Objective
Deep endometriosis transvaginal ultrasound (DE TVS) is accurate in the detection of ovarian endometriosis and DE; however, realisation of its full potential and utilisation remains ...variable. As such, patients may require a two‐step surgical approach (diagnostic followed by therapeutic laparoscopy) or experience incomplete surgical treatment. Besides the clinical implications, the economic impact of a two‐step approach to diagnosis and treatment on the healthcare system is likely to be significant. We aim to compare the economic costs of two diagnostic models of care for patients with potential endometriosis.
Design
Cost analysis using Markov model with 12‐month time horizon comparing the economic costs of two diagnostic models.
Setting
The study used a hypothetical population of 1000 women visiting a public tertiary gynaecology clinic.
Population
Women with potential endometriosis. Estimates for endometriosis prevalence and severity were drawn from local Australian hospital data.
Methods
The conventional model (M1) includes the basic TVS and diagnostic laparoscopy. The novel model (M2) includes the DE TVS. Probabilistic sensitivity analysis was conducted to capture the uncertainty in the information used to populate the models.
Main outcome measure
Changes to government, health‐service and patient costs with the adoption of the DE TVS compared with standard diagnostic methods. Costs are given in Australian dollars (AU$) and also in pound sterling (£).
Results
The total annual cost of the novel model (M2) is AU$12,547,724.03 (£6,826,673.63), cheaper than the conventional model (M1), which cost AU$13,472,161.67 (£7,329,620.15).
Conclusions
For a population of 1000 women, the integration of the DE TVS may save healthcare costs of AU$924,437 (£502,946.17) annually.
Tweetable
An endometriosis‐focused ultrasound may negate a two‐step surgery pathway, including diagnostic surgery, and save healthcare money.
Tweetable
An endometriosis‐focused ultrasound may negate a two‐step surgery pathway, including diagnostic surgery, and save healthcare money.
This study explores whether employees who have access to social media are more likely than employees who do not to develop shared cognition—similar perceptions of what and whom coworkers know. It ...also uncovers the behaviors associated with social media that allow employees to develop such shared cognition about their coworkers’ knowledge and social structures. I conducted a multimethodological, longitudinal field study of the use of one type of social media—a social networking site—by employees at a large financial services organization. In this paper, I draw on comparative data from two matched-sample groups within the same organization to show that users of the social networking site developed their cognition through three interrelated processes—network expansion, content integration, and triggered recalling. Because all members of the organization enacted this process with data from the same common pool (content on the social networking site), their cognitions became shared. A difference-in-differences estimation showed that shared cognition developed much more strongly over six months in the group that used the social networking site than the group that did not use it.
The newly released version of the Global Burden of Disease (GBD 2010) ranks migraine between the most disabling diseases, the first among neurological ones, with a two-fold increase with respect to ...the previous GBD 2000 version. Almost 3 % of worldwide disability attributable to a specific disease, in terms of years lived with a disability, is due to migraine. The public health impact of migraine and headache disorders is thus a consolidated fact; however, further research is needed to provide stronger recognition of and policy actions for headache disorders in general, and in particular with regard to chronic forms of headache.
Flow disruption with the WEB-DL device has been used safely for the treatment of wide-neck bifurcation aneurysms. The stability of aneurysm occlusion after this treatment was evaluated in the short ...and midterm, but not in the long term. This retrospective multicenter European study is the continuation of an already published series dealing with short- and midterm anatomic results and analyzes long-term data in patients treated with the WEB-DL.
Twelve European neurointerventional centers initially participated in the study. In addition to data collected for the initial publication, images obtained at long-term follow-up were collected and independently analyzed by the same experienced interventional neuroradiologist.
Of the initial 45 patients, 26 (20 women and 6 men; 35-73 years of age; mean, 55.2 ± 10.6 years; median, 55.5 years) with 26 aneurysms treated with the WEB-DL device had long-term follow-up (median, 27.4 months). Three of 26 patients (11.5%) were retreated between short- and midterm follow-up, and none, between mid- and long-term follow-up. Long-term aneurysm occlusion in the 19 patients treated with the WEB only and not retreated during follow-up was complete occlusion in 13/19 patients (68.4%), including aneurysms with opacification of the proximal recess in 9/19 patients (47.4%), neck remnant in 3/19 patients (15.8%), and aneurysm remnant in 3/19 patients (15.8%). In all patients (100.0%), aneurysm occlusion was stable between midterm and long-term follow-up.
The results suggest that WEB treatment of wide-neck bifurcation aneurysms offers long-term stable occlusion.
To perform a pilot diagnostic accuracy study of a novel transvaginal ultrasonography procedure called saline-infusion sonoPODography to predict superficial endometriosis in patients with suspected ...endometriosis.
A prospective single-center diagnostic accuracy study was performed from September 2019-November 2019. The index test sonoPODography was performed and the results were documented in a standardized fashion. SonoPODography was performed by installing saline into the pouch of Douglas (POD) via an intrauterine balloon catheter to create an acoustic window between the ultrasound probe and surrounding structures. The pelvis was then assessed for the presence or absence of superficial endometriosis using pre-defined features. Direct visualization at laparoscopy and histological assessment of excised endometriosis confirmed the outcome. The diagnostic performance of sonoPODography was evaluated.
42 consecutive participants underwent sonoPODography. Superficial endometriosis was identified by sonoPODography in 24/42 (57.1 %) and in 37/42 (88.1 %) participants by direct visualization at laparoscopy. The overall diagnostic performance of sonoPODography was: accuracy 69.1 %, sensitivity 64.9 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 27.8 %. Amongst those without deep endometriosis/endometriomas/pouch of Douglas obliteration, the diagnostic performance was: accuracy 80.0 %, sensitivity 77.7 %, specificity 100.0 %, positive predictive value 100.0 %, negative predictive value 33.3 %. The pouch of Douglas peritoneum was the most common site of superficial endometriosis.
SonoPODography is a novel ultrasound-based procedure that permits the direct visualization of superficial with respectable diagnostic accuracy. The findings of this pilot study are promising and justify the initiation of a larger outpatient study. SonoPODography may establish new avenues for the non-invasive diagnosis and investigation of endometriosis.
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