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[PMID]: 24440650
[Au] Autor:Homolka P; Leithner R; Billinger J; Gruber M
[Ad] Address:Zentrum für Medizinische Physik und Biomedizinische Technik, Medizinische Universität Wien, Währinger Gürtel 18-20, A-1090 Wien, Österreich. Electronic address: peter.homolka@meduniwien.ac.at....
[Ti] Title:Ergebnisse der Österreichischen CT-Dosisstudie 2010: Effektive Dosen der häufigsten CT-Untersuchungen und Unterschiede zwischen Anwendern. [Results of the Austrian CT dose study 2010: Typical effective doses of the most frequent CT examinations].
[So] Source:Z Med Phys;24(3):224-30, 2014 Sep.
[Is] ISSN:1876-4436
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:PURPOSE: To determine typical doses from common CT examinations of standard sized adult patients and their variability between CT operators for common CT indications. MATERIALS AND METHODS: In a nationwide Austrian CT dose survey doses from approx. 10,000 common CT examinations of adults during 2009 and 2010 were collected and "typical" radiation doses to the "average patient", which turned out to have 75.6kg body mass, calculated. Conversion coefficients from DLP to effective dose were determined and effective doses calculated according to ICRP 103. Variations of typically applied doses to the "average patient" were expressed as ratios between 90(th) and 10(th) percentile (inter-percentile width, IPW90/10), 1(st) and 3(rd) quartile (IPW75/25), and Maximum/Minimum. RESULTS: Median effective doses to the average patients for standard head and neck scans were 1.8 mSv (cervical spine), 1.9 mSv (brain: trauma/bleeding, stroke) to 2.2 mSv (brain: masses) with typical variation between facilities of a factor 2.5 (IPW90/10) and 1.7 (IPW75/25). In the thorax region doses were 6.4 to 6.8 mSv (pulmonary embolism, pneumonia and inflammation, oncologic scans), the variation between facilities was by a factor of 2.1 (IPW90/10) and 1.5 (IPW75/25), respectively. In the abdominal region median effective doses from 6.5 mSv (kidney stone search) to 22 mSv (liver lesions) were found (acute abdomen, staging/metastases, lumbar spine: 9-12 mSv; oncologic abdomen plus chest 16 mSv; renal tumor 20 mSv). Variation factors between facilities were on average for abdominal scans 2.7 (IPW90/10) and 1.8 (IPW75/25). CONCLUSION: Variations between CT operators are generally moderate for most operators, but in some indications the ratio between the minimum and the maximum of average dose to the typical standard patients exceeds a factor of 4 or even 5. Therefore, comparing average doses to Diagnostic Reference Levels (DRLs) and optimizing protocols need to be encouraged.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review

  2 / 3963124 MEDLINE  
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[PMID]: 25127350
[Au] Autor:Schubert RA; Schleussner E; Hoffmann J; Fiedler A; Stepan H; Gottschlich A
[Ad] Address:Klinik Gynäkologie und Geburtshilfe, Universitätsklinik, Oldenburg....
[Ti] Title:Klinische Ergebnisse der Cerclage nach Shirodkar bezüglich der Prävention der Frühgeburtlichkeit - eine retrospektive Analyse. [Prevention of preterm birth by shirodkar cerclage - clinical results of a retrospective analysis].
[So] Source:Z Geburtshilfe Neonatol;218(4):165-70, 2014 Aug.
[Is] ISSN:1439-1651
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:In spite of the continuous progress in prenatal care, 1 out of 10 babies is born too early - tendency rising worldwide. As a consequence of the heterogeneous aetiology of preterm birth, there is still no single and efficient interventional therapy. Cerclage is one option for pregnancies with cervical insufficiency, whereas the clinical benefit is discussed controversially. We analyzed in a retrospective study with 120 patients the effect of a cerclage intervention regarding pregnancy prolongation. Patients with cervical incompetence and Shirodkar cerclage were compared to those undergoing conservative treatment. As expected, gestational age at delivery was significantly lower after emergency cerclage (31 weeks) compared to prophylactic (36 weeks) and therapeutic cerclage (35 weeks). Prolongation differs significantly between the prophylactic (18 weeks), therapeutic (14 weeks) and emergency cerclage (10 weeks) groups. Conservative management achieved 8 weeks prolongation. Of note, particularly emergency cerclage in cases with advanced cervical incompetence resulted in a substantially higher pregnancy prolonga-tion (10 weeks) compared to no intervention (one week). The efficiency of cerclage operations has to be assessed in a differentiated manner based on the clinical situation and indication. The clinical benefit depends strongly on proper patient selection.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1055/s-0034-1382070

  3 / 3963124 MEDLINE  
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[PMID]: 25127346
[Au] Autor:Grosskopf AU; Brühwiler H; Eggimann T; Rautenberg W; Raio L
[Ad] Address:Gynäkologie und Geburtshilfe, Kantonsspital Münsterlingen, Münsterlingen, Switzerland....
[Ti] Title:Die Perikonzeptionelle Folsäureprophylaxe im Einzugsgebiet des Kantonsspitals Münsterlingen(KSM)/Thurgau: Was hat sich verändert von 2000 bis 2010? [Preconceptional Use of Folic Acid in the Region of the Kantonsspital Münsterlingen/Thurgau: Has it Changed Over the Past 10 Years?].
[So] Source:Z Geburtshilfe Neonatol;218(4):149-52, 2014 Aug.
[Is] ISSN:1439-1651
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:BACKGROUND: Numerous studies have shown that the preconceptional use of folic acid prevents neural tube defects. We created a study to find out whether the preconceptional use of folic acid has improved in the past 10 years, in the area of Münsterlingen, Switzerland. MATERIAL AND METHODS: We interviewed 2 groups of patients who delivered at our Institution, namely between 2000 and 2002 (period A) involving 287 women and from 2009 to 2010 (period B) involving 305 pregnant women. We asked them whether they used folic acid by means of a standardised questionnaire. RESULTS: In period B significantly more women have taken folic acid preconceptionally (period A: 27.5% vs. period B: 40.7%; p=0.001). A significant increase in folic acid intake was seen in the German speaking group from period A to B (30.3% vs. 52.7%; p=0.0005), while this was not the case in the non-German speaking group (21.4% in both periods). More multiparaé women were taking folic acid compared to nulliparae. A significant increase from period A to B was noted only in the German speaking group. Unexpectedly, in nulliparae non-German speaking women, folic acid supplementation decreased from 14% to 6.1%. DISCUSSION: We have found a significant increase in preconceptional folic acid supplementation from 2001 to 2010. The percentage of women taking folic acid is disappointingly low in all groups, particularly in nulliparae women of non-German ethnicity.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1055/s-0034-1382067

  4 / 3963124 MEDLINE  
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[PMID]: 25127345
[Au] Autor:Huber G; Seelbach-Göbel B
[Ad] Address:Klinik für Geburtshilfe und Frauenheilkunde der Universität Regensburg, Krankenhaus St. Hedwig, Regensburg.
[Ti] Title:Schwangerenbetreuung bei Drogenkonsum. [Substance abuse and pregnancy from an obstetric point of view].
[So] Source:Z Geburtshilfe Neonatol;218(4):142-8, 2014 Aug.
[Is] ISSN:1439-1651
[Cp] Country of publication:Germany
[La] Language:ger
[Ab] Abstract:INTRODUCTION: In Germany we find about 2 000 newborns per year with a mother misusing drugs. It is to be feared that there is a substantial amount of underreported substance abuse in pregnant women. To care for these pregnancies from an obstetric point of view as well as from an addiction treatment point of view is a challenge for all health-care professionals, due to multiple drugs being used and the special psychosocial and health issues these mothers and babies -present. METHOD: A selective search was undertaken in Pubmed, retrieving reviews and original articles from 2001-2013, with consideration of statements, recommendations and guidelines from national and international associations and committees on the topic. This review is intended to assist gynaecologists, obstetricians and paediatricians during the complex peripartum care for the drug abusing pregnant patient. RESULTS: When offering obstetric care for these pregnancies, several issues have to be taken into account: the special psychological situation of the pregnant drug user, with frequent occurrence of psychiatric comorbidities like depression and anxiety disorders, as well as gynaecological complications like premature labour, intrauterine growth restriction and maternal infectious diseases. The pharmacological complexity of the substances abused and the possible side-effects on the foetus have to be explained to the mother. Maintenance medication for foetomaternal risk reduction and maternal stabilisation remains the state-of-the-art treatment. Furthermore, it is important to explain the neonatal abstinence syndrome to the mother as well as the result of breast-feeding in the presence of smoking and/or infectious diseases. DISCUSSION: Professionalism and empathy are needed from gynaecologists in order to achieve risk reduction for mother and child in substance-using pregnancies. However, in spite of close cooperation of all health-care professionals and avoidance of stigma, it will be difficult to offer good obstetric care to the high-risk patients with poly-drug abuse.
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1055/s-0034-1382068

  5 / 3963124 MEDLINE  
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[PMID]: 25128060
[Au] Autor:Milte R; Ratcliffe J; Chen G; Lancsar E; Miller M; Crotty M
[Ad] Address:Department of Nutrition and Dietetics, Flinders University, Adelaide, Australia....
[Ti] Title:Cognitive overload? An exploration of the potential impact of cognitive functioning in discrete choice experiments with older people in health care.
[So] Source:Value Health;17(5):655-9, 2014 Jul.
[Is] ISSN:1524-4733
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: This exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people. METHODS: A DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity. RESULTS: Both the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of responses to the DCE. CONCLUSIONS: This study provides important preliminary evidence relating to the effect of mild cognitive impairment on DCE responses for older people. It is important that further research be conducted in larger samples and more diverse populations to further substantiate the findings from this exploratory study and to assess the practicality and validity of the DCE approach with populations of older people.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review

  6 / 3963124 MEDLINE  
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[PMID]: 25128055
[Au] Autor:Evan Pollack C; Wang H; Bekelman JE; Weissman G; Epstein AJ; Liao K; Dugoff EH; Armstrong K
[Ad] Address:Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD, USA; Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: cpollac2...
[Ti] Title:Physician social networks and variation in rates of complications after radical prostatectomy.
[So] Source:Value Health;17(5):611-8, 2014 Jul.
[Is] ISSN:1524-4733
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Variation in care within and across geographic areas remains poorly understood. The goal of this article was to examine whether physician social networks-as defined by shared patients-are associated with rates of complications after radical prostatectomy. METHODS: In five cities, we constructed networks of physicians on the basis of their shared patients in 2004-2005 Surveillance, Epidemiology and End Results-Medicare data. From these networks, we identified subgroups of urologists who most frequently shared patients with one another. Among men with localized prostate cancer who underwent radical prostatectomy, we used multilevel analysis with generalized linear mixed-effect models to examine whether physician network structure-along with specific characteristics of the network subgroups-was associated with rates of 30-day and late urinary complications, and long-term incontinence after accounting for patient-level sociodemographic, clinical factors, and urologist patient volume. RESULTS: Networks included 2677 men in five cities who underwent radical prostatectomy. The unadjusted rate of 30-day surgical complications varied across network subgroups from an 18.8 percentage-point difference in the rate of complications across network subgroups in city 1 to a 26.9 percentage-point difference in city 5. Large differences in unadjusted rates of late urinary complications and long-term incontinence across subgroups were similarly found. Network subgroup characteristics-average urologist centrality and patient racial composition-were significantly associated with rates of surgical complications. CONCLUSIONS: Analysis of physician networks using Surveillance, Epidemiology and End Results-Medicare data provides insight into observed variation in rates of complications for localized prostate cancer. If validated, such approaches may be used to target future quality improvement interventions.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review

  7 / 3963124 MEDLINE  
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[PMID]: 25128052
[Au] Autor:Goossens LM; Utens CM; Smeenk FW; Donkers B; van Schayck OC; Rutten-van Mölken MP
[Ad] Address:Institute for Medical Technology Assessment/Institute for Healthcare Policy and Management, Erasmus University, Rotterdam, The Netherlands. Electronic address: goossens@bmg.eur.nl....
[Ti] Title:Should I stay or should I go home? A latent class analysis of a discrete choice experiment on hospital-at-home.
[So] Source:Value Health;17(5):588-96, 2014 Jul.
[Is] ISSN:1524-4733
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: This study aimed 1) to quantify the strength of patient preferences for different aspects of early assisted discharge in The Netherlands for patients who were admitted with a chronic obstructive pulmonary disease exacerbation and 2) to illustrate the benefits of latent class modeling of discrete choice data. This technique is rarely used in health economics. METHODS: Respondents made multiple choices between hospital treatment as usual (7 days) and two combinations of hospital admission (3 days) followed by treatment at home. The latter was described by a set of attributes. Hospital treatment was constant across choice sets. Respondents were patients with chronic obstructive pulmonary disease in a randomized controlled trial investigating the cost-effectiveness of early assisted discharge and their informal caregivers. The data were analyzed using mixed logit, generalized multinomial logit, and latent-class conditional logit regression. These methods allow for heterogeneous preferences across groups, but in different ways. RESULTS: Twenty-five percent of the respondents opted for hospital treatment regardless of the description of the early assisted discharge program, and 46% never opted for the hospital. The best model contained four latent classes of respondents, defined by different preferences for the hospital and caregiver burden. Preferences for other attributes were constant across classes. Attributes with the strongest effect on choices were the burden on informal caregivers and co-payments. Except for the number of visits, all attributes had a significant effect on choices in the expected direction. CONCLUSIONS: Considerable segments of respondents had fixed preferences for either treatment option. Applying latent class analysis was essential in quantifying preferences for attributes of early assisted discharge.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review

  8 / 3963124 MEDLINE  
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[PMID]: 25128049
[Au] Autor:Ly TT; Brnabic AJ; Eggleston A; Kolivos A; McBride ME; Schrover R; Jones TW
[Ad] Address:Department of Endocrinology and Diabetes, Princess Margaret Hospital for Children, Perth, WA, Australia; Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia; School of Paediatrics and Child Health, The University o...
[Ti] Title:A Cost-Effectiveness Analysis of Sensor-Augmented Insulin Pump Therapy and Automated Insulin Suspension versus Standard Pump Therapy for Hypoglycemic Unaware Patients with Type 1 Diabetes.
[So] Source:Value Health;17(5):561-9, 2014 Jul.
[Is] ISSN:1524-4733
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: To assess the cost-effectiveness of sensor-augmented insulin pump therapy with "Low Glucose Suspend" (LGS) functionality versus standard pump therapy with self-monitoring of blood glucose in patients with type 1 diabetes who have impaired awareness of hypoglycemia. METHODS: A clinical trial-based economic evaluation was performed in which the net costs and effectiveness of the two treatment modalities were calculated and expressed as an incremental cost-effectiveness ratio (ICER). The clinical outcome of interest for the evaluation was the rate of severe hypoglycemia in each arm of the LGS study. Quality-of-life utility scores were calculated using the three-level EuroQol five-dimensional questionnaire. Resource use costs were estimated using public sources. RESULTS: After 6 months, the use of sensor-augmented insulin pump therapy with LGS significantly reduced the incidence of severe hypoglycemia compared with standard pump therapy (incident rate difference 1.85 [0.17-3.53]; P = 0.037). Based on a primary randomized study, the ICER per severe hypoglycemic event avoided was $18,257 for all patients and $14,944 for those aged 12 years and older. Including all major medical resource costs (e.g., hospital admissions), the ICERs were $17,602 and $14,289, respectively. Over the 6-month period, the cost per quality-adjusted life-year gained was $40,803 for patients aged 12 years and older. CONCLUSIONS: Based on the Australian experience evaluating new interventions across a broad range of therapeutic areas, sensor-augmented insulin pump therapy with LGS may be considered a cost-effective alternative to standard pump therapy with self-monitoring of blood glucose in hypoglycemia unaware patients with type 1 diabetes.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review

  9 / 3963124 MEDLINE  
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[PMID]: 25128047
[Au] Autor:Reed SD; Stewart SB; Scales CD; Moul JW
[Ad] Address:Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA; Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. Electronic address: shelby.reed@duke.edu....
[Ti] Title:A Framework to Evaluate the Cost-Effectiveness of the NADiA ProsVue Slope to Guide Adjuvant Radiotherapy among Men with High-Risk Characteristics Following Prostatectomy for Prostate Cancer.
[So] Source:Value Health;17(5):545-54, 2014 Jul.
[Is] ISSN:1524-4733
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: The NADiA ProsVue is a prognostic system that measures prostate-specific antigen slope to identify men at lower risk of clinical recurrence of prostate cancer after radical prostatectomy. We developed a decision-modeling framework to evaluate its cost-effectiveness to guide the use of adjuvant radiotherapy (ART). METHODS: We populated the model using patient-level data and external sources. Patients were classified as intermediate risk or high risk on the basis of Cancer of the Prostate Risk Assessment-Postsurgical (CAPRA-S) nomogram and then stratified by the ProsVue slope (≤2 pg/mL/mo; >2 pg/mL/mo) and receipt of ART. In sensitivity analyses, we varied the effect of the ProsVue slope on the use of ART and other model parameters. RESULTS: The cost-effectiveness of the ProsVue-guided strategy varied widely because of small differences in quality-adjusted life-years (QALYs) at 10 years. In the intermediate-risk group, when the use of ART decreased from 20% (standard care) to 7.5% among patients with a ProsVue slope value of 2 pg/mL/mo or less, the incremental cost-effectiveness ratio was $25,160/QALY. In the high-risk group, the use of ART would have to decrease from 40% (standard care) to 11.5% among those with a ProsVue slope value of 2 pg/mL/mo or less to obtain a ratio of $50,000/QALY. The cost-effectiveness ratios were sensitive to varying benefits of salvage therapy, quality of life, and costs of ART and ProsVue testing. CONCLUSIONS: The effect of the ProsVue system on costs will be dependent on the extent to which ART decreases among men identified as having a low risk of recurrence. Its effect on QALYs will remain conditional on uncertain clinical and quality-of-life benefits associated with ART.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review

  10 / 3963124 MEDLINE  
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[PMID]: 25128046
[Au] Autor:Kobelt G
[Ad] Address:University of Lund, Lund, Sweden; European Health Economics, Mulhouse, France. Electronic address: Gisela.Kobelt@he-europe.com.
[Ti] Title:Treating to target with etanercept in rheumatoid arthritis: cost-effectiveness of dose reductions when remission is achieved.
[So] Source:Value Health;17(5):537-44, 2014 Jul.
[Is] ISSN:1524-4733
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Current management of rheumatoid arthritis (RA) focuses on inducing remission as early as possible to avoid lasting joint damage, and maintenance of remission has become important. A 12-month clinical trial in 834 patients with moderate RA investigated whether etanercept 50 mg/wk could be reduced to half dose or discontinued in patients who achieved low disease activity after 36 weeks. OBJECTIVE: The objective of this study was to estimate the cost-effectiveness of the three maintenance strategies. METHODS: A Markov model integrated the three strategies from the clinical trial and extrapolated to 10 years using data from the Swedish RA registry. Assumed treatment strategies after the trial were similar in all three arms, with patients failing to maintain remission on half-dose etanercept or methotrexate alone switching to the full dose of etanercept and patients maintaining remission on full-dose etanercept allowed switching to half dose. Resource use and utilities were taken from an observational study. Results are presented as cost/quality-adjusted life-year (QALY) (both discounted 3%) in the societal perspective. RESULTS: The cost/QALY gained with half-dose etanercept versus methotrexate ranged from €14,000 to €29,000: Longer simulations result in a higher cost/QALY, as the acquisition cost of etanercept increases. Half-dose etanercept technically dominates the full dose (lower costs [€-3000 to 6300] and similar effectiveness [0.007-0.011]). CONCLUSIONS: Although ultimately all three strategies explored achieve a similar outcome as all three continuously manage patients to maintain remission, it appears that a dose reduction is the most advantageous strategy in patients with moderate disease activity.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1408
[Js] Journal subset:IM
[St] Status:In-Data-Review


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