley Hastings, Yasir Iqbal, Iris Lewandowski
In recent years, considerable progress has been made in miscanthus research: improvement of management practices, breeding of new genotypes, especially for marginal conditions, and development of novel utilization options. The purpose of the current study was a holistic analysis of the environmental performance of such novel miscanthus-based value chains. In addition, the relevance of the analyzed environmental impact categories was assessed. A Life Cycle Assessment was conducted to analyse the environmental performance of the miscanthus-based value chains in 18 impact categories...
2017: Frontiers in Plant Science
https://www.readbyqxmd.com/read/28640324/new-paradigms-in-venous-thromboprophylaxis-of-medically-ill-patients
#5
Alex C Spyropoulos, Alex Spyropoulos, Gary E Raskob
Acutelly-ill hospitalised medical patients are at risk of venous thromboembolism (VTE), both in-hospital and in the immediate post-discharge period, and mortality from VTE is thought to be particularly high in this patient population. However, despite previous mandates from international antithrombotic guidelines such as those of the American College of Chest Physicians (ACCP) for the "universal" use of thromboprophylaxis in hospitalised medical patients, global audits suggest that implementation of thromboprophylaxis continues to be challenging because of the perceived higher risk of bleeding and lower risk of VTE than that reported in clinical trials...
June 22, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28632874/screening-for-obesity-in-children-and-adolescents-us-preventive-services-task-force-recommendation-statement
#6
David C Grossman, Kirsten Bibbins-Domingo, Susan J Curry, Michael J Barry, Karina W Davidson, Chyke A Doubeni, John W Epling, Alex R Kemper, Alex H Krist, Ann E Kurth, C Seth Landefeld, Carol M Mangione, Maureen G Phipps, Michael Silverstein, Melissa A Simon, Chien-Wen Tseng
Importance: Based on year 2000 Centers for Disease Control and Prevention growth charts, approximately 17% of children and adolescents aged 2 to 19 years in the United States have obesity, and almost 32% of children and adolescents are overweight or have obesity. Obesity in children and adolescents is associated with morbidity such as mental health and psychological issues, asthma, obstructive sleep apnea, orthopedic problems, and adverse cardiovascular and metabolic outcomes (eg, high blood pressure, abnormal lipid levels, and insulin resistance)...
June 20, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28631197/prioritizing-future-research-on-allopurinol-and-febuxostat-for-the-management-of-gout-value-of-information-analysis
#7
Eric Jutkowitz, Fernando Alarid-Escudero, Hyon K Choi, Karen M Kuntz, Hawre Jalal
OBJECTIVES: The aim of this study was to quantify the value of conducting additional research and reducing uncertainty regarding the cost effectiveness of allopurinol and febuxostat for the management of gout. METHODS: We used a previously developed Markov model that evaluated the cost effectiveness of nine urate-lowering strategies: no treatment, allopurinol-only fixed dose (300 mg), allopurinol-only dose escalation (up to 800 mg), febuxostat-only fixed dose (80 mg), febuxostat-only dose escalation (up to 120 mg), allopurinol-febuxostat sequential therapy fixed dose, allopurinol-febuxostat sequential therapy dose escalation, febuxostat-allopurinol sequential therapy fixed dose, and febuxostat-allopurinol sequential therapy dose escalation...
June 19, 2017: PharmacoEconomics
https://www.readbyqxmd.com/read/28630238/impact-of-sex-on-cardiac-troponin-concentrations-a-critical-appraisal
#8
REVIEW
Kai M Eggers, Bertil Lindahl
BACKGROUND: The use of sex-specific cutoffs for cardiac troponin (cTn) is currently debated. Although endorsed by scientific working groups, concerns have been raised that sex-specific cutoffs may have only a small clinical effect at the cost of increased complexity in decision-making. METHODS: We reviewed studies investigating the interrelations between high-sensitivity (hs) cTn results and sex, diagnoses, and outcome. Investigated populations included community-dwelling subjects and patients with stable angina, congestive heart failure, or acute chest pain including those with acute coronary syndromes...
June 19, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28629709/energy-recovery-from-one-and-two-stage-anaerobic-digestion-of-food-waste
#9
Giorgia De Gioannis, Aldo Muntoni, Alessandra Polettini, Raffaella Pomi, Daniela Spiga
One- and two-stage anaerobic digestion of food waste aimed at recovering methane (CH4) and hydrogen and methane (H2+CH4), respectively, were compared in order to assess the potential benefits from the two-stage process in terms of overall energy recovery. Results suggest that a two-stage process where the first reactor is properly operated in order to achieve a significant net hydrogen production, may display a 20% comparatively higher energy recovery yield as a result, mainly, of enhanced methane production as well as of the associated hydrogen production...
June 16, 2017: Waste Management
https://www.readbyqxmd.com/read/28629610/a-model-for-assessing-the-clinical-and-economic-benefits-of-bone-forming-agents-for-reducing-fractures-in-postmenopausal-women-at-high-near-term-risk-of-osteoporotic-fracture
#10
Claire E O'Hanlon, Anju Parthan, Morgan Kruse, Shannon Cartier, Bjorn Stollenwerk, Yawen Jiang, John P Caloyeras, Daria B Crittenden, Richard Barron
PURPOSE: The goal of this study was to assess and compare the potential clinical and economic value of emerging bone-forming agents using the only currently available agent, teriparatide, as a reference case in patients at high, near-term (imminent, 1- to 2-year) risk of osteoporotic fractures, extending to a lifetime horizon with sequenced antiresorptive agents for maintenance treatment. METHODS: Analyses were performed by using a Markov cohort model accounting for time-specific fracture protection effects of bone-forming agents followed by antiresorptive treatment with denosumab...
June 16, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28629510/screening-strategies-for-atrial-fibrillation-a-systematic-review-and-cost-effectiveness-analysis
#11
Nicky J Welton, Alexandra McAleenan, Howard Hz Thom, Philippa Davies, Will Hollingworth, Julian Pt Higgins, George Okoli, Jonathan Ac Sterne, Gene Feder, Diane Eaton, Aroon Hingorani, Christopher Fawsitt, Trudie Lobban, Peter Bryden, Alison Richards, Reecha Sofat
BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources. OBJECTIVES: To conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model...
May 2017: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/28629348/applying-the-plan-do-study-act-pdsa-approach-to-a-large-pragmatic-study-involving-safety-net-clinics
#12
Jennifer Coury, Jennifer L Schneider, Jennifer S Rivelli, Amanda F Petrik, Evelyn Seibel, Brieshon D'Agostini, Stephen H Taplin, Beverly B Green, Gloria D Coronado
BACKGROUND: The Plan-Do-Study-Act (PDSA) cycle is a commonly used improvement process in health care settings, although its documented use in pragmatic clinical research is rare. A recent pragmatic clinical research study, called the Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC), used this process to optimize the research implementation of an automated colon cancer screening outreach program in intervention clinics. We describe the process of using this PDSA approach, the selection of PDSA topics by clinic leaders, and project leaders' reactions to using PDSA in pragmatic research...
June 19, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28628931/-the-probabilistic-efficiency-frontier-a-value-assessment-of-treatment-options-in-hepatitis-c
#13
Axel C Mühlbacher, Andrew Sadler
Background The German Institute for Quality and Efficiency in Health Care (IQWiG) recommends the concept of the efficiency frontier to assess health care interventions. The efficiency frontier supports regulatory decisions on reimbursement prices for the appropriate allocation of health care resources. Until today this cost-benefit assessment framework has only been applied on the basis of individual patient-relevant endpoints. This contradicts the reality of a multi-dimensional patient benefit. Objective The objective of this study was to illustrate the operationalization of multi-dimensional benefit considering the uncertainty in clinical effects and preference data in order to calculate the efficiency of different treatment options for hepatitis C (HCV)...
June 19, 2017: Das Gesundheitswesen
https://www.readbyqxmd.com/read/28627808/evaluation-of-a-pharmaceutical-risk-sharing-agreement-when-patients-are-screened-for-the-probability-of-success
#14
Reza Mahjoub, Fredrik Ødegaard, Gregory S Zaric
We analyze a game-theoretic model of a risk-sharing agreement between a payer and a pharmaceutical firm. The drug manufacturer chooses the price while the payer sets the rebate rate and decides which patients are eligible for treatment. The manufacturer provides the payer with a rebate for nonresponding patients. We generalize on the existing literature, by making both price and rebate rate decision variables, allowing the rebate rate to be different from 100%, and incorporating 2 types of administrative costs...
June 19, 2017: Health Economics
https://www.readbyqxmd.com/read/28627730/does-involvement-of-local-ngos-enhance-public-service-delivery-cautionary-evidence-from-a-malaria-prevention-program-in-india
#15
Ashis Das, Jed Friedman, Eeshani Kandpal
Partnerships between government and non-state actors that aim to enhance the quality or efficiency of service delivery are increasingly common in today's development policy landscape. We investigate the impacts of such an approach using data from an experimental supportive intervention to India's malaria control program that leveraged local non-state capacity in order to promote mosquito net usage and recommended fever care-seeking patterns. The supportive activities were conducted simultaneously by 3 NGOs, contracted out by the Indian government, in 2 endemic districts in the state of Odisha...
June 19, 2017: Health Economics
https://www.readbyqxmd.com/read/28626878/should-women-be-advised-to-use-calcium-supplements-during-pregnancy-a-decision-analysis
#16
Linda J E Meertens, Hubertina C J Scheepers, Jessica P M M Willemse, Marc E A Spaanderman, Luc J M Smits
Adequate calcium intake during pregnancy is important in the prevention of pre-eclampsia. A substantial proportion of pregnant women do not meet the recommended daily calcium intake, even in developed countries. Nonetheless, calcium supplementation is not routinely advised to pregnant women in most countries. We aimed to predict the impact of advising pregnant women to use calcium supplements (1,000 mg/day) on the number of cases of pre-eclampsia prevented and related health care costs. By use of a decision-analytic model, we assessed the expected impact of advising calcium supplementation to either (1) all pregnant women, (2) women at high risk of developing pre-eclampsia, or (3) women with a low dietary calcium intake compared with current care...
June 18, 2017: Maternal & Child Nutrition
https://www.readbyqxmd.com/read/28625370/rationale-and-design-of-the-apixaban-for-the-reduction-of-thrombo-embolism-in-patients-with-device-detected-sub-clinical-atrial-fibrillation-artesia-trial
#17
Renato D Lopes, Marco Alings, Stuart J Connolly, Heather Beresh, Christopher B Granger, Juan Benezet Mazuecos, Giuseppe Boriani, Jens C Nielsen, David Conen, Stefan H Hohnloser, Georges H Mairesse, Philippe Mabo, A John Camm, Jeffrey S Healey
BACKGROUND: Device-detected subclinical atrial fibrillation (AF) refers to infrequent, short-lasting, asymptomatic AF that is detected only with long-term continuous monitoring. Subclinical AF is common and associated with an increased risk of stroke; however, the risk of stroke with subclinical AF is lower than for clinical AF, and very few patients with subclinical AF alone have been included in large AF anticoagulation trials. The net benefit of anticoagulation in patients with subclinical AF is unknown...
July 2017: American Heart Journal
https://www.readbyqxmd.com/read/28624286/genomic-evaluation-of-age-at-first-calving
#18
J L Hutchison, P M VanRaden, D J Null, J B Cole, D M Bickhart
From their time of birth until their first lactation, dairy heifers incur management, health, and feed expenses while not producing milk. Much effort has been made to estimate optimal ages of first calving (AFC) for cows to reduce these costs, which can be as high as $2.50 per day, and ensure that animals are productive earlier in life. To identify AFC for 3 dairy cattle breeds (Holstein, Jersey, and Brown Swiss) that maximizes production, we retrieved phenotypic records for more than 14 million cows calving between 1997 and 2015 from the US national dairy database...
June 14, 2017: Journal of Dairy Science
https://www.readbyqxmd.com/read/28624178/liver-transplantation-in-patients-with-liver-metastases-from-neuroendocrine-tumors-a%C3%A2-systematic-review
#19
Dimitrios Moris, Diamantis I Tsilimigras, Ioannis Ntanasis-Stathopoulos, Eliza W Beal, Evangelos Felekouras, Spiridon Vernadakis, John J Fung, Timothy M Pawlik
BACKGROUND: Liver transplantation to treat neuroendocrine tumors, especially in the setting of diffuse liver involvement not amenable to operative resection remains controversial. We sought to perform a systematic review of the current literature to summarize data on patients undergoing liver transplantation with neuroendocrine tumors liver metastases as the indication. METHODS: A systematic review was conducted in accordance to the Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines...
June 14, 2017: Surgery
https://www.readbyqxmd.com/read/28622732/cost-effectiveness-of-memory-assessment-services-for-the-diagnosis-and-early-support-of-patients-with-dementia-in-england
#20
Manuel Gomes, Mark Pennington, Raphael Wittenberg, Martin Knapp, Nick Black, Sarah Smith
Background Policy makers in England advocate referral of patients with suspected dementia to Memory Assessment Services (MAS), but it is unclear how any improvement in patients' health-related quality of life (HRQL) compares with the associated costs. Aims To evaluate the cost-effectiveness of MAS for the diagnosis and follow-up care of patients with suspected dementia. Method We analysed observational data from 1318 patients referred to 69 MAS, and their lay carers (n = 944), who completed resource use and HRQL questionnaires at baseline, three and six months...
January 1, 2017: Journal of Health Services Research & Policy
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