Abstract The 5-2-1 criteria was developed to facilitate the identification and referral of patients with Parkinson’s Disease (PD) inadequately controlled by oral medications. The criterion was not ...developed to screen patients with PD for device-aided therapy eligibility. The robust design and validation of the 5-2-1 criteria minimizes over or inappropriate referrals, and supports physicians in the timely identification of patients with PD who may warrant further evaluation for treatment optimization. This response letter clarifies concerns raised by Moes et al.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
Post-cataract macular edema (PCME) is a condition that can occur in patients following cataract surgery without risk factors and complications. Although 80% of patients experience ...spontaneous resolution after 3 to 12 months, in persistent cases, it can lead to permanent vision loss if left untreated. There are currently no standardized treatment guidelines for PCME, and there have been limited studies showing the impact of PCME on annual Medicare spending and ophthalmology-related outpatient visits per case compared to those without the complication. This study aims to evaluate real-world treatment patterns and the economic burden of patients with PCME.
Methods
This retrospective claims analysis identified patients from the IBM
®
MarketScan
®
Commercial and Medicare Supplemental databases. Patients with (n = 2430) and without (n = 7290) PCME 1 year post cataract surgery were propensity score matched 1:3 based on age, geographic region, diabetes presence, cataract surgery type, and Charlson Comorbidity Index. Treatment pattern analysis for each PCME patient summarized the distribution of medications across lines of therapy. Economic burden analysis compared the mean number and costs of eye-related outpatient visits, optical coherence tomography imaging scans, and ophthalmic medications between the 2 groups using linear regression models.
Results
Treatment pattern analysis found 27 different treatment combinations across 6 treatment lines. The most common first-line treatments were topical steroid drops (372 30%), topical nonsteroidal anti-inflammatory drug drops (321 27%), and intraocular or periocular injectable steroids (189 15%). Compared to match controls, PCME patients averaged 6 additional eye-related outpatient office visits (95% CI: 5.7–6.2) resulting in an additional $3,897 (95% CI: $3,475 - $4,319) in total costs. Patients filled 3 more ophthalmology-related outpatient prescription medications (95% CI: 2.8–3.2), adding $371 in total cost (95% CI: $332 – $410).
Conclusions
PCME treatment patterns showed wide clinical variability in treatments and time, specifically regarding injectable treatments and combination therapy. Additionally, significantly higher healthcare resource use and economic burden were found for both patients and payers when comparing PCME patients to non-PMCE controls. These results highlight the need for treatment standardization and demonstrate that interventions targeted at preventing PCME may be valuable.
The burden of Parkinson's disease (PD) worsens with disease progression. However, the lack of objective and uniform disease classification challenges our understanding of the incremental burden in ...patients with advanced Parkinson's disease (APD) and suboptimal medication control. The 5-2-1 criteria was proposed by clinical consensus to identify patients with advancing PD. Our objective was to evaluate the screening accuracy and incremental clinical burden, healthcare resource utilization (HCRU), and humanistic burden in PD patients meeting the 5-2-1 screening criteria.
Data were drawn from the Adelphi Parkinson's Disease Specific Program (DSP™), a multi-country point-in-time survey (2017-2020). People with PD who were naive to device-aided therapy and on oral PD therapy were included. Patients meeting the 5-2-1 screening criteria had one or more of the three clinical indicators of APD: (i) ≥5 doses of oral levodopa/day, OR (ii) "off" symptoms for ≥2 h of waking day, OR (iii) ≥1 h of troublesome dyskinesia. Clinician assessment of PD stage was used as the reference in this study. Clinical screening accuracy of the 5-2-1 criteria was assessed using area under the curve and multivariable logistic regression models. Incremental clinical, HCRU, and humanistic burden were assessed by known-group comparisons between 5 and 2-1-positive and negative patients.
From the analytic sample (n = 4714), 33% of patients met the 5-2-1 screening criteria. Among physician-classified APD patients, 78.6% were 5-2-1 positive. Concordance between clinician judgment and 5-2-1 screening criteria was > 75%. 5-2-1-positive patients were nearly 7-times more likely to be classified as APD by physician judgment. Compared with the 5-2-1-negative group, 5-2-1-positive patients had significantly higher clinical, HCRU, and humanistic burden across all measures. In particular, 5-2-1-positive patients had 3.8-times more falls, 3.6-times higher annual hospitalization rate, and 3.4-times greater dissatisfaction with PD treatment. 5-2-1-positive patients also had significantly lower quality of life and worse caregiver burden.
5-2-1 criteria demonstrated potential as a screening tool for identifying people with APD with considerable clinical, humanistic, and HCRU burden. The 5-2-1 screening criteria is an objective and reliable tool that may aid the timely identification and treatment optimization of patients inadequately controlled on oral PD medications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This paper presents an assessment of the criteria for setting the maximum amount of compensation given to a property developer when a buyer breaches their contractual obligations according to the law ...of the Interim Real Property Register in the Emirate of Dubai. The register gives the developer the power to deduct a certain percentage of the amount paid to them by the buyer, without the need to resort to justice or arbitration. Such a power is one of certain exceptional powers granted to the developer under this law to encourage property investment in Dubai. This research aims to define the type of compensation that the property developer deserves, as well as present the criteria for the maximum amount of compensation and an evaluation of them. This was achieved by analyzing Article 11 of the mentioned law for accuracy and fairness on this issue, and its success in balancing the conflicting interests of both parties. One key result found was that the legislator had not succeeded in balancing the two parties of the off-plan sale. It is strongly recommended that the legislator abolish the three criteria on the maximum amount of compensation and adopt alternative criteria.
Background
Parkinson’s disease is now one of the fastest-growing neurodegenerative disorders in the developed world, with an increasing prevalence and associated socioeconomic costs. Progression of ...the disease leads to a gradual deterioration in patients’ quality of life, despite optimal treatment, and both medical and societal needs increase, often with the assistance of paid and/or unpaid caregivers.
Objective
We aimed to quantify the incremental economic burden of Parkinson’s disease by disease severity in a real-world setting across differing geographic regions.
Methods
Demographics, clinical characteristics, health status, patient quality of life, caregiver burden, and healthcare resource utilization data were drawn from the Adelphi Parkinson’s Disease Specific Program™, conducted in the USA, five European countries, and Japan.
Results
A total of 563 neurologists provided data for 5299 individuals with Parkinson’s disease; 61% were male, with a mean age of 64 years. Approximately 15% of individuals were deemed to have advanced disease, with significantly more comorbidities, and a poorer quality of life, than those with non-advanced disease. Overall, the mean annual healthcare resource utilization increased significantly with advancing disease, and resulted in a three-fold difference in the USA and Europe. The main drivers behind the high economic burden included hospitalizations, prescription medications, and indirect costs.
Conclusions
People with Parkinson’s disease, and their caregivers, incur a higher economic burden as their disease progresses. Future interventions that can control symptoms or slow disease progression could reduce the burden on people with Parkinson’s disease and their caregivers, whilst also substantially impacting societal costs.
Copper/Cuprous oxide/Carbon nanoparticles decorated MXene composite was prepared and subsequently examined for its potential application as a non-enzymatic glucose sensor. To carry out this, ...initially the Cu MOF/MXene composite was synthesised by the hydrothermal method and was annealed in an unreacted environment at different time intervals. During this process, petal like Cu MOF on MXene loses the organic ligands to form a Cu/Cu2O/C based nanoparticles on MXene. Further, an electrode was fabricated with the developed material for understanding the sensing performance by cyclic voltammetry and chronoamperometry in 0.1 M NaOH solution. Results reveal that the highest weight percentage of copper oxide in the composite (15 min of annealed material) shows a higher electro catalytic activity for sensing glucose molecules due to more active sites with good electron transfer ability in the composite. The formed composite exhibits a wide linear range of 0.001-26.5 mM, with a sensitivity of 762.53μAmM-1cm-2(0.001-10.1 mM), and 397.18μAmM-1cm-2(11.2-26.9 mM) and the limit of detection was 0.103μM. In addition to this, the prepared electrode shows a good reusability, repeatability, selectivity with other interferences, stability (93.65% after 30 days of storage), and feasibility of measuring glucose in real samples. This finding reveals that the metal oxide derived from MOF based nanoparticle on the MXene surface will promote the use of non-enzymatic glucose sensors.Copper/Cuprous oxide/Carbon nanoparticles decorated MXene composite was prepared and subsequently examined for its potential application as a non-enzymatic glucose sensor. To carry out this, initially the Cu MOF/MXene composite was synthesised by the hydrothermal method and was annealed in an unreacted environment at different time intervals. During this process, petal like Cu MOF on MXene loses the organic ligands to form a Cu/Cu2O/C based nanoparticles on MXene. Further, an electrode was fabricated with the developed material for understanding the sensing performance by cyclic voltammetry and chronoamperometry in 0.1 M NaOH solution. Results reveal that the highest weight percentage of copper oxide in the composite (15 min of annealed material) shows a higher electro catalytic activity for sensing glucose molecules due to more active sites with good electron transfer ability in the composite. The formed composite exhibits a wide linear range of 0.001-26.5 mM, with a sensitivity of 762.53μAmM-1cm-2(0.001-10.1 mM), and 397.18μAmM-1cm-2(11.2-26.9 mM) and the limit of detection was 0.103μM. In addition to this, the prepared electrode shows a good reusability, repeatability, selectivity with other interferences, stability (93.65% after 30 days of storage), and feasibility of measuring glucose in real samples. This finding reveals that the metal oxide derived from MOF based nanoparticle on the MXene surface will promote the use of non-enzymatic glucose sensors.
Anticoagulation with warfarin represents a transportation‐sensitive treatment state. Transportation barrier is a common reason for not using health care services.
To assess the association between ...transportation barriers to anticoagulation clinic and anticoagulation control (AC) among an inner‐city, low‐income population.
Adults expected to be on chronic warfarin therapy were recruited from an ambulatory anticoagulation clinic. Participants completed a validated questionnaire that assessed transportation barriers to clinic, defined as self‐reported trouble getting transportation to a clinic and a composite score of the presence of transportation barriers. Suboptimal AC was defined as time in therapeutic range (TTR) <60% over 6 months. Prevalence ratios with 95% confidence intervals (CIs), adjusted for age, sex, and annual household income, described the association of transportation trouble and barriers with AC.
Of 133 participants, 42.9% had suboptimal AC. Mean age was 60.4 (SD, 13.6) years, and the majority of participants were women (62.2%). Participants with transportation trouble were more likely to report being disabled/unable to work (63.6%) and annual household income <$15 000 (45.5%). Mean TTR was significantly lower for participants with transportation trouble compared to those without (53.8% SD, 24.7% vs 64.7% SD, 25.0%; P= .03). Participants reporting transportation trouble or at least one transportation barrier were 1.60 (95% CI, 1.07‐2.39) and 1.68 (95% CI, 1.01‐2.80) times more likely, respectively, to have suboptimal AC compared to those without.
Inner‐city, low‐income individuals with transportation barriers were more likely to have suboptimal AC. Further research is warranted to evaluate the impact of alleviating patient‐specific transportation barriers on anticoagulation outcomes.
This paper describes the construction of a high voltage DC generator using single-phase transformer and Cockcroft-Walton voltage multiplier. The aim is to simulate high voltage DC for simulating ...electric field produced before a lightning strike near the ground. Lower AC voltage is step up to high AC voltage using a neon transformer. The AC voltage is then converted into high DC voltage using variable stages of Cockcroft-Walton voltage multiplier. The generator HVDC is connected to the adjustable parallel plate to ground. Variable stages of Cockcroft-Walton voltage multiplier produce high voltage magnitude proportional to each stage of it. The electric field generated from high voltage DC can also be varied depending on the distance between DC output plate and ground. The application of high voltage DC in generating electric field useful in testing locally assembled Electric Field Sensor.
Use of the vasodilator midodrine for the treatment of treprostinil-induced hypotension is reported.
Intradialytic hypotension is a common complication of dialysis that increases patient mortality due ...to suboptimal ultrafiltration and interruption of hemodialysis. Midodrine is an α1 vasoconstrictor commonly used for the treatment of pulmonary arterial hypertension (PAH) and intradialytic hypotension. The safety of midodrine dosing at greater than 30 mg daily has not been established to date. A 49-year-old African-American man with a history of PAH and end-stage renal disease (ESRD) was receiving hemodialysis (HD) 3 times weekly. Subcutaneous treprostinil infusions were initiated for PAH, subsequently causing hypotension, with predialysis blood pressure values as low as 60/50 mm Hg. During a 6-month follow-up period, 38 of 62 dialysis sessions were interrupted or discontinued due to severe intradialytic hypotension. Counteraction of treprostinil effects was achieved by increasing the total daily midodrine dose from 30 mg to 90 mg over 6 months, with no remarkable adverse effects. In previously reported cases, maximum midodrine daily doses of 30 mg in nondialysis patients and 25 mg in patients with ESRD receiving hemodialysis were reported. The patient described here received a total daily dose of 90 mg, including 60 mg administered in divided doses for daily maintenance and 30-mg intradialytic doses; this was the highest daily midodrine dose reported to date.
A 49-year-old patient tolerated 60-mg daily doses of midodrine along with 30-mg intradialytic doses for the management of treprostinil-induced hypotension and prevention of HD interruption, without adverse effects.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Introduction: Colorectal cancer (CRC) has different forms of colon cancer or rectal cancer. CRCs are often considered together because they possess many similar features. A severe form of the disease ...with higher mortality rate increases with increase in age. The most common CRC risk factors include smoking, diabetes, and obesity. This study aims to evaluate the awareness of CRC in a random population of Asir region and to identify the subpopulation that can be recipients of awareness and screening programs. Material and Methods: Cross-sectional nonprobable random sampling study using a self-administered questionnaire survey which was employed to include healthy males and females from Asir region. The questionnaire included ten questions in Arabic language and data were categorized according to gender, marital status, age, and level of education to determine whether these demographic groups possess difference in knowledge about CRC. Results: Most of the respondents (51% and 71.6%) knew what is colon and rectum. About 33.8% know the correct function of the colon while 22.5% know the correct incidence and 22.1% know the correct time of screening for CRC. Very few respondents know the symptoms, risks, and screening modalities of CRC.Pearson's Chi-square test was employed to evaluate the differences in responses in four demographic categories of the study population. P <0.05 was considered as statistically significant Conclusions: Single less educated males lack knowledge of CRC. In addition, there is very low awareness of CRC symptoms, risk factors, and screening modalities among the entire surveyed population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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