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Specific Indications (specific + indication)

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Medical Sciences	100%

Selected Abstracts

The efficiency frontier approach to economic evaluation of health-care interventions

HEALTH ECONOMICS, Issue 10 2010
J. Jaime Caro
Abstract Background: IQWiG commissioned an international panel of experts to develop methods for the assessment of the relation of benefits to costs in the German statutory health-care system. Proposed methods: The panel recommended that IQWiG inform German decision makers of the net costs and value of additional benefits of an intervention in the context of relevant other interventions in that indication. To facilitate guidance regarding maximum reimbursement, this information is presented in an efficiency plot with costs on the horizontal axis and value of benefits on the vertical. The efficiency frontier links the interventions that are not dominated and provides guidance. A technology that places on the frontier or to the left is reasonably efficient, while one falling to the right requires further justification for reimbursement at that price. This information does not automatically give the maximum reimbursement, as other considerations may be relevant. Given that the estimates are for a specific indication, they do not address priority setting across the health-care system. Conclusion: This approach informs decision makers about efficiency of interventions, conforms to the mandate and is consistent with basic economic principles. Empirical testing of its feasibility and usefulness is required. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Adherence to Pressure Ulcer Prevention Guidelines: Implications for Nursing Home Quality

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2003
Debra Saliba MD
OBJECTIVES: This study aims to assess overall nursing home (NH) implementation of pressure ulcer (PU) prevention guidelines and variation in implementation rates among a geographically diverse sample of NHs. DESIGN: Review of NH medical records. SETTING: A geographically diverse sample of 35 Veterans Health Administration NHs. PARTICIPANTS: A nested random sample of 834 residents free of PU on admission. MEASUREMENTS: Adherence to explicit quality review criteria based on the Agency for Healthcare Research and Quality Practice Guidelines for PU prevention was measured. Medical record review was used to determine overall and facility-specific adherence rates for 15 PU guideline recommendations and for a subset of six key recommendations judged as most critical. RESULTS: Six thousand two hundred eighty-three instances were identified in which one of the 15 guideline recommendations was applicable to a study patient based on a specific indication or resident characteristic in the medical record. NH clinicians adhered to the appropriate recommendation in 41% of these instances. For the six key recommendations, clinicians adhered in 50% of instances. NHs varied significantly in adherence to indicated guideline recommendations, ranging from 29% to 51% overall adherence across all 15 recommendations (P < .001) and from 24% to 75% across the six key recommendations (P < .001). Adherence rates for specific indications also varied, ranging from 94% (skin inspection) to 1% (education of residents or families). Standardized assessment of PU risk was identified as one of the most important and measurable recommendations. Clinicians performed this assessment in only 61% of patients for whom it was indicated. CONCLUSIONS: NHs' overall adherence to PU prevention guidelines is relatively low and is characterized by large variations between homes in adherence to many recommendations. The low level of adherence and high level of variation to many best-care practices for PU prevention indicate a continued need for quality improvement, particularly for some guidelines. [source]

Selecting Nanotechnology-Based Composites Using Colorimetric and Visual Analysis for the Restoration of Anterior Dentition: A Case Report

JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 2 2004
FRANK J. MILNAR DDS
ABSTRACT Currently it is possible to use direct composites and layering techniques to replicate the complex internal structures, visible shape, color, and surface anatomy of natural teeth. To do so, however, requires dentists to understand the principles of nature and the science of dental materials to determine the most suitable restorative material for a specific indication. By incorporating relatively new technologies,colorimetric analysis, which provides computerized shade guide definitions of a tooth and essential information to verify shade mapping, and a new nanotechnology-based direct composite,into composite layering techniques, dentists can more predictably replicate the esthetics of natural teeth. This article presents a case in which both technologies, used in combination with a composite layering technique, contributed to the esthetic and functional restoration of the maxillary central incisors. [source]

Fulminant hepatic failure: Outcome after listing for highly urgent liver transplantation,12 years experience in the nordic countries

LIVER TRANSPLANTATION, Issue 11 2002
Bjørn Brandsæter
Fulminant hepatic failure is a common indication for liver transplantation. Outcomes of patients listed for a highly urgent liver transplantation have been studied, with special emphasis on etiology of the liver disease, clinical condition, and ABO blood type. Data have been collected from the Nordic Liver Transplantation Registry. All Nordic patients listed for a highly urgent primary liver transplantation during a 12-year period have been included. Of the 315 patients listed for a highly urgent liver transplantation, 229 (73%) received a first liver allograft, 50 patients (16%) died without transplantation, and 36 patients (11%) were permanently withdrawn and survived. In 43% of the patients, no definite etiology of the liver failure could be established. Paracetamol intoxication was the most frequent specific indication for listing. Patients with blood type A had no significant shorter waiting time (3.8 v 6.6 days; P = .1) but a higher rate of transplantation (82% v 66%, P = .006) as compared with blood type O patients. In a multivariate analysis, paracetamol intoxication remained the single independent predictor of an outcome without transplantation. In conclusion, a high transplantation rate was observed among patients listed for a highly urgent liver transplantation because of fulminant hepatic failure. Blood type O patients had a lower chance of receiving a liver allograft. Patients with paracetamol intoxication had both a higher mortality without transplantation and a higher withdrawal rate attributable to improved condition. [source]

Treatment of essential tremor with the barbiturate t2000 (1,3-dimethoxymethyl-5,5-diphenyl-barbituric acid)

MOVEMENT DISORDERS, Issue 5 2007
Calvin Melmed MD
Abstract The effect of the barbiturate T2000 (1,3-dimethoxymethyl-5,5-diphenyl-barbituric acid; DMMDPB) on essential tremor, given in twice daily doses of 400 and 300 mg, was assessed in two brief, randomized, placebo-controlled, parallel-group, double-blinded, single-center trials in 12 and 22 patients, respectively. These trials represent the first clinical use of T2000 for a specific indication. The primary endpoint was the change in the mean scores of the treated and control groups based on the Fahn-Tolosa-Marin tremor scale. In the first study of 12 patients treated with 400 mg or placebo twice daily for 14 days, the mean change from baseline at day 14 was 19.3 (P < 0.0001) in the treated group and 9.0 (P = 0.0121) in the control group. Using a two-factor mixed ANOVA model to evaluate within group and between group changes, the effect of T2000 was significantly different from that of the placebo group (P = 0.03). In the second study of 22 patients treated with 300 mg of T2000 or placebo twice daily for 20 days, statistically significant changes were seen in treated patients compared to baseline, but the ANOVA model did not demonstrate a significant treatment effect of T2000 compared to placebo. When the treated groups from each study are compared, the 800-mg daily group is significantly different from the 600-mg daily group (P = 0.02). Some treated patients in each study, but no placebo patients, experienced marked improvement. These results support further evaluation of T2000 in the treatment of essential tremor. © 2006 Movement Disorder Society [source]

The impact of cytomorphology, cytogenetics, molecular genetics, and immunophenotyping in a comprehensive diagnostic workup of myelodysplastic syndromes

CANCER, Issue 19 2009
Ulrike Bacher MD
Abstract BACKGROUND: Because of limited reproducibility of morphologic features, the morphological categorization of initial myelodysplastic syndromes (MDS) cases remains a major task in a diagnostic setting. METHODS: To further evaluate the role of additional diagnostic methods for suspected early MDS, the authors analyzed 1965 cases with unclear cytopenia where at least cytomorphology and immunophenotyping were performed in parallel, combined with cytogenetics and molecular genetics. RESULTS: In 353 patients, both methods diagnosed malignant/nonmalignant disease other than MDS, and 557 patients had MDS-refractory anemia with excess of blasts/chronic myelomonocytic leukemia. The remaining 1055 patients (53.7%), where early MDS/reactive cytopenia had to be assumed, were categorized into 6 groups depending on cytomorphology/immunophenotyping results for or against MDS. In 659 of 1055 cases (62.4%) with suspected initial MDS, cytomorphology and immunophenotyping were concordant in the categorization of MDS/non-MDS. Cytogenetics, available in 951 of 1055 patients, revealed the highest frequency of aberrant karyotypes when both cytomorphology and immunophenotyping proposed MDS (63 of 227; 27.8%). But also in the groups where either cytomorphology or immunophenotyping showed evidence of MDS, aberrant karyotypes were found in 6% to 14% of patients. Even when both morphology and immunophenotyping showed no MDS, 11 of 208 (5.3%) had cytogenetic aberrations. RUNX1/AML1 mutation screening was positive in 15% in the latter group. NRAS, MLL -PTD, NPM1, and JAK2V617F were detected in low frequencies, confirming MDS diagnosis in the respective cases. CONCLUSIONS: This report outlines the power of a combined diagnostic approach for suspected initial cases of MDS including immunophenotyping, cytogenetics, and molecular genetics with selected markers in addition to cytomorphology. Diagnostic algorithms should be developed, and immunophenotyping should be further validated for this specific indication. Cancer 2009. © 2009 American Cancer Society. [source]

Topical antibiotics: therapeutic value or ecologic mischief?

DERMATOLOGIC THERAPY, Issue 5 2009
James Q. Del Rosso
ABSTRACT Based on antibiotic prescribing data from 2003, dermatologists account annually for 8,9 million prescriptions for oral antibiotics, and 3,4 million prescriptions for topical antibiotics. Overall, much of the emphasis on concerns related to emergence of clinically significant antibiotic-resistant bacterial strains focuses on use of systemic antibiotics, however, topical antibiotic use may also have potential implications. The following article discusses the perspectives of the authors related to the potential therapeutic benefits and ecologic implications ("ecologic mischief") of topical antibiotic therapy for specific indications encountered in ambulatory dermatology practice. [source]

Intraoperative Transesophageal Echocardiography in Congenital Heart Disease

ECHOCARDIOGRAPHY, Issue 8 2002
F.R.A.C.P., F.R.C.P.(C.)Article first published online: 24 JUL 200, Jeffrey F. Smallhorn M.B.B.S.
Intraoperative transesophageal echocardiography has become an integral component of the repair of congenital heart defects. It currently has a direct impact on reducing morbidity and mortality in the pediatric cardiac population. To establish a successful program, it is important to follow guidelines for training as well as having a systematic approach to the evaluation of this patient population. This article addresses the specific indications in a patient population as practiced at the Hospital For Sick Children, Toronto. While there may be subtle differences between programs, the objectives are to provide excellent service to the pediatric cardiac patient in the operating room. [source]

Current modalities and new advances in the treatment of basal cell carcinoma

INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2006
Roger I. Ceilley MD
Basal cell carcinoma (BCC) is one of the most common cancers. Surgical extirpation is currently the standard of care for BCC, which is associated with several advantages and disadvantages. Procedures such as surgical excision used to treat superficial BCC (sBCC) and nodular BCC (nBCC) may have high 5-year recurrence rates if tumors are not completely excised. Curettage with electrodesiccation is a common method for treating primary BCC. However, multiple cycles are recommended and the procedure can have unsatisfactory cosmetic results (e.g. scarring and hypopigmentation). Mohs micrographic surgery has a low rate of disease recurrence but is a specialized procedure usually limited to specific indications (e.g. high-risk tumors). Cryosurgery and photodynamic therapy require multiple cycles and are associated with variable cosmetic outcomes and recurrence rates. As with any procedure, potential risks and patient quality-of-life issues need to be considered. In addition, substantial patient and healthcare provider inconvenience limit the practical utility of some modalities. Pharmacologic interventions provide another treatment option as adjunctive or monotherapy. Investigations of imiquimod, a novel immune response modifier, have indicated that this topical, noninvasive agent is safe and well tolerated and may be efficacious in the treatment of BCC. This review will highlight the role of standard treatment modalities and introduce new advances in the treatment of BCC. [source]

Adherence to Pressure Ulcer Prevention Guidelines: Implications for Nursing Home Quality

Contraception of women with intellectual disability: prevalence and determinants

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 2 2002
L. Servais
Abstract Background The contraception of women with intellectual disability (ID) is a major concern for caregivers. However, the prevalence of contraception and the frequency of use of different methods (e.g. sterilization) remain generally unknown. Moreover, indications specific to women with ID are controversial. Methods The present authors conducted a population-based study among 97% of the women with ID aged between 18 and 46 years attending government-funded facilities in Brussels and the nearby province of Walloon Brabant in Belgium. Results Out of 397 subjects, 40.8% did not use any contraceptive method, 22.2% were sterilized, 18.4% used an oral contraceptive agent, 17.6% used depotmedroxyprogesterone acetate and 1% used an intrauterine device. These figures differ widely from those of the general Belgian population. Binary logistic regression for ,contraceptive utilization' showed the strong influence of institutional factors such as sleeping environment (i.e. institutional or parental), sexual relationship policy and contraception policy. Having or having had a boyfriend is also correlated with a stronger probability of contraceptive use. Other factors have a smaller influence (e.g. a milder level of ID). Very few factors, none of which are medical, are correlated with an increased use of a specific method. The present results are discussed in the light of the general medical application of contraception and the commonly assumed specific indications for women with ID. [source]

Defining the role of surgery for complications after pancreatoduodenectomy

ANZ JOURNAL OF SURGERY, Issue 1-2 2009
Parul J Shukla
Abstract Background:, Although mortality rates following pancreatoduodenectomy have drastically reduced over the last few decades, high morbidity rates have continued to trouble pancreatic surgeons across the world. Interventional radiology has reduced the need for re-exploration for complications following pancreatoduodenectomy. There remain specific indications for re-exploration in such scenarios. It is thus pertinent to identify those clinical scenarios where surgery still has a role in managing complications of pancreatoduodenectomy. The aim of the study was to define the role of surgery for dealing with complications following pancreatoduodenectomy. Methods:, One hundred and fifty-seven consecutive pancreatoduodenectomies carried out at a single institution between 1 January 2001 and 28 February 2007, were analysed. The database was looked into to identify patients who underwent re-exploration for complications and to define the indications for the exploration in these patients. Results:, Out of the 157 pancreatoduodenectomies, there were, in all, 39 complications (24.2%) in 38 patients. Most of these complications were successfully managed conservatively and with the help of interventional radiology. Seventeen patients had to be re-explored (10.8%). The indications were primarily for haemorrhage, clinically significant pancreatic leaks, biliary leaks, adhesive intestinal obstruction and burst abdomen. The overall mortality rate was 3.1%. The mortality rate in the patients undergoing re-exploration was 11.7%. Conclusion:, Early haemorrhage (from the pancreatic stump or anastomotic line), clinically significant pancreatic anastomotic leak with discharge from the main wound and an early biliary anastomotic leak are prime indications for re-exploration in patients with complications following pancreatoduodenectomy. [source]

Efficacy of micronised vaginal progesterone versus oral dydrogestrone in the treatment of irregular dysfunctional uterine bleeding: A pilot randomised controlled trial

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 6 2009
Savas KARAKUS
Background:, The vaginal route is more effective than the other drug delivery routes for some specific indications. Aim:, To compare the efficacy of a vaginal progesterone preparation with that of oral dydrogesterone. Methods:, A total of 69 women with irregular dysfunctional uterine bleeding were randomly assigned into one of two groups: oral dydrogesterone group (n = 35) and vaginal progesterone group (n = 34). At the end of a three-month treatment period, the women were re-evaluated. The endometrial histology findings and menstrual cycle characteristics were used as primary outcome measures. Pearson chi-square and Fisher's exact test were used for data analysis. Results:, Findings from 54 eligible women were evaluated. There was no statistically significant difference in both menstrual recordings and endometrial histology results between the groups. Conclusions:, Vaginal micronised progesterone could be an alternative to oral preparations in the treatment of dysfunctional uterine bleeding. This needs to be further evaluated in adequately controlled randomised trials against other effective treatments. [source]

Management of retinal tumours

ACTA OPHTHALMOLOGICA, Issue 2009
L DESJARDINS
Purpose To describe the clinical presentation, main diagnostic tools, differential diagnostic and managment of retinoblastoma. Methods Diagnostic modalities include fundus exam under general anesthesia with fundus pictures, ultrasonography and MRI. The more frequent differential diagnosis are coats disease and PHPV. Diffuse infiltrating retinoblastoma can be very difficult to identify An overview of the different therapeutic modalities of retinoblastoma with their specific indications and guidelines for follow up of patients and genetic counseling will be given. Results Unilateral massive retinoblastoma with no vision left is usually treated by enucleation while most bilateral retinoblastoma and 20% of unilateral can be treated by various conservative techniques including chemotherapy and chemothermotherapy, cryotherapy, plaque brachytherapy and external beam radiotherapy. Conclusion Early diagnosis of retinoblastoma is still the most important prognostic factor examination of the fundus is warranted in all children with leucokoria and/or strabismus. [source]