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Medical Sciences	100%

Selected Abstracts

Cost-Effectiveness of Screening for Unhealthy Alcohol Use with %Carbohydrate Deficient Transferrin: Results From a Literature-Based Decision Analytic Computer Model

ALCOHOLISM, Issue 8 2009
Alok Kapoor
Background:, The %carbohydrate deficient transferrin (%CDT) test offers objective evidence of unhealthy alcohol use but its cost-effectiveness in primary care conditions is unknown. Methods:, Using a decision tree and Markov model, we performed a literature-based cost-effectiveness analysis of 4 strategies for detecting unhealthy alcohol use in adult primary care patients: (i) Questionnaire Only, using a validated 3-item alcohol questionnaire; (ii) %CDT Only; (iii) Questionnaire followed by %CDT (Questionnaire-%CDT) if the questionnaire is negative; and (iv) No Screening. For those patients screening positive, clinicians performed more detailed assessment to characterize unhealthy use and determine therapy. We estimated costs using Medicare reimbursement and the Medical Expenditure Panel Survey. We determined sensitivity, specificity, prevalence of disease, and mortality from the medical literature. In the base case, we calculated the incremental cost-effectiveness ratio (ICER) in 2006 dollars per quality-adjusted life year ($/QALY) for a 50-year-old cohort. Results:, In the base case, the ICER for the Questionnaire-%CDT strategy was $15,500/QALY compared with the Questionnaire Only strategy. Other strategies were dominated. When the prevalence of unhealthy alcohol use exceeded 15% and screening age was <60 years, the Questionnaire-%CDT strategy costs less than $50,000/QALY compared to the Questionnaire Only strategy. Conclusions:, Adding %CDT to questionnaire-based screening for unhealthy alcohol use was cost-effective in our literature-based decision analytic model set in typical primary care conditions. Screening with %CDT should be considered for adults up to the age of 60 when the prevalence of unhealthy alcohol use is 15% or more and screening questionnaires are negative. [source]

Patient responses to an integrated service, initiated by community pharmacists, for the prevention of osteoporosis

INTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 2 2008
Dr. Judith A. Crockett project officer
Objective This study aimed to develop, implement and evaluate an integrated service provided by pharmacists to consumers based on the results of a risk-assessment survey carried out by the pharmacist and testing of bone mineral density (BMD) by a radiographer. It also investigated whether measurement of BMD in the pharmacy increased the effectiveness of the service and pharmacist referral in terms of adherence to advice and uptake of referral compared with the same service offered without BMD testing. Setting Community pharmacists in urban and rural settings in New South Wales, Australia, delivered the service. Method The adherence to advice or referral given by 12 community pharmacists during 2003 to 217 participants about the prevention of osteoporosis following screening with either a BMD test plus risk-assessment questionnaire or a risk-assessment questionnaire only was compared. Key findings No significant between-group differences in adherence to advice or referral were found. However, participants valued the BMD service significantly more highly than the non-BMD service as measured by satisfaction scores. Conclusions Consumers were interested in receiving information about osteoporosis and their own risk of it and even greater interest in BMD testing in the pharmacy. There was no difference in uptake of referral or advice following either questionnaire only or questionnaire plus BMD testing. Low uptake of referral and advice overall by those deemed to be at high risk is of concern. Far greater education and encouragement for consumers to follow through is required. [source]

Reactivity to alcohol assessment measures: an experimental test

ADDICTION, Issue 8 2009
Scott T. Walters
ABSTRACT Aims Previous research has suggested that alcohol screening and assessment may affect drinking. Design This study was a randomized test of reactivity to alcohol assessment questionnaires among a group of heavy drinking college students. Setting and participants A total of 147 university students completed a screening questionnaire and were randomized to either immediate assessment or delayed assessment. The immediate assessment group completed a set of drinking questionnaires at baseline, 3, 6 and 12 months, while the delayed assessment group completed questionnaires only at 12 months. Measurements Primary outcomes included overall volume of drinking, risky drinking and use of risk reduction behaviors. Findings We found a significant effect of assessment on measures of risky drinking and risk reduction behaviors, but not on overall volume of drinking. Specifically, at 12 months, participants who had previously completed drinking assessments had a lower peak blood alcohol concentration (BAC) (d = ,0.373), were more likely to report a low score on the Alcohol Use Disorders Identification Test (AUDIT; odds ratio = 2.55) and tended to use more strategies to moderate their alcohol consumption (d = 0.352). Risk reduction behaviors that were affected tended to be those that limited alcohol consumption, rather than those that minimized consequences. Conclusions These results may have implications for the development of brief interventions. [source]

Long term review of laparoscopic sacrocolpopexy

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 8 2005
P.J. Higgs
Objective Assessment of long term outcome following laparoscopic sacrocolpopexy. Design Retrospective follow up study using standardised examination with pelvic organ prolapse quantification system (POP-Q) and questionnaires. Setting A tertiary urogynaecology unit in the North West of England. Population One hundred and forty consecutive cases who had a laparoscopic sacrocolpopexy at St Mary's Hospital, Manchester, between 1993 and 1999. Methods Women completed questionnaires and were examined in gynaecology clinic or sent postal questionnaires if unable to attend the clinic. Main outcome measures Adequacy of vault support and recurrent vaginal prolapse assessed by POP-Q score. Assessment of prolapse, urinary and bowel symptoms and sexual function using questionnaires. Results One hundred and three women were contacted after a median of 66 months. Sixty-six women were examined and a further 37 women filled in questionnaires only. Recurrent vault prolapse occurred in 4 of the 66 women who were examined. Prolapse had recurred or persisted in 21 of 66 women, with equal numbers of anterior and posterior vaginal wall prolapse. Overall, 81/102 (79%) said that their symptoms of prolapse were ,cured' or ,improved'; 39/103 (38%) still had symptoms of prolapse. For every two women who were cured of their urinary or bowel symptoms, one woman developed worse symptoms. Conclusions Among the 66 women available for examination laparoscopic sacrocolpopexy provided good long term support of the vault in 92%. Forty-two percent of these women had recurrent vaginal wall prolapse. Despite this, 79% of women felt that their symptoms of prolapse were cured or improved following surgery. [source]