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Nair KV, Santoro JD. The Neurologist's Guide to Drug Pricing in the United States. Continuum (Minneap Minn) 2024; 30:1259-1271. [PMID: 39088295 DOI: 10.1212/con.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
ABSTRACT As newer, innovative neurology drugs enter the US health care system, neurologists should consider the cost of these treatments in addition to their efficacy, safety, and tolerability. To do so thoughtfully requires an understanding of how prescription drugs are priced in the United States. The process of drug pricing is linked to the distribution supply chain and the many stakeholders involved. Stakeholders include pharmaceutical manufacturers; wholesalers; pharmacies; pharmacy benefit managers; payers, including health insurers; hospital systems; neurologists and other clinicians; and patients. Drug pricing has taken center stage as the Inflation Reduction Act of 2022 has set maximum out-of-pocket expenses for Medicare beneficiaries for the first time in the program's history and limits drug price increases for a select group of Medicare Part D drugs. This article describes the US drug distribution supply chain and its stakeholders and introduces key drug pricing terms; a brief description of how rebates are generally estimated will also be discussed. Finally, as newer neurology outpatient drugs enter the market, the "value" of drugs will be described through cost-effectiveness terminology and their utility for the clinical neurologist.
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Qu HM, Zhong HY, Xiao T, Li YJ, Ren P, Chen XJ. Perceived control, self-management efficacy, and quality of life in patients treated with radiation therapy for breast cancer: a longitudinal study. Support Care Cancer 2024; 32:284. [PMID: 38607445 DOI: 10.1007/s00520-024-08485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This longitudinal study aims to examine the present state of perceived control, self-management efficacy, and overall quality of life (QoL) in patients with breast cancer undergoing radiotherapy, and gain insight into the dynamic trends and factors that influence the quality of life experienced by patients during the course of radiotherapy. METHODS Participants completed the Cancer Experience and Efficacy Scale (CEES), Strategies Used by People to Promote Health (SUPPH), and Functional Assessment of Cancer Therapy- Breast (FACT-B). The data was analyzed using the software SPSS26.0. Repeated measures analysis of variance (ANOVA) and mixed-effects linear models were used to analyze trends in perceived control, self-management efficacy, and QoL at three-time points, as well as factors affecting QoL during radiotherapy. RESULTS Perceived control and self-management efficacy were associated with QoL over the course of the radiotherapy. Self-management efficacy (β = 0.30, P < 0.001), presence of chemotherapy (β = 18.33, P = 0.024), and duration of illness (β = 2.25, P = 0.028) had a positive effect on the change in QoL, while time (β = - 2.95, P < 0.001), cancer experience (β = - 0.46, P < 0.001), and type of medical insurance (β = - 2.77, P = 0.021) had the negative effect on the change in QoL. CONCLUSION The QoL, perceived control, and self-efficacy of patients with breast cancer show dynamic changes during radiotherapy. The higher the self-efficacy, the better the QoL, and the worse the QoL when the sense of disease control is poor. At the same time, more attention should be paid to the QoL of breast cancer radiotherapy patients with a long course of the disease, receiving chemotherapy, and different medical payment methods.
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Affiliation(s)
- Hai-Mei Qu
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Nursing, Xuanhan County People's Hospital, Dazhou, Sichuan, China
| | - Hong-Yue Zhong
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Tian Xiao
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Yan-Jun Li
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
- Department of Nursing, Suining Central Hospital, Suining, Sichuan, China
| | - Pan Ren
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China
| | - Xiao-Ju Chen
- School of Nursing, Chengdu Medical College, Chengdu, Sichuan, China.
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García-Perea A, Fernández-Cruz E, de la O-Pascual V, Gonzalez-Zorzano E, Moreno-Aliaga MJ, Tur JA, Martinez JA. Nutritional and Lifestyle Features in a Mediterranean Cohort: An Epidemiological Instrument for Categorizing Metabotypes Based on a Computational Algorithm. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:610. [PMID: 38674256 PMCID: PMC11051796 DOI: 10.3390/medicina60040610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Modern classification and categorization of individuals' health requires personalized variables such as nutrition, physical activity, lifestyle, and medical data through advanced analysis and clustering methods involving machine learning tools. The objective of this project was to categorize Mediterranean dwellers' health factors and design metabotypes to provide personalized well-being in order to develop professional implementation tools in addition to characterizing nutritional and lifestyle features in such populations. Materials and Methods: A two-phase observational study was conducted by the Pharmacists Council to identify Spanish nutritional and lifestyle characteristics. Adults over 18 years of age completed questionnaires on general lifestyle habits, dietary patterns (FFQ, MEDAS-17 p), physical activity (IPAQ), quality of life (SF-12), and validated well-being indices (LS7, MEDLIFE, HHS, MHL). Subsequently, exploratory factor, clustering, and random forest analysis methods were conducted to objectively define the metabotypes considering population determinants. Results: A total of 46.4% of the sample (n = 5496) had moderate-to-high adherence to the Mediterranean diet (>8 points), while 71% of the participants declared that they had moderate physical activity. Almost half of the volunteers had a good self-perception of health (49.9%). Regarding lifestyle index, population LS7 showed a fair cardiovascular health status (7.9 ± 1.7), as well as moderate quality of life by MEDLIFE (9.3 ± 2.6) and MHL scores (2.4 ± 0.8). In addition, five metabotype models were developed based on 26 variables: Westernized Millennial (28.6%), healthy (25.1%), active Mediterranean (16.5%), dysmetabolic/pre-morbid (11.5%), and metabolically vulnerable/pro-morbid (18.3%). Conclusions: The support of tools related to precision nutrition and lifestyle integrates well-being characteristics and contributes to reducing the impact of unhealthy lifestyle habits with practical implications for primary care. Combining lifestyle, metabolic, and quality of life traits will facilitate personalized precision interventions and the implementation of targeted public health policies.
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Affiliation(s)
| | - Edwin Fernández-Cruz
- IMDEA-Food Institute (Madrid Institute for Advances Studies), 28049 Madrid, Spain
- Faculty of Health Sciences, International University of La Rioja (UNIR), 26006 Logroño, Spain
| | - Victor de la O-Pascual
- IMDEA-Food Institute (Madrid Institute for Advances Studies), 28049 Madrid, Spain
- Faculty of Health Sciences, International University of La Rioja (UNIR), 26006 Logroño, Spain
| | | | - María J. Moreno-Aliaga
- CIBEROBN (Pathophysiology of Obesity and Nutrition), Carlos III Health Institute, 28029 Madrid, Spain
- Center for Nutrition Research and Department of Nutrition, Food Sciences and Physiology, University of Navarra, 31008 Pamplona, Spain
- IdISNA, Navarra Institute for Health Research, 31008 Pamplona, Spain
| | - Josep A. Tur
- CIBEROBN (Pathophysiology of Obesity and Nutrition), Carlos III Health Institute, 28029 Madrid, Spain
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, 07122 Palma de Mallorca, Spain
- IDISBA, Health Research Institute of the Balearic Islands, 07120 Palma de Mallorca, Spain
| | - J. Alfredo Martinez
- IMDEA-Food Institute (Madrid Institute for Advances Studies), 28049 Madrid, Spain
- CIBEROBN (Pathophysiology of Obesity and Nutrition), Carlos III Health Institute, 28029 Madrid, Spain
- Department of Medicine, Dermatology, and Toxicology, University of Valladolid, 47005 Valladolid, Spain
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Yu J, Xu B, Ma G, Liu Y, Yang Y, Xu J, Sun M. A Prospective Observational Study of Factors Affecting the Change in Quality of Life in Patients With Primary Aldosteronism After Treatment. Endocr Pract 2024; 30:19-24. [PMID: 37858723 DOI: 10.1016/j.eprac.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To explore the changes in the health-related quality of life (HRQoL) in patients with primary aldosteronism (PA) after standardized treatment and determine the effects of different variables on the change in the HRQoL of patients. METHODS A total of 116 patients with PA were prospectively included from November 2020 to March 2022. Data were collected at their initial diagnosis and the follow-up after 12 months of treatment, including demographic and clinical data and the scores of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The scores of each dimension of SF-36 of patients before and after treatment were compared, and the factors affecting their change in the quality of life were analyzed using multiple linear regression. RESULTS After standardized treatment, the aldosterone-to-renin ratio (Z = -4.967, P < .001), systolic blood pressure (t = 8.985, P < .001), and diastolic blood pressure (t = 7.233, P < .001) of patients with PA decreased compared with baseline, and hypokalemia was effectively corrected (χ2 = 69.014, P < .001). In terms of quality of life, 6 of 8 dimensions of SF-36 and the total score of SF-36 significantly improved at 1-year follow-up compared with baseline (all P < .05). The results of multiple linear regression showed that the improvement in the HRQoL in patients with PA after standardized treatment was correlated with the change in the blood potassium level (P = .007) and systolic blood pressure (P = .003). CONCLUSION Correction of hypokalemia and control of diastolic blood pressure are essential factors contributing to the improvement in the HRQoL in patients with PA regardless of the standardized treatment received.
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Affiliation(s)
- Jian Yu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bei Xu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guodong Ma
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuqing Liu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuhong Yang
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jingjing Xu
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Sun
- Department of Endocrinology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Topolnitskiy EB, Shefer NA, Yunusov AN. [Quality of life in patients with postoperative unilateral diaphragm relaxation]. Khirurgiia (Mosk) 2024:21-27. [PMID: 38785235 DOI: 10.17116/hirurgia202405121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
OBJECTIVE To evaluate the quality of life before and after video-assisted thoracoscopic plication of relaxed dome of diaphragm. MATERIAL AND METHODS The study included 17 patients operated on for unilateral relaxation of diaphragm. We analyzed quality of life in preoperative period, 1, 3, 6 and 12 months after surgery using the SF-36 and EuroQ-5D-5L questionnaires. To assess the impact of abnormality on respiratory function, we estimated diaphragm position, spirometry data and SGRQ scores. RESULTS FVC increased by 16.5% after 1 month, 19.5% after 6 months and 20.1% after 12 months. In addition, FEV1 significantly increased (by 12.6% after 1 month, 10.1% after 6 months and 12.7% after 12 months). Mean values of diaphragm elevation in postoperative period decreased by 25.5-25.6%. According to the SF-36 and EuroQ-5D-5L questionnaires, physical and psychological health components significantly increased within a month after surgical treatment. According to the SGRQ questionnaire, influence of disease on overall status decreased a month after surgery as evidences by lower total score (p<0.05). CONCLUSION Objective and survey data revealed significant improvement in quality of life after surgery. A trend towards higher quality of life was demonstrated by all questionnaires in a month after surgery.
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Affiliation(s)
- E B Topolnitskiy
- Siberian State Medical University, Tomsk, Russia
- Tomsk Regional Clinical Hospital, Tomsk, Russia
- Tomsk State University, Tomsk, Russia
| | - N A Shefer
- Siberian State Medical University, Tomsk, Russia
- Tomsk Regional Clinical Hospital, Tomsk, Russia
| | - A N Yunusov
- Tomsk Regional Clinical Hospital, Tomsk, Russia
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Abdalla R, Pavlova M, Groot W. Prioritizing Outcome Measures for Value-Based Healthcare: Physicians' Perspectives in Saudi Arabia. Value Health Reg Issues 2023; 37:62-70. [PMID: 37327619 DOI: 10.1016/j.vhri.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/31/2023] [Accepted: 05/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To inform the stepwise transformation to value-based healthcare in Saudi Arabia, we assess physicians' priorities for measuring general patient outcomes. This is done as an initial step toward the implementation of disease-specific outcome sets. METHODS A cross-sectional, electronic self-administered questionnaire-based study among physicians in 6 hospitals in Saudi Arabia was conducted between March 2022 and May 2022. Purposive sampling was used to select hospitals and physicians. The questionnaire included 30 health outcomes taken from about 60 disease-specific outcome sets. These were classified into 6 domains per the Outcome Measures Hierarchy Framework of Michael Porter. The physicians were asked to prioritize outcomes in each domain by their order of importance. The Relative Importance Index (RII) and multivariate binary logistic regression were used to analyze the priorities and to relate them to physicians' characteristics. RESULTS A total of 204 physicians completed the questionnaire accounting for 40% response rate. The top priority outcomes per domain were overall survival (RII 89.4%); quality of life (RII 92.4%); time to treatment (RII 90.8%); incidence of adverse effects (RII 72.9%); need for retreatment (RII 80.5%); and incidence of hospital-acquired infections (RII 89.3%). Regression analysis revealed that physician seniority is a characteristic associated with physicians' perceptions of the importance of measuring health outcomes (highest odds ratio 2.693; 95% CI 1.501-4.833; P = .001). CONCLUSION Establishing a general set of the most important outcomes that applies to all patients, including survival and mortality, quality of life, adverse events, and complications, need to be considered in the early stages of hospitals' transformation to value-based healthcare.
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Affiliation(s)
- Rawia Abdalla
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands.
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Wim Groot
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, The Netherlands; Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, Limburg, The Netherlands
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Muir JM, Radhakrishnan A, Freitag A, Ozer Stillman I, Sarri G. Reconstructing the value puzzle in health technology assessment: a pragmatic review to determine which modelling methods can account for additional value elements. Front Pharmacol 2023; 14:1197259. [PMID: 37521458 PMCID: PMC10372435 DOI: 10.3389/fphar.2023.1197259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Health technology assessment (HTA) has traditionally relied on cost-effectiveness analysis (CEA) as a cornerstone of evaluation of new therapies, assessing the clinical validity and utility, the efficacy, and the cost-effectiveness of new interventions. The current format of cost-effectiveness analysis, however, does not allow for inclusion of more holistic aspects of health and, therefore, value elements for new technologies such as the impact on patients and society beyond its pure clinical and economic value. This study aimed to review the recent modelling attempts to expand the traditional cost-effectiveness analysis approach by incorporating additional elements of value in health technology assessment. A pragmatic literature review was conducted for articles published between 2012 and 2022 reporting cost-effectiveness analysis including value aspects beyond the clinical and cost-effectiveness estimates; searches identified 13 articles that were eligible for inclusion. These expanded modelling approaches mainly focused on integrating the impact of societal values and health equity in cost-effectiveness analysis, both of which were championed as important aspects of health technology assessment that should be incorporated into future technology assessments. The reviewed cost-effectiveness analysis methods included modification of the current cost-effectiveness analysis methodology (distributional cost-effectiveness analysis, augmented cost-effectiveness analysis, extended cost-effectiveness analysis) or the use of multi-criteria decision analysis. Of these approaches, augmented cost-effectiveness analysis appears to have the most potential by expanding traditional aspects of value, as it uses techniques already familiar to health technology assessment agencies but also allows space for incorporation of qualitative aspects of a product's value. This review showcases that methods to unravel additional value elements for technology assessment exist, therefore, patient access to promising technologies can be improved by moving the discussion from "if" to "how" additional value elements can inform decision-making.
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Nardi AE, Sancassiani F, Barrui V, Kalcev G, Uras V, Meloni G, Marongiu L, Tamburini G, Maleci A, Quagliato LA, La Nasa G, Carta MG. The Effects of Tyrosine Kinase Inhibitors (TKIs) in Monotherapy and with Add-on Treatments on Health-related Quality of Life of People with Chronic Myeloid Leukemia: A Systematic Review of Randomized-Controlled Trials. Clin Pract Epidemiol Ment Health 2023; 19:e1745017921112200. [PMID: 38659630 PMCID: PMC11037549 DOI: 10.2174/17450179-v17-e211118-2021-ht2-1910-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/04/2021] [Accepted: 10/01/2021] [Indexed: 04/26/2024]
Abstract
Background The era of establishing tyrosine kinase inhibitors (TKIs) in the treatment of chronic myeloid leukemia (CML) changed the outcome and the course of this life-threatening malignancy. People suffering from CML have now a better prognosis and a longer life expectancy due to the development of TKIs, even if it requires long-term, often lifelong, treatments that are nonetheless associated with improved Health-related Quality of life (HRQoL). However, data on the effects of TKIs on HRQoL are not always systematic; sometimes the data have been obtained by studies different from RCTs, or without a clear definition of what HRQoL is. The main purpose of this systematic review is to summarize all randomized-controlled trials (RCTs) including HRQoL as main or secondary outcome in patients with CML treated with TKIs or with TKIs plus an add-on treatment. Methods A systematic review has been conducted by searching the relevant papers in PubMed/Medline and Web of Science with the following keywords: "quality of life" OR "health-related quality of life" OR "QoL" OR "HRQoL" OR "H-QoL" AND "chronic myeloid leukemia". Interval was set from January 2000 to December 2020. Results 40 papers were identified through the search. Out of them, 7 RCTs were included. All the studies used standardized measures to assess HRQoL, even not always specific for CML. 5 RCTs randomized subjects to 2 or 3 arms to evaluate the effects of TKIs of the first, second and third generation in monotherapy. 2 RCTs randomized subjects to TKI therapy plus an add-on treatment versus TKI therapy as usual. The results of all these trials were examined and discussed. Conclusion All the included RCTs pointed out significant findings regarding the positive effects of TKIs on HRQoL of people with CML, both when they were used in monotherapy or, notably, with an add-on treatment to enhance TKIs effects.
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Affiliation(s)
- Antonio E. Nardi
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Vanessa Barrui
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Goce Kalcev
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Veronica Uras
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giulia Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luigi Marongiu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio Tamburini
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alberto Maleci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laiana A. Quagliato
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Giorgio La Nasa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Kiloatar H, Aras O, Korkmaz M, Vural AH. An evaluation of quality of life, physical activity level and symptoms in patients with early stages of chronic venous disease. JOURNAL OF VASCULAR NURSING 2021; 39:108-113. [PMID: 34865720 DOI: 10.1016/j.jvn.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Chronic venous disease (CVD) is a common, long-term disease that has a variety of symptoms, signs and decreases the patients' quality of life (QoL) of the patients. The aim of this study was to evaluate QoL, symptoms, and physical activity level of CVD patients with early stages (C1 and C2 classes). METHODS The sample of this study composed of 40 patients diagnosed with CVD. The data were collected by face-to-face interview method in the cardiovascular surgery outpatient clinic. Participants were diagnosed with duplex ultrasound (DUS). A personal information form, venous insufficiency epidemiological and economic study-quality of life/symptoms (VEINS-QOL/Sym), and international physical activity questionnaire were used to assess the participants. RESULTS According to DUS results, 23 participants had unilateral CVD, 17 participants had bilateral CVD. Thirty-six of these limbs were stage C2 according to CEAP, twenty one were stage C3. The patients with CVD had low QoL and physical activity level, also moderate pain intensity. Pain, swelling, restless leg, heavy legs, night cramps, and itching were more common symptoms. There was no statistical difference between unilateral/bilateral CVD patients in QoL scores, physical activity level, and pain intensity (p˃0.05). CONCLUSION There was no difference between the extent and severity of the disease and QoL, physical activity level, variety of symptoms. To increase the physical activity level and to evaluate the quality of life may be important for the management of the disease from the early stages of the disease (C1 and C2 classes).
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Affiliation(s)
- Humeyra Kiloatar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Campus of Evliya Celebi, 43100 Kutahya, Turkey.
| | - Ozgen Aras
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Kutahya Health Sciences University, Campus of Evliya Celebi, 43100 Kutahya, Turkey
| | - Mehmet Korkmaz
- Department of Radiology, Faculty of Medicine, Kutahya Health Sciences University, Campus of Evliya Celebi, 43100 Kutahya, Turkey
| | - Ahmet Hakan Vural
- Department of Cardiovasculary Surgery, Gebze Medical Park Hospital, Kocaeli, Turkey
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Lowe JR, Wallace SJ, Sam S, Young A. Minimum data and core outcomes for subacute rehabilitation: A scoping review. Clin Rehabil 2021; 36:388-406. [PMID: 34873966 DOI: 10.1177/02692155211060468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In clinical practice and research, standardised sets of data and outcomes are routinely collected to facilitate data comparison, benchmarking and quality improvement. Most existing data sets are condition-specific and cannot be applied to all patients in a given clinical setting. This review aimed to determine whether the development of a minimum data set for subacute rehabilitation is feasible by collating and comparing existing rehabilitation minimum data sets and core outcome sets. DATA SOURCES Published literature was identified through database searches (Scopus, PubMed, EMBASE, CINAHL and the COMET Initiative) in September 2021. Additional data sets were identified through a grey literature search. REVIEW METHODS This review was conducted in alignment with the PRISMA-ScR recommendations. Datasets were included if they were published in English, designed for adults, and intended for use in subacute rehabilitation. Data were extracted and taxonomically organised to identify commonalities. Items present in ≥50% of data sets were considered common. RESULTS Twenty minimum data sets and seven core outcome sets were included. There were 29 common minimum data set domains, with 19 relating to Patient Information, seven relating to Outcomes, two relating to Service Delivery and one relating to Provider Demographics. Four common domains were identified within the Core Outcome Set analysis, which all related to Life Impact, specifically Physical Functioning (86%), Emotional Functioning/Wellbeing (57%), Social Functioning (86%) and Global Quality of Life (100%). CONCLUSION Common item domains in conditions requiring subacute rehabilitation have been identified, suggesting that development of a dataset for subacute rehabilitation may be feasible.
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Affiliation(s)
| | - Sarah J Wallace
- 1974The University of Queensland, Australia.,Queensland Aphasia Research Centre, Australia
| | - Sonia Sam
- 3883Royal Brisbane and Women's Hospital, Australia
| | - Adrienne Young
- 1974The University of Queensland, Australia.,3883Royal Brisbane and Women's Hospital, Australia
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Landon SN, Padikkala J, Horwitz LI. Defining value in health care: a scoping review of the literature. Int J Qual Health Care 2021; 33:6426034. [PMID: 34788819 DOI: 10.1093/intqhc/mzab140] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/31/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND As health-care spending rises internationally, policymakers have increasingly begun to look to improve health-care value. However, the precise definition of health-care value remains ambiguous. METHODS We conducted a scoping review of the literature to understand how value has been defined in the context of health care. We searched PubMed, Embase, Google Scholar, PolicyFile and Scopus between February and March 2020 to identify articles eligible for inclusion. Publications that defined value (including high or low value) using an element of cost and an element of outcomes were included in this review. No restrictions were placed on the date of publication. Articles were limited to those published in English. RESULTS Out of 1750 publications screened, 46 met inclusion criteria. Among the 46 included articles, 22 focused on overall value, 19 on low value and 5 on high value. We developed a framework to categorize definitions based on three core domains: components, perspective and scope. Differences across these three domains contributed to significant variations in definitions of value. CONCLUSIONS How value is defined has the potential to influence measurement and intervention strategies in meaningful ways. To effectively improve value in health-care systems, we must understand what is meant by value and the merits of different definitions.
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Affiliation(s)
- Susan N Landon
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 E 30th St, Room 633, New York, NY 10016, USA
| | - Jane Padikkala
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 E 30th St, Room 633, New York, NY 10016, USA
| | - Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, 227 E 30th St, Room 633, New York, NY 10016, USA.,Center for Healthcare Innovation and Delivery Science, NYU Langone Health, 550 1st Avenue, New York, NY 10016, USA.,Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, 550 1st Avenue, New York, NY 10016, USA
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Montanari Vergallo G, Varone MC, Del Rio A. COVID-19: when health care resources run short, how to pick who should (not) get treated? ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021372. [PMID: 34487065 PMCID: PMC8477128 DOI: 10.23750/abm.v92i4.11696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
Introduction: Almost a year and a half after its appearance, Covid-19 continues to make painful triage choices necessary in granting access intensive care. Objective: the article aims to illustrate the difference between the utilitarian-collectivist approach and the deontologic approach, which inspired the guidelines drawn up in Italy in 2021 by SIAARTI in collaboration with SIMLA. Materials and methods: the article draws upon international scientific sources and documents from ethics committees and scientific societies on triage for Covid-19 patients in intensive care. Results: only medical parameters should be evaluated to establish the prognosis through which to identify the patients to be treated as a priority. If non-medical standards are taken into account, such as patient age, discrimination is likely to arise, and the patient’s interest is somehow subordinated to that of the community. Discussion: it is not part of the doctor’s duty to exclude patients from intensive care in order to grant access to treatment to those most likely to survive. Guaranteeing treatment availability for as many patients as possible is the duty of national and local health policy managers, and cannot be deemed to be the doctors’ responsibility. Conclusion: moral judgment cannot concern only the choices of doctors. According to the principle of beneficence, hospital directors and national and local health policy managers must also take action, in particular to eliminate waste of economic resources so as to allocate more of them to health protection, especially in consideration of the predictability with which infection rates increase, and in light of the fact that immunization through vaccination is only temporary. (www.actabiomedica.it)
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Affiliation(s)
- Gianluca Montanari Vergallo
- Department of Anatomical, Histological, Medico-Legal and Orthopaedic Sciences, "Sapienza" University of Rome.
| | - Maria Cristina Varone
- Department of Anatomical, Histological, Medico-Legal and Orthopaedic Sciences, "Sapienza" University of Rome.
| | - Alessandro Del Rio
- Department of Anatomical, Histological, Medico-Legal and Orthopaedic Sciences, "Sapienza" University of Rome.
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Grande RAN, Butcon VER, Indonto MCL, Villacorte LM, Berdida DJE. Quality of life of nursing internship students in Saudi Arabia during the COVID-19 pandemic: A cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021; 14:100301. [PMID: 33824852 PMCID: PMC8015389 DOI: 10.1016/j.ijans.2021.100301] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/05/2021] [Accepted: 03/17/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic caused an unprecedented negative impact on the usual way of life. The fight against this fatal virus demands the united force of healthcare workers, including nurse interns (NIs). Therefore, being unprepared for a crisis of this magnitude which never happened in a century, nurses and NIs experience stress, trauma, and mental health issues that affect their quality of life (QoL). OBJECTIVES This study inquired the demographic of the NIs, the responses of the participants to the domains of Quality of Life Evaluation Scale (QOLES), and the relationship between the participants' responses to the scale to each of their demographic profiles. METHODS This study used a quantitative cross-sectional design through an electronic survey form in the collection of data. Utilizing total enumeration as sampling technique, 152 NIs in Saudi Arabia completed the survey. RESULTS Across the 22-item questionnaire, the NIs still feel safe being in the hospital, clinic, or other healthcare facilities with a mean of 3.32; while item 8, which is having abundant energy, had the lowest mean of 1.91. The overall mean is 2.61, interpreted as 'important,' signifying that the participants 'agree to some extent.' CONCLUSION The QoL of the NIs focused more on their psychological wellbeing and social relationships while the environmental and physical domains had lesser emphasis. In terms of enhancing specificity, comprehensiveness, and generalizability of future studies in QoL, a larger sample and more rigorous design is recommended.
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