- Détails du magazine
- Première publication
- 01 Jun 2007
- Période de publication
- 6 fois par an
- Accès libre
Pages: 299 - 300
- Accès libre
Pages: 301 - 310
Background: In the Diagnosis Related Group (DRG) payment system, hospitals are usually suspected of ‘DRG creep,’ which has been narrowly regarded as reporting diagnostic and procedural codes that result in larger reimbursement.
Objective: This review was aimed to systematically explore ways in which hospital manipulations of DRG coding may occur.
Methods: A systematic scoping review was conducted using MEDLINE, EMBASE, Web of Science, EconLIT, Proquest Digital Dissertation and Theses, Conference Proceedings, and Thai Index Medicus, using appropriate search strategies. Based on predefined criteria, each article abstract was screened by two screeners with good inter-rater reliability. The included articles were qualitatively explored using thematic content analysis.
Results: Hospital manipulations of the DRG system can be categorized into three groups: corporate, clinical, and coding practices. Corporate includes all activities not directly related to patient care; possible manipulations are focused on hospital management, administration, or finance and therefore are the responsibility of the executive board or hospital director. Clinical manipulation deals with activities in the care process and is the responsibility of health care professionals. The last group covers conventional definition of DRG creep that focuses on documentation and coding.
Conclusion: Hospital managers who deal with the DRG payment system should be aware that DRG creep is not merely about upcoding. Indeed, the DRG system can be manipulated by hospitals in three different approaches, the so-called “3C”: corporate, clinical, and coding practices.
- Diagnosis related group
- DRG creep
- hospital coding practice
- provider payment
- Accès libre
Pages: 311 - 318
Background: Chemotherapies are highly effective in treating most cancers, but their use is limited by potential cardiotoxicity, the most serious of a wide range of adverse effects. The severity of these effects is related to the chemotherapy regimen, patient population characteristics and duration.
Objective: To review strategies to reduce cardiotoxicity in patients who receive chemotherapies.
Materials and Method: We reviewed and abstracted information from published peer review journals and provided examples from our relevant experiences.
Results: The severity of these effects is related to the chemotherapy regimen, patient population characteristics and duration. The incidence of cardiomyopathy because of chemotherapy varies and its onset can be acute (during or shortly after treatment), sub-acute (within days or weeks after completion of chemotherapy) or chronic (weeks to months after drug administration). A number of risk factors may predispose a patient to certain cancer therapy-induced cardiotoxicities. These can be identified, monitored, and possibly modified before initiation of cancer therapy so that cardiotoxicity can be prevented where possible.
Conclusion: Cardiotoxicity is an adverse event associated with many cancer therapy agents. The potential for cardiotoxic events should be recognized before therapy is started and serial monitoring of ventricular performance in order to minimize the possibility of irreversible cardiac damage.
- Cancer therapy
- Accès libre
Pages: 319 - 324
Background: Surgical care is often regarded as too expensive and complex for people in poor countries and so has long been neglected.
Objective: We demonstrated that the cost per disability-adjusted life year (DALY) saved of reconstructive surgery in Cambodia is competitive with many basic public health interventions.
Methods: The Children’s Surgical Centre (CSC) in Phnom Penh provides orthopedic, plastic, ophthalmological, and general reconstructive surgical services free to disabled people in Cambodia. Following standard guidelines for calculating operation costs and assigning disability weights we calculated the cost effectiveness of surgical treatment for 343 patients treated at CSC in January and March, 2012.
Results: Our data for these two months yielded 1785 DALYs averted and operating costs totaling $164,543; resulting in $99 per DALY averted.
Conclusion: Reconstructive surgery is cost effective compared to other basic public health interventions and should not be neglected when designing integrated health care services in a developing country.
- Disability-adjusted life year (DALY)
- reconstructive surgery
- Accès libre
Pages: 325 - 331
Background: The role of nursing in the management of chest drains is diverse and important. There is a paucity of data regarding the management of chest drains by nurses.
Objective: To establish an evaluation system for nurses to help guide the care of patients being treated with closed thoracic drainage tubes.
Methods: An ADC (availability, dependability, and capacity) model was used as the framework to evaluate treatment guidelines. A questionnaire was developed and tested for reliability and validity based on experimental models of thoracic drainage. Patients were subsequently randomly selected and screened using the effectiveness assessment form.
Results: Overall dimension scores and subgroups were correlated (r > 0.7). Test-retest reliability met required standards (r = 0.769-0.889, p < 0.01). The correlation coefficient between scores of each dimension and total score was 0.542 to 0.920, and correlation coefficients for each item and its dimension were 0.429 to 0.887.
Conclusions: The proposed assessment form provides an evidence-based tool for nurses to effectively manage patients with closed thoracic drainage systems. Experimental and clinical measures confirm the tool’s reliability and validity.
- Closed thoracic chest drain
- Accès libre
Pages: 333 - 338
Background: Lipoaspirate contains noxious substances derived from liposuction. Therefore, extensive washing is recommended before the lipoaspirate is processed further for culture or fat grafting. Washing a small amount of lipoaspirate may not pose a problem, but washing a large volume of lipoaspirate may be cumbersome, time consuming, and requires a lot of phosphate buffered saline (PBS).
Objective: To introduce a simple method for lipoaspirate washing using fine-mesh stainless-steel tea or coffee filter, a small tea spoon, and a porcelain bowl.
Methods: The filter was used to collect the adipose tissue fragments. Further washing of the fragments was achieved by soaking the adipose tissue containing filter in a PBS containing porcelain bowl and stirring using a small tea spoon to transfer the contaminating materials to the PBS. Enzymatic processing to dissociate the cells from the tissue and primary cultures was conducted as usual in MesenCult.
Results: Using the equipment mentioned above, the adipose tissue fragments were readily separated from the blood, free lipids, anesthetics, and other noxious material in the liquid portion. This simple method saves time and PBS compared with previously described methods. Further enzymatic processing produced sufficient cells to be cultured, and culture results showed plastic adherent cells on day 2 that became confluent on day 6.
Conclusion: Lipoaspirate washing using a fine mesh stainless steel filter is time saving and produced cells that grow well in MesenCult.
- Accès libre
Investigation of the high frequency band of heart rate variability: identification of preeclamptic pregnancy from normal pregnancy in Oman
Pages: 339 - 346
Background: The spectral analysis of heart rate variability (HRV) shows a decrease in the power of the high frequency (HF) component in preeclamptic pregnancy compared with normal pregnancy; such a decrease is associated with an increase in the low frequency (LF/HF) ratio of the HRV. The physiological interpretation is that preclamptic pregnancy and normal pregnancy is associated with a facilitation of sympathetic regulation and an attenuation of parasympathetic influence of HR compared with nonpregnancy.
Objective: We used a spectral analysis of HRV to identify preeclamptic pregnancy in Oman.
Methods: Fast Fourier transform (FFT) spectral analysis was used to show whether patients with preeclamptic pregnancy have a reduction in the power of the HF band of HRV compared with subjects with normal pregnancy. The soft-decision wavelet-based technique is then implemented to scan the HF band to find which part of it is associated with preeclampsia. Data was obtained from eight preeclamptic pregnant subjects and nine normal pregnant controls of the same pregnancy duration.
Results: The classical FFT approach to the LF/HF power ratio of HRV is a possible classification factor. The identification accuracy obtained was 76.47%, while the sensitivity (identification of patients) and the specificity (identification of normal subjects) were found to be 75% and 77.77%, respectively. The soft-decision wavelet-based technique with five decomposition stages of Coif5 wavelets, finds that B10 and B11 (out of 32 bands) covering the frequency range of (0.1406-0.1563) Hz, and (0.1563-0.1719) Hz, respectively, are the most dominant parts of the HF band affected by preeclampsia. The identification accuracy, sensitivity, and specificity using this range are found to be 94.11%, 100%, and 88.88%, respectively.
Conclusion: Soft-decision wavelet decomposition is shown to be a successful tool for identification of preeclampsia.
- soft-decision wavelet-decomposition
- Accès libre
Computational approach to long-term potentiation in hippocampal CA1 area describes the efficacy of stimulation patterns
Pages: 347 - 356
Background: Long-term potentiation (LTP) is the best characterized form of enhancement in synaptic plasticity, which is a widely accepted model of learning and memory. The modification of long-term plasticity is a complex process and varies throughout synaptic events.
Objective: To investigate efficacy of electrical stimulus patterns for LTP induction where characteristics of hippocampal LTP are described by least-squares curve fitting.
Methods: In vitro hippocampal brain slice techniques were used to investigate the effects of tetanic stimulation (consisting square pulse at 100 Hz in 1 second) and theta-burst stimulation (TBS; typically consisting of 3 trains of 10 brief 100 Hz burst, 4 impulses each, interval of 200 milliseconds between bursts and repeated in 10 seconds between trains). The experimental data were modeled as three mathematical equations, polynomial form, exponential form, and power form. Curve fitting with the least-squares procedure and parameter solving were computed using the Levenberg-Marquardt method, with OriginPro 8.5 software.
Results: The stimulation intensity was 0.37 ± 0.0677 V with tetanic stimulation and 0.31 ± 0.0862 V with TBS. There were no significant differences among groups (one-way ANOVA, p = 0.122). TBS effectively induces LTP more than tetanic stimulation with 144.42 ± 6.54% of baseline (n = 10) and 134.88 ± 6.92% of baseline (n = 10), respectively. Moreover, curve fitting with the power form produced the best adjusted R2 value and initial posttetanic potentiation approximation. The polynomial model produced a small relative error with abundant residual. Therefore, the power form was a good model for LTP approximation.
Conclusion: Least-squares curve fitting could describe experimental results for investigating LTP induction under two patterns of stimuli: tetanic stimulation and TBS. We found that curve fitting with a power form is the most appropriate model for overall estimations when comparison is made with polynomial and exponential forms.
- least squares curve fitting
- long-term potentiation
- tetanic stimulation
- thetaburst stimulation
- Accès libre
Pages: 357 - 364
Background: Assessment of the severity of acute pancreatitis is important for its proper management. Contrast-enhanced CT has been accepted as useful to assess disease severity and determine its prognosis. The correct differentiation and identification of patients at risk are beneficial for the patient outcome.
Objective: We assessed the prognostic value of contrast-enhanced CT (CECT) in acute pancreatitis and the additional value of necrosis in predicting complication and mortality.
Methods: Two radiologists retrospectively reviewed CECT of 72 patients who were diagnosed with their first episode of acute pancreatitis and were admitted in King Chulalongkorn Memorial Hospital between January 1, 2005 and April 30, 2010. Determination of CECT grade, degree of necrosis and CT severity index were assessed. Data regarding the incidence of complications, the need for surgery or percutaneous intervention, and the number of deaths were collected. Correlation between severity of acute pancreatitis and the patient outcome was analyzed using a χ2 test or Student t test.
Results: All complications (n = 14) and deaths (n = 5) occurred in patients with a severe CT grade; however, the differences compared with the mild grade did not reach statistical significance (p = 0.036 and p = 0.58, respectively). Necrosis was identified in 25 patients, all were in the severe grade (p = 0.001). Presence of necrosis in severe CT grade correlates well with occurrence of complications (p = 0.024, OR = 15.0) and mortality (p = 0.046, OR = 8.7). CTSI > 5 correlates well with occurrence of complication (p = 0.024, OR = 17.5) and mortality (p = 0.019, OR = 12.7).
Conclusions: CECT is an effective tool for predicting complication and mortality of acute pancreatitis. Glandular necrosis, which was seen only in patients with a severe CT grade added value in predicting outcomes. Therefore, these results suggest that the use of iodinated contrast material is essential in acute pancreatitis, which is useful for risk stratification, particularly in severe CT disease.
- Acute pancreatitis
- contrast-enhanced CT grade
- CT severity index
Brief communication (Original)
- Accès libre
Developing Iranian patient safety indicators: an essential approach for improving safety of healthcare
Pages: 365 - 373
Background: Patient safety indicators are valuable tools by which to monitor quantitatively patient safety.
Objective: We developed patient safety indicators for the Iranian health system.
Methods: Fifty-four patient safety indicators were identified in literature and 24 of them were selected as candidate indicators. In the first round of Delphi, panelists agreed upon 20 of them and suggested eight new indicators. In the second round, four uncertain and eight new indicators were evaluated. In this round, nine indicators were agreed upon and three were dropped.
Conclusion: This study suggested 29 consensus-based indicators for the Iranian health system to assess safety of care. Establishing reporting systems and pilot testing of this set of indicators are strongly recommended.
- Health care evaluation mechanisms
- patient safety
- patient safety indicators
- patient safety management
- quality indicators
- quality of health care
- Accès libre
Pages: 375 - 380
Background: The importance of mosquito-borne diseases can be aggravated when there is an occurrence of mixed infestation between the mosquitoes in a habitat. However, there is limited available information on mixed infestation behavior among Malaysian mosquitoes.
Objective: We elucidated the nature of co-occurrence among mosquito species from residential areas in Malaysia.
Methods: Entomological investigation was carried out by using a previously described larval dipping method in 20 residential areas across 11 states and a federal territory (i.e., Kuala Lumpur) in Peninsular Malaysia as well as two states in East Malaysia.
Results: Of 20 study sites, eight study sites exhibited co-occurrence of mosquito larvae, ranging from 1.28% to 50.00%. Culex quinquefasciatus was able to breed simultaneously with Cx. gelidus (10.00%-50.00%), Lutzia fuscanus (2.94%-13.33%), Cx. vishnui (5.00%) and Armigeres subalbatus (1.28%-3.77%). On the other hand, Cx. vishnui was able to breed simultaneously with Cx. gelidus (20.00%) and Lu. fuscanus (3.33%).
Conclusion: The findings of this study have implications for the development of a better understanding of their mixed infestation behavior and prevention of vector-borne disease transmission from these study sites.
- mixed infestation
- Accès libre
Angiotensin-converting enzyme inhibitor captopril ameliorates renal damage in a rat model of thermal injury
Pages: 381 - 389
Background: Burn is a posttraumatic inflammatory condition accompanied by both local and distant effects leading to intense inflammation, tissue damage, and infection. Acute renal failure is a well-known complication of severe burns and is an important factor leading to an increase in mortality.
Objective: To determine the effect of captopril treatment on renal damage in a rat model of thermal injury by evaluating oxidant-antioxidant system parameters, sialic acid levels, glutathione-S-transferase (GST), and tissue factor (TF) activities.
Methods: Under ether anesthesia, the shaved dorsum of the rats was exposed to a 90°C water bath for 10 seconds to induce burn injury. Captopril (1 mg/kg) or saline was administered intraperitoneally immediately after, and at 24 hours after burn injury. Rats were decapitated at 48 hours following the burn injury and trunk blood was collected to assay blood urea nitrogen (BUN) and creatinine concentrations. To evaluate the presence of oxidant injury, kidney tissue samples were taken to determine malondialdehyde (MDA), glutathione (GSH), sialic acid levels, and the activities of superoxide dismutase (SOD), catalase, GST, and TF. In the sham group the same protocol was applied except that the dorsum was dipped in a 25°C water bath for 10 seconds.
Results: Severe skin scald injury (30% of total body surface area) caused significant decreases in GSH level, SOD and catalase activities, and significant increases in TF and GST activities, and sialic acid levels. Treatment of rats with captopril (1mg/kg) significantly elevated the reduced GSH levels, SOD and catalase activities, while it decreased MDA, sialic acid levels, GST and TF activities.
Conclusions: The present study showed for the first time that, captopril scavenging of reactive free radicals, normalizing the activities of TF and GST seems to be a promising agent for restoring renal damage following thermal trauma.
- lipid peroxidation
- sialic acid
- superoxide dismutase
- tissue factor
- Accès libre
Reliability, validity, and responsiveness of the short form 36 (SF-36) health survey questionnaire in patients with Graves’ disease
Pages: 391 - 397
Background: The SF-36 as a generic instrument has been used widely to evaluate health-related quality of life in both healthy subjects and groups of patients. However, no data can be found on its performance in patients with Graves’ disease. Hence, this study aimed to assess the reliability, validity, and responsiveness of the SF-36 in a Chinese population of patients with Graves’ disease.
Methods: A total of 325 patients with Graves’ disease completed interviews that included the SF-36. Internal consistency was measured by Cronbach’s α and item-scale correlations. The validity of the SF-36 was studied by means of factor analysis and the association of this scale with sociodemographic and clinical variables. A standardized response mean was used to assess the responsiveness of the SF-36 to change.
Results: Cronbach’s α coefficients surpassed the 0.70 criteria for seven subscales and 0.63 for the SF subscale indicating good internal consistency. The correlation coefficients between items and the remainder of the same subscale ranged from 0.51 to 0.96, which were all higher than with other subscales. A principal components factor analysis with varimax rotation identified eight factors. Hamilton Anxiety Rating Scale (HARS) scores correlated negatively to scores at the physical functioning, general health, social functioning, vitality, and role limitations due to emotional problems SF-36 subscales, while HARS scores correlated negatively only to scores on the mental health SF-36 subscale. No correlations were found between SF-36 scores and the levels of thyroid hormones. Responsiveness to improvements in health status was acceptable overall (standardized response means 0.33-0.88).
Conclusion: The Chinese (mainland) version of the SF-36 is a suitable instrument that can be used in patients with Graves’ disease.
- Graves’ disease
- Accès libre
Higher plasma C-reactive protein and lower plasma adiponectin are associated with increased carotid artery intima-media thickness in patients with impaired glucose regulation
Pages: 399 - 405
Background: Impaired Glucose Regulation (IGR) is a term that refers to blood glucose levels that are higher than the normal range, but lower than Type 2 diabetes mellitus (T2DM).
Objective:We aimed to test the role of plasma adiponectin (APN) and plasma C-reactive protein (CRP) in predicting the risk of cardiovascular disease in patients with different degrees of impaired glucose regulation (IGR).
Methods: A total of 210 outpatients for physical examination were divided into 4 groups: 42 cases of normal glucose tolerance (NGT), 36 cases of impaired fasting glucose (IFG), 92 cases of impaired glucose tolerance (IGT) and 40 cases of IFG+IGT. Body mass index (BMI), blood pressure, lipids, insulin resistance (homeostasis model assessment, HOMA-IR), APN, CRP and carotid intima-media thickness (CIMT) were measured.
Results: In IGT and IFG+ IGT groups, CIMT and CRP were significantly higher, whereas APN was significantly lower compared with IFG and NGT groups (p < 0.05). BMI and HOMA-IR were significantly higher in IGR patients compared with control subjects (p < 0.05). CIMT was positively related to CRP and HOMA-IR and negatively to APN (p < 0.05). Multiple stepwise regression analysis using CIMT as a dependent variable showed that APN and 2hPG were independently risk factors associated with CIMT.
Conclusion: Increased CIMT in prediabetes state may in part be explained by lower plasma adiponectin and higher C-reactive protein levels.
- carotid intima-media thickness
- C-reactive protein
- fasting plasma glucose
- impaired glucose regulation
- impaired glucose tolerance
- Accès libre
Pages: 407 - 410
Background: Low antitubercular drug level is a risk factor for treatment failures. Antitubercular drug level determination has been suggested for complicated tuberculosis patients, but there has been interest in performing such studies in normal hosts.
Objective: To identify whether there are advantages of routine antitubercular drug level determination.
Patients and Methods: We determined drug levels in 15 new normal host Thai tuberculosis patients by using published methods. All patients received the Directly Observed Treatment Short-course including pyrazinamide, rifampicin, and isoniazid.
Results: We started with 15 patients of whom 27% (4 patients) were mycobacteria smear-positive, 33% (5 patients) had low blood levels of pyrazinamide and 87% had low levels of rifampicin. The drug levels in the smear-positive group were lower than in the smear-negative group. All smear-positive patients had a rifampicin levels lower than the therapeutic range.
Conclusion: Antitubercular drug level determination has a potential to identify patients who may be at risk of poor treatment results.
- Anti-tubercular drug levels
- standard short course regimen
- Accès libre
Pathologically-based positive lymph node ratio (pLNR) for stage III colorectal cancer patients: prognostic impact on cases with fewer than 12 lymph node retrievals
Pages: 411 - 417
Background: The pathologically-based positive lymph node ratio (pLNR) has been proposed as alternative lymph node (LN) parameters to the conventional TNM staging.
Objective: We evaluated the prognostic value of the pLNR for patients with stage III colorectal after curative surgery with adequate and inadequate LN retrieval (<12).
Materials and Method: A total of 258 patients with stage III colorectal adenocarcinoma who underwent curative resection performed in Phramongkutklao Hospital from January 1, 2003 through December 31, 2010 were given a regular follow-up according to established guidelines with routine physical examination, serum carcinoembryonic antigen (CEA), and colonoscopic surveillance. Imaging studies for detecting organ metastases were computed tomography (CT), magnetic resonance imaging, positron emission tomography (PET) CT scan, and ultrasonography. Patients were categorized into four groups according to the pathologically-based positive lymph node ratio (pLNR) (pLNR1: 0.1 to 0.25, pLNR2: 0.26 to 0.50, pLNR3: 0.51 to 0.75, and pLNR4: 0.76 to 1.0). Tumor-free survival was calculated from the date of primary colorectal tumor resection to the date of appearance of local recurrence or metastatic disease. The prognostic impact of pLNR was determined in the evaluated cohort and in a subgroup of patients with fewer than 12 LN retrievals who were examined.
Results: The number of LN examined ranged from 2 to 50 with a mean (SD) of 15.8 (8.7). In all, 93 (36%) patients with fewer than 12 LN were examined. Local recurrence or distant site metastases were found in 123 (47.7%) patients during the surveillance period with a median tumor-free survival of 41 months (95% CI, 28.7-53.3). Median tumor-free survival was categorized according to pLNR as follows: pLNR1 = 56 (95% CI, 36.3-75.7), pLNR2 = 22 (95% CI, 18.5-25.5), pLNR3 = 26 (95% CI, 10.5-70.9), and pLNR4 = 8 (95% CI, 1.1-5.8) months. Serum carcinoembryonic antigen (CEA) > 10 ng/dl, AJCC tumor stage 3C, and higher pLNR were found significantly associated with shorter tumor-free survival with univariate analysis. Potentially associated variables were then tested using multivariate analysis with a Cox regression model. This study found that the pLNR was the independent factor that was significantly associated with a risk of local recurrence or distant site metastases. In the evaluated cohort, the adjusted hazard ratio (HR) compared pLNR1 for pLNR2 = 2.27 (95% CI, 1.058-4.875; p < 0.01), pLNR3 = 4.365 (95% CI, 1.447-13.166; p < 0.05) and pLNR4 = 4.897 (95% CI, 1.546-15.518; p < 0.01). In the subgroup of patients with fewer than 12 LN retrievals who were examined, multivariate analysis was not consistently significant for all ranges of the adjusted hazard ration (HR) compared with pLN1 for pLNR3 = 10.552 (95% CI, 1.911-58.277; p < 0.05)
Conclusion: This study revealed pLNR was a significant independent prognostic factor that was associated with a risk of local recurrence or distant site metastases in patients with stage III colorectal cancer after curative surgery. A higher pLNR had a negative impact on tumor-free survival irrespective of the adequacy of LN retrieval.
- Colorectal cancer
- lymph node
- lymph node ratio
- prognostic factor
- Accès libre
Volumetric modulated arc therapy dosimetry and treatment time compared with conventional intensity-modulated radiotherapy for unresectable cholangiocarcinoma
Pages: 419 - 423
Background: Cholangiocarcinoma is a locally extending tumor with a high incidence in Thailand. Most patients are diagnosed when the tumor is unresectable, which requires concurrent chemotherapy and/or radiation. Volumetric modulated arc therapy (VMAT) and conventional intensity-modulated radiotherapy (cIMRT) are advanced techniques that improve survival and reduce radiation-induced complications.
Objectives: To compare conformity, homogeneity, and treatment time between VMAT and cIMRT in unresectable cholangiocarcinoma.
Methods: Between September 2004 and December 2010, CT images of 11 unresectable cholangiocarcinoma patients were retrieved and replanned by VMAT and cIMRT. Comparison was made in conformation number, homogeneity index, and monitor units using a Wilcoxon signed-rank test. Dose constraints for critical organs such as the liver, kidneys, and spinal cord were restricted by Quantitative Analyses of Normal Tissue Effects in the Clinic criteria.
Results: Mean conformation number was 0.91 in both the VMAT and cIMRT plans (p = 0.477). Mean homogeneity index was 2% different, 1.11 in VMAT plans and 1.09 in cIMRT plans (p = 0.008). Mean monitor units was 529 in VMAT plans and 1,279 in cIMRT plans (p = 0.003).
Conclusion: This study is the first VMAT study in unresectable cholangiocarcinoma. Conformity was not different, but treatment time was shorter by VMAT as reported in other cancer studies. Homogeneity was 2% statistically higher by VMAT; however, clinical differences should be evaluated.
- conformation number
- dosimetric study
- index monitor units
- Accès libre
Cost-utility evaluation of influenza vaccination in patients with existing coronary heart diseases in Thailand
Pages: 425 - 435
Background: Influenza can exacerbate chronic coronary heart diseases (CHD) and health policy recommends influenza vaccination in this population group. However, cost effectiveness of influenza vaccination in protecting CHD population has not been, to our knowledge, well studied before especially in CHD patients with different disease severities.
Objectives: To assess life-time cost utility of influenza vaccination in CHD patients either with angina and/or cardiac arrest/myocardial infarction (CA/MI) and to identify the most cost-effective influenza vaccination strategies.
Method: The Markov model of CHD progression concurrent with the influenza infection was developed to quantify life-time costs and health effects of the three influenza vaccination strategies compared with no influenza vaccination (base case): (1) influenza vaccination in all CHD patients, (2) influenza vaccination in CA/MI patients-only, and (3) influenza vaccination in angina patients-only. The cost-effectiveness analysis (CEA) was based on the societal perspective. Deterministic and probabilistic sensitivity analyses were performed to identify variables that influence the sensitivity of the results and examine the effects of model parameters uncertainty, respectively.
Results: For the base case, the expected value (EV) results of no influenza vaccination, influenza vaccination in all CHD groups, influenza vaccination in angina patients, and influenza vaccination in CA/MI are 346,437 Thai baht (THB) yielded 18.26 Quality adjusted life year (QALYs), 454,664 THB yielded 21.46 QALYs, 360,786 THB yielded 19.96 QALYs, and 437,901 THB yielded 19.72 QALYs; respectively. CEA graph comparing all influenza vaccination strategies shows that vaccination in all CHD patients groups and angina patients are in the costeffectiveness frontier, but not influenza vaccination in CA/MI patients. The cost-effectiveness rankings report shows that the willingness-to-pay (WTP) threshold (100,000 THB) is greater than the incremental cost effectiveness ratio (ICER) of vaccination in all CHD groups (ICER = 33,813 THB per QALY gained) and angina group (8,420 THB per QALY gained) and therefore the vaccination in all CHD groups, which is more expensive, but more effective would be recommended. The deterministic sensitivity analysis shows the most influential parameters driving the cost-effectiveness of vaccination strategies are the effect of influenza vaccination on CHD both for acute myocardial infarction and cardiovascular death, respectively. The probabilistic sensitivity analysis shows the same influenza strategy recommendation (vaccination in all CHD groups) as the base case analysis.
Conclusion: From a societal perspective, influenza vaccination in all CHD groups is recommended. The information from economic modeling should be confirmed by primary economic research.
- Coronary heart disease
- influenza vaccine
- Markov model
- Accès libre
Pages: 437 - 441
Background: Ethyl-2-cyanoacrylate adhesive has been widely used for sealing small corneal perforations in Thailand. However, its efficacy has not been reported.
Objective: To study the efficacy and safety of ethyl-2-cyanoacrylate adhesive for corneal gluing in impending or perforated corneas.
Methods: This is a retrospective study of a case series of patients who had corneal gluing with ethyl-2-cyanoacrylate in a tertiary care center in Thailand from 1992-2010. Data includes demographic data, indications for treatment, visual acuity before and after gluing, number of gluing, definite treatment, success and complications after gluing.
Results: Sixty-six eyes were treated with ethyl-2-cyanoacrylate adhesive. There were 39 men (59%) and 27 women (41%). Age ranged from 11 to 87 years (mean age 49.74 years). The most common indications were perforated corneal ulcer (32%) and descemetocele (29%). Overall success rate of gluing was 91% (n = 60). Success rate on the first, second, third, and fifth attempt of gluing was 70% (n = 46), 14% (n = 9), 6% (n = 4), and 2% (n = 1), respectively. Definite treatments were performed on 17 patients after gluing. Six patients had penetrating keratoplasty, 6 had lamellar keratoplasty, 3 had amniotic membrane transplantation, 1 had corneal resuturing, and 1 immunocompromised patient with a severe corneal infection had an evisceration. One patient developed corneal irritation. No serious complications were found.
Conclusion: Ethyl-2-cyanoacrylate adhesive is safe and efficacious in gluing both noninfectious and infectious corneal perforations.
- Corneal perforation
- Accès libre
Pages: 443 - 448
Background: Only a few cases of Leiomyomatoid angiomatous neuroendocrine tumor (LANT) have been reported in the literature. Our case adds clinical, pathological, and immunohistochemical features.
Objective: To investigate the clinicopathological characteristics of LANT.
Material and Method: One case of LANT of the myometrium was reported in a review of literature. The morphological and immunohistochemical features were analyzed.
Results: In the course of an annual health examination of a 40-year-old woman, ultrasound results revealed a mass in the myometrium, which was clinically diagnosed as uterine leiomyoma. The patient underwent hysterectomy. Histological examination demonstrated that the tumor was composed of prominent vasculature and cellular stromal around vessels. Mitotic activity was absent. Both vascular and stromal cells showed diffusely expressed CD56 and chromogranin A. Stromal cells also expressed actin, SMA, and desmin, but not CK or HMB45. The pathological diagnosis was LANT of the myometrium. Follow up reported no evidence of recurrence three months after surgery.
Conclusion: LANT is a possible new disease entity. LANT is a dimorphic tumor consisting of smooth muscle and neurosecretory phenotype cells surrounding intratumoral vessels. Surgery may be the best treatment, resulting in good prognosis.
- neuroendocrine neoplasm
- Accès libre
Neoadjuvant gemcitabine and docetaxel in primary breast angiosarcoma revealed complete pathological remission
Pages: 449 - 454
Background: Breast angiosarcoma is a rare but aggressive vascular-origin soft tissue tumor. Surgery is the main treatment. However, recent evidence has shown activity of the single agents, paclitaxel or docetaxel, in unresectable or metastasis angiosarcoma.
Objective: To report the case of a patient who received systemic chemotherapy as part of multidisciplinary approach to improve clinical outcome.
Results: We report the case of a 56-year-old female patient who presented with a locally advanced primary angiosarcoma of the left breast and received a combination gemcitabine and docetaxel as neoadjuvant chemotherapy in addition to standard multidisciplinary treatment. The patient was followed for at least 20 months without evidence of disease recurrence.
Conclusion: A perioperative combination chemotherapy consisting of docetaxel and gemcitabine can be considered as a strategy to achieve a pathological complete response and durable remission.
- Breast angiosarcoma
- neoadjuvant gemcitabine and docetaxel