Anterior vertebral body tethering (VBT) is a non-fusion, minimally invasive, growth-modulating procedure with some early positive clinical outcomes reported in pediatric patients with idiopathic ...scoliosis (IS). VBT offers potential health-related quality of life (HRQoL) benefits over spinal fusion in allowing patients to retain a greater range of motion after surgery. We conducted an early cost-utility analysis (CUA) to compare VBT with fusion as a first-choice surgical treatment for skeletally immature patients (age >10 years) with moderate to severe IS, who have failed nonoperative management, from a US integrated healthcare delivery system perspective.
The CUA uses a Markov state transition model, capturing a 15-year period following index surgery. Transition probabilities, including revision risk and subsequent fusion, were based on published surgical outcomes and an ongoing VBT observational study (NCT02897453). Patients were assigned utilities derived from published patient-reported outcomes (PROs; SRS-22r mapped to EQ-5D) following fusion and the above VBT study. Index and revision procedure costs were included. Probabilistic (PSA) and deterministic sensitivity analyses (DSA) were performed.
VBT was associated with higher costs but also higher quality-adjusted life years (QALYs) than fusion (incremental costs: $45,546; QALYs gained: 0.54). The subsequent incremental cost-effectiveness ratio for VBT vs fusion was $84,391/QALY gained. Mean PSA results were similar to the base case, indicating that results were generally robust to uncertainty. The DSA indicated that results were most sensitive to variations in utility values.
This is the first CUA comparing VBT with fusion in pediatric patients with IS and suggests that VBT may be a cost-effective alternative to fusion in the US, given recommended willingness-to-pay thresholds ($100,000-$150,000). The results rely on HRQoL benefits for VBT compared with fusion. For improved model accuracy, further analyses with longer-term PROs for VBT, and comparative effectiveness studies, would be needed.
Objectives. To evaluate Indiana pediatricians’ current practices related to oral health, knowledge of oral health prevention, and opinions on anticipatory guidance integration into their practices. ...Background. The American Academy of Pediatrics (AAP) May 2003 policy statement on oral health risk assessment timing and establishment of a dental home has provided pediatricians with guidelines to assess patients’ oral health and caries risk status. Methods. A survey of 31 questions was distributed via mail to all active Indiana pediatricians (300) registered in the Indiana State Medical Association to evaluate current practices relating to oral health prevention and guidance. Results. Of the 300 distributed surveys, 138 were returned (46%). The authors found that 15% of pediatricians recognize the AAP-recommended age for a dental home as 12 months and practice this recommendation. Among the respondents, 7% believe application of fluoride should be part of a well-child visit. The majority (89%) of respondents reported interest in obtaining further knowledge on oral health.
We present the case of a female patient who developed chiasmatic apoplexy and menstrual alterations. CT scanning showed a suprasellar hemorrhage. She underwent surgery with the presumptive diagnosis ...of pituitary tumor. At surgery, we find a brown-grayish lesion involving left optic nerve and chiasm. Cavernous angioma was diagnosed by histopathology. Cavernous angiomas constitute nearly 15% of all central nervous system vascular malformations. Location at the optic pathway is very rare, but must to be ruled out in the diagnosis of a patient with chiasmatic and/or optic apoplexy. Surgery is useful in preventing worsening of the previous deficit or a new visual defect.
Cerebral angiography (CA) is considered as the gold standard in diagnosis of intracranial aneurysms; nevertheless, the magnetic resonance angiography (MR-angiography) is wide spread used in detection ...of unruptured aneurysm. For this reason, several authors had proposed that MR-angiography could replace CA in the diagnosis of ruptured aneurysms.
To asses the efficacy of MR-angiography in diagnosis of ruptured intracranial aneurysms, and in addition to determine the safeness of its surgical management with MR-angiography alone.
We studied prospectively 52 patients with subarachnoid haemorrhage admitted at Teodoro Maldonado Carbo and Alcívar Guayaquil hospitals of Guayaquil, Ecuador, in a 5 years period. We compared the results of MR-angiography with CA and surgical findings in the diagnosis and categorization of intracranial aneurysms.
We made diagnosis of 100% of 54 aneurysms with MR-angiography, while 98% with CA. The surgical findings were similar to the characteristics showed by MR-angiography.
MR-angiography is an excellent no invasive method in the diagnosis of ruptured intracranial aneurysms, and could replace CA in selected cases.
Discusses the use of historical events as examples for teaching college level statistics courses. Focuses on examples of the space shuttle Challenger, Pearl Harbor (Hawaii), and the RMS Titanic. ...Finds real life examples can bridge a link to short term experiential learning and provide a means for long term understanding of statistics. (KDR)
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