Cost-Effectiveness of Revascularization Strategies Zhang, Zugui, PhD; Kolm, Paul, PhD; Grau-Sepulveda, Maria V., MD, MPH ...
Journal of the American College of Cardiology,
01/2015, Letnik:
65, Številka:
1
Journal Article
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Abstract Background ASCERT (American College of Cardiology Foundation and the Society of Thoracic Surgeons Collaboration on the Comparative Effectiveness of Revascularization Strategies) was a large ...observational study designed to compare the long-term effectiveness of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) to treat coronary artery disease (CAD) over 4 to 5 years. Objectives This study examined the cost-effectiveness of CABG versus PCI for stable ischemic heart disease. Methods The Society of Thoracic Surgeons and American College of Cardiology Foundation databases were linked to the Centers for Medicare and Medicaid Services claims data. Costs for the index and observation period (2004 to 2008) hospitalizations were assessed by diagnosis-related group Medicare reimbursement rates; costs beyond the observation period were estimated from average Medicare participant per capita expenditure. Effectiveness was measured via mortality and life-expectancy data. Cost and effectiveness comparisons were adjusted using propensity score matching with the incremental cost-effectiveness ratio expressed as cost per quality-adjusted life-year gained. Results CABG patients (n = 86,244) and PCI patients (n = 103,549) were at least 65 years old with 2- or 3-vessel coronary artery disease. Adjusted costs were higher for CABG for the index hospitalization, study period, and lifetime by $10,670, $8,145, and $11,575, respectively. Patients undergoing CABG gained an adjusted average of 0.2525 and 0.3801 life-years relative to PCI over the observation period and lifetime, respectively. The life-time incremental cost-effectiveness ratio of CABG compared to PCI was $30,454/QALY gained. Conclusions Over a period of 4 years or longer, patients undergoing CABG had better outcomes but at higher costs than those undergoing PCI.
To investigate safety, efficacy, and immunogenicity of live quadrivalent rotavirus vaccine (QRV) containing human-bovine (WC3) reassortant rotavirus serotypes G1, G2, G3, and P1a.
This was a ...randomized, double-blinded, placebo-controlled trial. During 1993 to 1994, at 10 US study sites, 439 healthy infants ∼2 to 6 months of age, were enrolled to receive 3 doses of oral QRV or placebo at approximately 8-week intervals.
The vaccine was generally well tolerated; no serious vaccine-related adverse experiences were reported. Risk differences and 95% confidence intervals suggested no differences between vaccine and placebo recipients in the incidences of fever, irritability, vomiting, or diarrhea during the 14 days after any dose. QRV was 74.6% efficacious (95% CI: 49.5%, 88.3%) in preventing rotavirus acute gastroenteritis (AGE), regardless of severity and 100% efficacious (95% CI: 43.5%, 100%) in preventing severe rotavirus AGE through one rotavirus season. Serotype G1 was identified in most infants with rotavirus AGE. A ≥3-fold rise in serum neutralizing antibody to G1 was observed in 57% (45/79) of vaccinees. A ≥3-fold rise in serum anti-rotavirus IgA and fecal anti-rotavirus IgA was observed in 88% (162/185) and 65% (104/159) of vaccinees, respectively.
QRV was generally well tolerated, immungenic, and highly effective against rotavirus gastroenteritis.
Background
We studied the prevalence of neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) in Indigenous populations of Australia and New Zealand with the aim of assessing ...potential differences.
Methods
Cases of possible NMOSD and MS were collected from Australia and New Zealand. Clinical details, MR imaging, and serologic results were used to apply 2015 IPND diagnostic criteria for NMOSD and 2010 McDonald criteria for MS. Frequencies of self-determined ethnic ancestry were calculated for confirmed NMOSD, suspected NMOSD, and MS. Prevalence rates for NMOSD and MS according to ancestry were compared.
Results
There were 75 cases with NMOSD, 89 with suspected NMSOD, and 101 with MS. NMOSD cases were more likely to have Asian, Indigenous, or Other ancestry compared to suspected NMOSD or MS. There were no differences in the clinical phenotype of NMOSD seen in Indigenous compared to European ancestry populations. Per 100,000, the prevalence estimate for NMOSD in people with Māori ancestry was 1.50 (95% CI 0.52–2.49) which was similar to those with Asian ancestry 1.57 (95% CI 1.15–1.98). NMOSD prevalence in Australian Aboriginal and Torres Strait Islander populations was 0.38 (95% CI 0.00–0.80) per 100,000.
Conclusion
The prevalence of NMOSD in the Māori population is similar to South East Asian countries, reflecting their historical origins. The prevalence of MS in this group is intermediate between those with South East Asian and European ancestry living in New Zealand. Both NMOSD and particularly MS appear to be uncommon in the Indigenous populations of Australia.
Abstract
We describe an autosomal dominant, multi‐generational, amyotrophic lateral sclerosis (ALS) pedigree in which disease co‐segregates with a heterozygous p.Y374X nonsense mutation within ...TDP‐43. Mislocalization of TDP‐43 and formation of insoluble TDP‐43‐positive neuronal cytoplasmic inclusions is the hallmark pathology in >95% of ALS patients. Neuropathological examination of the single case for which CNS tissue was available indicated typical TDP‐43 pathology within lower motor neurons, but classical TDP‐43‐positive inclusions were absent from motor cortex. The mutated allele is transcribed and translated in patient fibroblasts and motor cortex tissue, but overall TDP‐43 protein expression is reduced compared to wild‐type controls. Despite absence of TDP‐43‐positive inclusions we confirmed deficient TDP‐43 splicing function within motor cortex tissue. Furthermore, urea fractionation and mass spectrometry of motor cortex tissue carrying the mutation revealed atypical TDP‐43 protein species but not typical C‐terminal fragments. We conclude that the p.Y374X mutation underpins a monogenic, fully penetrant form of ALS. Reduced expression of TDP‐43 combined with atypical TDP‐43 protein species and absent C‐terminal fragments extends the molecular phenotypes associated with TDP‐43 mutations and with ALS more broadly. Future work will need to include the findings from this pedigree in dissecting the mechanisms of TDP‐43‐mediated toxicity.
Premature birth has been associated with a number of adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and ...parenting style. Infants and children who were premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, a number of educational and behavioral interventions have been developed that target maternal psychological functioning, parenting, and aspects of the parent–infant relationship. Since the last comprehensive review of this topic in 2002, there have been a significant number of developments in the quality of the studies conducted and the theoretical models that address the experience of parents of premature infants. In the current review, 18 new interventions were identified and grouped into four categories based on treatment length and the target of the intervention. Findings suggest a trend toward early, brief interventions that are theoretically based, specifically target parent trauma, and utilize cognitive behavioral techniques. Although it is difficult to generalize study findings, conclusions from the review suggest that targeted interventions may have positive effects on both maternal and infant outcomes.
Se ha asociado el nacimiento prematuro con una serie de resultados sicológicos maternos adversos, entre ellos la depresión, la ansiedad y el trauma, así como efectos adversos en la habilidad de la madre para arreglárselas y en su estilo de crianza. Los infantes y niños que nacieron prematuramente están más propensos a tener un funcionamiento cognitivo y de desarrollo más pobre, lo cual pudiera ser más duro para la madre. A manera de respuesta a estos resultados, se ha desarrollado una serie de intervenciones educativas y de conducta que tienen como meta el funcionamiento sicológico maternal, la crianza y aspectos de la relación madre‐infante. Desde la última revisión comprensiva de este tema en 2002, se ha producido un número significativo de desarrollos en la calidad de los estudios llevados a cabo y los modelos teóricos que se enfocan en la experiencia de los padres de infantes prematuros. En la presente revisión, se identificaron dieciocho nuevas intervenciones las cuales se agruparon en cuatro categorías basadas en la duración del tratamiento y el enfoque de la intervención. Los resultados sugieren una tendencia hacia las intervenciones tempranas y breves que tienen una base teórica, que específicamente se enfocan en el trauma de la madre, y que utilizan técnicas de conducta cognitiva. Aunque fue difícil generalizar los resultados del estudio, las conclusiones de la revisión que se enfocaron en las intervenciones pudieran tener efectos positivos tanto en los resultados maternales como del infante.
La naissance prématurée a été liée à un nombre de résultats psychologiques maternels négatifs qui incluent la dépression, l'anxiété et le traumatisme ainsi que des effets sur l'aptitude maternelle à faire face et le style de parentage. Les bébés et les enfants qui étaient prématurés sont plus à même d'avoir un fonctionnement cognitif moins développé et un fonctionnement développemental moindre et donc ils peuvent s'avérer plus difficiles à élever. En réponse à ces résultats un nombre d'interventions éducationnelles et comportementales ont été développées, mettant l'accent sur le fonctionnement psychologique maternel, le parentage et les aspects de la relation parent‐bébé. Depuis la dernière revue complète de ce sujet en 2002 un nombre important de développements se sont produits dans la qualité des études faites et les modèles théoriques qui abordent l'expérience de parents de bébés prématurés. Dans ce passage en revue, dix‐huit nouvelles interventions ont été identifies et groupées en quatre catégories basées sur la longueur de traitement et la cible de l'intervention.Les résultats suggèrent une tendance vers des interventions brèves et précoces qui sont basées sur une théorie, qui ont pour but spécifique le trauma parental et qui utilisent des techniques cognitives de comportement. Bien qu'il soit difficile de généraliser des résultats d'étude les conclusions émanant de la revue suggèrent que les interventions ciblées peuvent avoir des effets positifs à la fois sur les résultats maternels et sur les résultats avec les bébés.
Frühgeburten werden mit einer Reihe von psychologischen Belastungen für Mütter in Zusammenhang gebracht. Darunter fallen z.B. die Depression, Angst und Trauma, aber auch negative Einflüsse auf mütterliche Copingfunktionen und Erziehungsstile. Säuglinge und Kinder, die früh geboren werden, haben eine höhere Wahrscheinlichkeit schwächere kognitive und Entwicklungsfunktionen aufzuweisen und könnten aufgrund dessen schwerer zu erziehen sein. Als Reaktion auf diese Befunde wurden eine Vielzahl an edukativen und verhaltensbasierten Interventionen entwickelt, die eine Verbesserung der psychologischen Funktionen, des Erziehungsverhaltens und Aspekten der Eltern‐Säugling Beziehung zum Ziel haben. Seit der letzten weitreichenden Übersichtsarbeit zu diesem Thema im Jahr 2002, hat es eine signifikante Anzahl an Entwicklungen in der Qualität der durchgeführten Studien und den theoretischen Modellen, die sich der Erfahrung von Eltern und frühgeborenen Säuglingen widmen, gegeben. In der vorliegenden Übersichtsarbeit wurden achtzehn neue Interventionen identifiziert und basierend auf der Behandlungslänge und dem Ziel der Intervention in vier Kategorien eingeteilt. Die Befunde deuten auf einen Trend zu frühen, kurzen Interventionen hin, die theoretisch fundiert sind, spezifisch auf das elterliche Trauma abzielen, und Techniken der kognitiven Verhaltenstherapie anwenden. Obwohl es schwer ist die Studienergebnisse zu generalisieren, deuten Schlussfolgerungen dieser Übersichtsarbeit darauf hin, dass gezielte Interventionen sich positiv auf die Belastungen der Mutter und des Säuglings auswirken können.
抄録：未熟児の出産は、母親の、うつ、不安および外傷を含む、多くの有害な心理的結果を伴うばかりでなく、母親の対処能力と養育スタイルに有害な影響を伴っている。未熟児で生まれた乳児と子どもは、より弱い認知と発達機能を持つ可能性が高く、そのために育児がより難しいだろう。これらの所見の反応として、母親の心理的機能、養育、および親と乳児の関係性の側面を目標とした、多くの教育的および行動的介入が、開発された。このトピックについての前回2002年の包括的レビュー以来、実施された研究の質および未熟児の親の経験に向けられた理論的モデルにおける、かなりの数の発展が見られてきた。このレビューでは、18の新しい介入が見いだされ、治療期間と介入の目標にしたがって4つのカテゴリーにグループ化された。所見から、理論に基づき、親の外傷に特異的な目標を置き、認知行動的技法を利用する、早期の短期介入への傾向が示唆される。研究の所見を一般化するのは困難だが、レビューの結論として、目標を定めた介入は、母親の結果と子どもの結果の両者に肯定的な影響があるだろうと、示唆される。
Background Recent observational studies show that patients with multivessel coronary disease have a long-term survival advantage with coronary artery bypass grafting (CABG) compared with percutaneous ...coronary intervention (PCI). Important nonfatal outcomes may also affect optimal treatment recommendation. Methods CABG was compared with percutaneous catheter intervention by using a composite of death, myocardial infarction (MI), or stroke. Medicare patients undergoing revascularization for stable multivessel coronary disease from 2004 through 2008 were identified in national registries. Short-term clinical information from the registries was linked to Medicare data to obtain long-term follow-up out to 4 years from the time of the procedure. Propensity scoring with inverse probability weighting was used to adjust for baseline risk factors. Results There were 86,244 CABG and 103,549 PCI patients. The mean age was 74 years, with a median 2.67 years of follow-up. At 4 years, the propensity-adjusted adjusted cumulative incidence of MI was 3.2% in CABG compared with 6.6% in PCI (risk ratio, 0.49; 95% confidence interval, 0.45 to 0.53). At 4 years, the cumulative incidence of stroke was 4.5% in CABG compared with 3.1% in PCI patients (risk ratio, 1.43; 95% confidence interval, 1.31 to 1.54). This difference was primarily due to the higher 30-day stroke rate for CABG (1.55% vs 0.37%). For the composite of death, MI, or stroke, the 4-year adjusted cumulative incidence was 21.6% for CABG and 26.7% for PCI (risk ratio, 0.81; 95% confidence interval, 0.78 to 0.83). Conclusions The 4-year composite event rate of death, MI, and stroke favored CABG, whereas the risk of stroke alone favored PCI.
Eschscholtzine, a new alkaloid from Eschscholtzia californica, has been shown to be the bismethylenedioxy analogue of N-methylpavine (argemonine). The mass spectrometric fragmentation of alkaloids of ...the pavine type is discussed.
The Apolipoprotein E ε4 allele (i.e. ApoE4) is the strongest genetic risk factor for sporadic Alzheimer's disease (AD). TREM2 (i.e. Triggering receptor expressed on myeloid cells 2) is a microglial ...transmembrane protein brain that plays a central role in microglia activation in response to AD brain pathologies. Whether higher TREM2-related microglia activity modulates the risk to develop clinical AD is an open question. Thus, the aim of the current study was to assess whether higher sTREM2 attenuates the effects of ApoE4-effects on future cognitive decline and neurodegeneration.
We included 708 subjects ranging from cognitively normal (CN, n = 221) to mild cognitive impairment (MCI, n = 414) and AD dementia (n = 73) from the Alzheimer's disease Neuroimaging Initiative. We used linear regression to test the interaction between ApoE4-carriage by CSF-assessed sTREM2 levels as a predictor of longitudinally assessed cognitive decline and MRI-assessed changes in hippocampal volume changes (mean follow-up of 4 years, range of 1.7-7 years).
Across the entire sample, we found that higher CSF sTREM2 at baseline was associated with attenuated effects of ApoE4-carriage (i.e. sTREM2 x ApoE4 interaction) on longitudinal global cognitive (p = 0.001, Cohen's f
= 0.137) and memory decline (p = 0.006, Cohen's f
= 0.104) as well as longitudinally assessed hippocampal atrophy (p = 0.046, Cohen's f
= 0.089), independent of CSF markers of primary AD pathology (i.e. Aβ
, p-tau
). While overall effects of sTREM2 were small, exploratory subanalyses stratified by diagnostic groups showed that beneficial effects of sTREM2 were pronounced in the MCI group.
Our results suggest that a higher CSF sTREM2 levels are associated with attenuated ApoE4-related risk for future cognitive decline and AD-typical neurodegeneration. These findings provide further evidence that TREM2 may be protective against the development of AD.
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