The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. ...The MICADOS study had 2 primary objectives: 1)to evaluate the impact of CTCL on patient quality of life, and 2)to evaluate the costs associated with the disease. This article reports the results of the cost analysis.
We estimated the cost of treating CTCL over a period of 1year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS).
A total of 141 patients (57.4% male) with a mean age of 63.6 years (95%CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stageI disease, €23,506.21 for stageII disease, €38,771.81 for stageIII disease, and €72,748.84 for stageIV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stageI disease accounted for 81% of all costs, stageII for 7%, and stagesIII andIV for 6% each.
The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.
Abstract
Background
Kidney transplantations (KT) from uncontrolled donation after cardiac death (uDCD) achieve very good outcomes to short and long follow-up, but the incidence of primary ...non-function and venous thrombosis (VT) is very high. The resistance index (RI) after kidney transplantation increase in the VT cases and in other kidney diseases.
Aims
To describe the effect of prophylactic anticoagulation in KT from uDCD with RI ≥0.8 to avoid VT and its secondary effect.
Method
Unicentric retrospective cohorts study that included all KT from uDCD with RI ≥0.8 measured by ecodoppler in the first 72 hours post-transplantation. We compared one group, which never received anticoagulation (Group I), and a second one which received prophylactic anticoagulation (Group II). Sodic heparin was the administer anticoagulant to achieve aPTT 1.5-2 time normal range and/or low molecular weight heparin adjusted to patient's weight and renal function.
Results
We included 107 KT from uDCD with RI≥0.8, with 36 in Group I and 76 in Group II. In Group I the donors were younger (39 ± 12 vs 46 ± 8; p = 0.003) and there were more men donors (97.2% vs 81.7%; p = 0.032). The prevalence of VT was higher in Group I (19.4% vs 0%; p<0.001). Patients in Group II needed more red blood transfusions (19.4% vs 39.4%; p = 0.05) and had more macroscopic haematuria (5.6% vs 21.1%; p = 0.049). The competing risk analysis showed a higher probability to develop a VT in non-anticoagulation group (p = 0.00012) than anticoagulation group or other causes of primary non-function (Figure 1).
Conclusion
The prophylactic anticoagulation treatment in KT from uDCD with RI≥0.8 decreases the VT incidence and it is safe for a donor recipient.
AIMS:We analyzed indirect costs related to loss of labor productivity (LLP) in informal caregivers (ICs) of people with dementia (PwD) and the associated caregiver burden and patients’ clinical ...variables.
METHODS:Multicenter cohort study of PwD and their ICs (n = 287) focused on two groups(1) home care and (2) institutional long-term care. The costs of LLP were assessed using the Resource Utilization Dementia instrument and a human capital approach.
RESULTS:The cost for LLP was 378 /month or 4.536 /year. Greater disease severity increased the likelihood of reducing working hours and missing a working day. There was a significant association between partial absenteeism and burden in employed informal caregiver in both the home and institutional setting.
CONCLUSION:Cognitive impairment contributes to the cost of LLP in IC especially in home-care. LLP has a negative impact on IC burden.
Resumen Objetivo Describir la aplicación del modelo Balance of Care en la toma de decisiones acerca del mejor cuidado para las personas con demencia en el contexto español. Métodos Se utilizó el ...modelo Balance of Care , que consistió en 1) la descripción del perfil de los casos más habituales de personas con demencia y sus cuidadores, 2) la identificación del emplazamiento más adecuado (domiciliario o centro sociosanitario) para cada caso, 3) el diseño de planes de cuidados específicos para cada caso, y 4) la evaluación del coste de los planes de cuidados. Resultados En el diseño de los casos participaron 1641 personas con demencia y sus cuidadores de ocho países europeos. La evaluación de los casos la realizaron 20 profesionales expertos en demencia de distintos ámbitos asistenciales. En España, los resultados indican que inicialmente el lugar más idóneo para cuidar de las personas con demencia es el domicilio, pero en los casos con mayor dependencia para las actividades de la vida diaria el centro sociosanitario era el emplazamiento con mejor prestación de cuidados. Los recursos escogidos en el plan de cuidados fueron ayuda profesional para realizar las actividades de la vida diaria e instrumentales, centro de día, equipo de atención domiciliaria, apoyo económico, enfermera de enlace y trabajador/a social. Discusión El modelo Balance of Care permite evaluar de manera sistemática, objetiva y mediante un equipo multidisciplinario el emplazamiento más adecuado para las personas con demencia. Se deberían incluir otras intervenciones coste-eficientes para mejorar la situación domiciliaria de estas personas.
•The rebound phenomenon, a period of increased disease activity, following natalizumab discontinuation is recognised but its incidence has not been well documented.•Using two different treatment ...schedules of intravenous methylprednisolone, we observed disease activity following natalizumab discontinuation.•The incidence of rebound was 10%, lower than previously observed.•Rebound, in our study population, occurred in younger patients.•Treatment with intravenous methylprednisolone may reduce the incidence and severity of the rebound phenomenon.
Natalizumab (NTZ) is a disease-modifying treatment (DMT) in multiple sclerosis (MS) whose discontinuation can produce a “rebound effect”, consisting of severe clinical deterioration and/or evidence of disease reactivation on magnetic resonance imaging (MRI).
To analyze the efficacy of two treatment schedules with intravenous methylprednisolone (IVMP) administered during the washout period of natalizumab (i.e., before starting another DMT) in preventing the rebound phenomenon.
Five-year retrospective study of NTZ withdrawals after at least 24 uninterrupted doses. Two IVMP schedules were tested. In schedule 1 (3-month washout), 1, 2, and 3 g of IVMP were administered on the first, second, and third month respectively. In schedule 2 (2-month washout), 1 and 2 g of IVMP were administered on the first and second month respectively. A new DMT was started 10 days after the end of each schedule. Rebound was defined as at least one clinical relapse plus rebound activity on MRI (>5 gadolinium-enhanced lesions and a number of new/T2-enhanced and/or gadolinium-enhanced lesions greater than before initiation of NTZ) during washout or at 6 months after new DMT initiation (6M-DMT). Clinical and MRI evaluations were performed at 3, 6, 12, and 24 months after initiation of the new DMT.
Fifty patients (68% women) were included, with a mean (SD) age of 37.76 (10.88) years and pre-NTZ annualized relapse rate (ARR) of 1.78 (1.04). During NTZ therapy, mean Expanded Disability Status Scale (EDSS) score was 3.7 (1.73) and ARR was 0.23 (0.39). The ARR (mean of both schedules) was 0.1 (0.71) during washout and 0.32 (0.84) at 6M-DMT. Rebound was observed in 10% of cases (n = 5), with no significant clinical or radiological differences (p>0.05) between the two IVMP schedules. Rebound was observed in younger patients and was associated with new MRI lesions and higher ARR at 3M-DMT and 6M-DMT respectively, with no difference in EDSS after 2 years of follow-up. Neither the ARR before NTZ initiation nor the choice of new DMT after NTZ discontinuation was associated with development of rebound effect.
Both IVMP schedules were well tolerated during NTZ washout and rebound was observed in only 10% of cases. In our experience, administration of IVMP during NTZ washout could reduce the possibility of a rebound effect.
Cardiac anatomy is complex and its understanding is essential for the interventional arrhythmologist. The first difficulty is the terminology used to describe the location of sites of mapping and ...ablation. For many years, electrophysiologists have named these positions following the conventional electrocardiographical vocabulary, or the terminology used by surgeons performing arrhythmic surgery. This traditional nomenclature, however, failed to take note of the crucial principle of considering the location of the heart in the human body as viewed in its erect position. In other words, it had failed to use an attitudinally appropriate terminology. Almost 10 years ago, a new attitudinal nomenclature was proposed for the right and left atrioventricular junctions. In this first of a series of reviews of cardiac anatomy as seen by the interventional arrhythmologist, we discuss the role of attitudinally appropriate terminology, and relate this to the projections used for cardiac fluoroscopy, fluorography, and angiography. Throughout our series of reviews, we will illustrate the value of The Visible Human Slice and Surface Server in facilitating the understanding of the fluoroscopic anatomy. (PACE 2010; 497–507)
Abstract
Objectives
to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European ...study ‘RightTimePlaceCare’, and to evaluate factors and adverse outcomes associated with PIM prescription.
Methods
survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription.
Results
overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and ‘drugs for acid-related disorders’ (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up.
Conclusions
PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.
Las guerras mundiales, las dictaduras y los Estados totalitarios del siglo xx han dejado ver la paradójica coexistencia de actos de exterminio y destrucción del otro y la diferencia, junto a actos de ...restitución del reconocimiento y la humanidad del otro. Estos últimos han sido puesto en relieve por autores como Todorov y Roisin, demostrando que aún en las condiciones más adversas para la propia existencia, hay quienes desobedecen la moral imperante, sosteniendo la dignidad de sí y del otro. En este panorama, el presente artículo da cuenta de una investigación cualitativa realizada por sus autores, guiada por el enfoque biográfico, cuyo objeto de estudio fue la desobediencia en la dictadura cívico militar chilena, específicamente en el contexto de la institución militar. Mediante la reconstrucción y el análisis de dos historias de vida de exmilitares de la Fuerzas Aérea de Chile, fue posible desplegar material inédito en este campo y aportar a la comprensión y complejización del concepto de acto de desobediencia. Los resultados del estudio muestran la especificidad de estos actos en el contexto de la institución militar en la dictadura chilena, su heterogeneidad tanto en su forma como en los antecedentes que los organizan, así como su relación con las biografías personales, donde resuenan experiencias de reconocimiento, respeto y cuidado del otro y de sí en situaciones extremas por parte de personas significativas.
Heart failure (HF) is a common condition associated with a high rate of hospitalizations and adverse outcomes. HF is characterized by impairments of either the cardiac ventricular filling, ejection ...of blood capacity or both. Sleep fragmentation (SF) involves a series of short sleep interruptions that lead to fatigue and contribute to cognitive impairments and dementia. Both conditions are known to be associated with increased inflammation and dysbiosis of the gut microbiota. In the present study, mice were distributed into four groups, and subjected for four weeks to either HF, SF, both HF and SF, or left unperturbed as controls. We used 16S metabarcoding to assess fecal microbiome composition before and after the experiments. Evidence for distinct alterations in several bacterial groups and an overall decrease in alpha diversity emerged in HF and SF treatment groups. Combined HF and SF conditions, however, showed no synergism, and observed changes were not always additive, suggesting preliminarily that some of the individual effects of either HF or SF cancel each other out when applied concomitantly.
Aims
To describe differences in caregiver burden and health‐related quality of life of informal caregivers of people with dementia in eight European countries and assess changes after transition from ...home to institutional long‐term care.
Background
Country differences in the experience of burden and health‐related quality of life are rarely described.
Design
Prospective cohort study.
Methods
Data on burden and health‐related quality of life were collected at baseline (conducted between November 2010–April 2012) and follow‐up (after 3 months) using face‐to‐face interviews. Two groups of informal caregivers included those: (1) of people with dementia recently admitted to institutional long‐term care facilities; and those (2) of people with dementia receiving home care. Statistical analyses focused on descriptive comparisons between groups and countries.
Results
Informal caregivers of about 2014 were interviewed. Informal caregivers of people with dementia at home experienced more burden compared with informal caregivers of recently institutionalised people with dementia. Almost no differences in health‐related quality of life were found between groups. Large differences between countries on outcomes were found. Informal caregivers of people with dementia who made the transition to an institutional long‐term care facility experienced a statistically significant decrease in burden and psychological distress at follow‐up.
Conclusion
Cross‐country differences may be related to differences in health and social care systems. Taking this into account, informal caregiver interventions need to be tailored to (country specific) contexts and (individual) needs. Findings highlight the positive impact of admission to institutional long‐term care on informal caregiver well‐being.
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