A Predictive Model of Chronic Time Pressure in the Australian Population: Implications for Leisure Research

Time pressure is a perception of being rushed or pressed for time. In its most extreme form, time pressure has implications for leisure, health and wellbeing. Although previous findings from the Australian Bureau of Statistics (ABS) show that time pressure affects large numbers of Australians (ABS, 1998 Australian Bureau of Statistics. 1998. How Australians use their time, Canberra: Australian Bureau of Statistics. Catalogue No. 4153.0 [Google Scholar]; Bittman, 1998 Bittman, M. 1998. The land of the lost long weekend: Trends in free time among working age Australians. SPRC Discussion Paper, 83 [Google Scholar]), no research has addressed chronic time pressure (ie. always feeling time pressured). This study aims to use selected demographic variables to develop a model to predict chronic time pressure in the Australian population. The implications of chronic time pressure for leisure research are also discussed.     

基于PLC的汽车输送主副线速同步控制系统的设计

本文基于PLC、变频器、编码器组成汽车输送主、副线主从控制的双闭环随动控制系统,采用主输送线的实际运行速度作为副输送线的设定值,实现汽车输送主副线的传动速度同步、高精度稳速控制;该系统可有效抑制外部干扰,消除速度偏差,稳定程度高;实际应用效果达到设计要求。     

Economic burden of comorbid chronic kidney disease and diabetes

Objective: To estimate real-world healthcare utilization and expenditures across the spectrum of chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) categories in patients with diabetes.

Methods: This study employed a retrospective cohort study design using the Truven Healthcare and Claims Dataset from 2009–2012. Index date was defined as the first eGFR value during a continuous enrollment period of 24 months. Cohorts of patients were stratified by Kidney Disease: Improving Global Outcomes CKD stage based on eGFR (stages 1: ≥90?mL/min/1.73?m²; 2: 60–89; 3A: 45–59; 3B: 30–44; 4: 15–29; 5: <15). Healthcare expenditures (total patient and payer paid claims) and utilization (number of claims or visits) were estimated 12-months post-index date using generalized linear modeling and negative binomial modeling, respectively, after adjusting for baseline characteristics.

Results: Of 130,098 patients with an index eGFR value and 24-months continuous enrolment, 64,521 (49.59%) were in stage 1 CKD, 47,816 (36.75%) were in stage 2, 13,377 (10.28%) were in stage 3A, 3,217 (2.47%) were in stage 3B, 898 (0.69%) were in stage 4, and 269 (0.21%) were in stage 5. Patients in stages 3A, 3B, and 4 CKD had 1.32 (95% CI?=?1.22–1.43), 1.59 (95% CI?=?1.41–1.80), and 2.65 (95% CI?=?2.23–3.14) times higher rates of diabetes-associated inpatient visits, respectively, compared with stage 1 CKD patients. Patients in stages 3A, 3B, and 4 CKD had increased incremental total annual healthcare expenditures of $1,732 (95% CI?=?$1,109–$2,356), $2,632 (95% CI?=?$1,647–$3,619), and $6,949 (95% CI?=?$5,466–$8,432), respectively, compared with stage 1 CKD patients.

Limitations: The claims data were generated for billing and reimbursement, not for research purposes.

Conclusions: These real-world data suggest an incremental and significant increase in economic burden in diabetes as kidney function declines, starting with moderate (stage 3A) CKD.     

重症监护室中中央静脉导管对血液感染的影响

目的探讨与中央静脉导管相关的血液感染的风险因素,尤其是护工和抗菌浸渍因素的影响,这对有效确立预防措施至关重要。方法在两年期间,有预见性地监测重症监护室中抗菌浸渍、护工以及成年患者中中央静脉导管相关的血液感染的变量因素。结果在210例患者中,中中央静脉导管相关的血液感染的案例被确认的共计32例。只有在中央静脉导管被用于管理全肠外营养的患者中,抗菌浸渍中央静脉导管才降低了与中央静脉导管相关的血液感染风险。而没有接受全肠外营养管理的患者,其受与中央静脉导管相关的血液感染风险增加了。结论抗菌浸渍中央静脉导管在接受全肠外营养管理的患者中,其与中央静脉导管相关的血液感染的风险降低了66%。限制采用倒班护工对在使用中央静脉导管患者进行护理、使用外周静脉置入的中央静脉导管都能降低与中央静脉导管相关的血液感染的风险。     

喜炎平注射液联合抗菌药物治疗小儿急性上呼吸道感染患儿的疗效

目的 探讨喜炎平注射液联合抗菌药物治疗小儿急性上呼吸道感染患儿的疗效.方法 选取2019年7月至2020年9月沈阳市儿童医院收治的160例小儿急性上呼吸道感染患儿作为研究对象,随机分为联合组与抗菌药物组,各80例.抗菌药物组仅用抗菌药物治疗,联合组实施喜炎平注射液联合抗菌药物治疗,比较两组的治疗效果.结果 治疗后,两组...     

Cost effectiveness of posaconazole in the prophylaxis of invasive fungal infections in acute leukaemia patients for the French healthcare system

Abstract

Background:

Acute myeloblastic leukaemia (AML) patients are at high risk of suffering from invasive fungal infections (IFI). Posaconazole demonstrated higher efficacy than standard azole agents (SAA) in the prophylaxis of IFI in this population.

The authors estimated the cost effectiveness of posaconazole versus SAA in France.

Methods:

A decision-tree model was developed to compare posaconazole with SAA with the results of a published clinical trial. Clinical events were modelled with chance nodes reflecting probabilities of IFI, IFI-related death, and death from other causes. Medical resource consumption and costs were obtained from results of the clinical trial and from a dedicated survey on the costs of treating IFI using a retrospective chart review design.

Results:

IFI treatment costs were estimated using medical files from 50 AML patients from six French centres, with a proven and probable IFI, who had been followed-up for 298 days on average. Direct costs directly related to IFI were estimated at €51,033, including extra costs of index hospitalisation, costs of antifungal therapy and additional hospitalisations related to IFI treatment. The model indicated that the healthcare costs for the posaconazole strategy were €5,223 (€2,697 for prophylaxis and €2,526 for IFI management), which was €859 less than the €6,083 in costs with SAA (€469 for prophylaxis and €5614 for IFI management). A sensitivity analysis indicated that there was an 80% probability that prophylaxis using the posaconazole strategy would be superior.

Conclusion:

The findings from this analysis suggest that posaconazole use is a clinically and economically dominant strategy in the prophylaxis of IFI in AML patients, given the usual limits of economic models and the uncertainty of costs estimates.     

高剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌肺部感染合并低蛋白血症患者的临床疗效

目的 探讨高剂量替考拉宁治疗耐甲氧西林金黄色葡萄球菌(MRSA)肺部感染合并低蛋白血症患者的临床疗效和安全性.方法 选取2018年6月至2019年6月台州市立医院收治的61例MRSA肺部感染合并低蛋白血症住院患者作为研究对象,随机分为对照组(31例)与试验组(30例).对照组给予替考拉宁注射液负荷剂量6 mg/kg,每...     

Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review

Abstract

Aims: The overall cost and health-related quality of life (HRQoL) associated with current treatments for chronic kidney disease (CKD)-related anemia are not well characterized. A systematic literature review (SLR) was conducted on the costs and HRQoL associated with current treatments for CKD-related anemia among dialysis-dependent (DD) patients.

Materials and methods: The authors searched the Cochrane Library, MEDLINE, EMBASE, NHS EED, and NHS HTA for English-language publications. Original studies published between January 1, 2000 and March 17, 2017 meeting the following criteria were included: adult population; study focus was CKD-related anemia; included results on patients receiving iron supplementation, red blood cell transfusion, or erythropoiesis stimulating agents (ESAs); reported results on HRQoL and/or costs. Studies which included patients with DD-CKD, did not directly compare different treatments, and had designs relevant to the objective were retained. HRQoL and cost outcomes, including healthcare resource utilization (HRU), were extracted and summarized in a narrative synthesis.

Results: A total of 1,625 publications were retrieved, 15 of which met all inclusion criteria. All identified studies included ESAs as a treatment of interest. Two randomized controlled trials reported that ESA treatment improves HRQoL relative to placebo. Across eight studies comparing HRQoL of patients achieving high vs low hemoglobin (Hb) targets, aiming for higher Hb targets with ESAs generally led to modest HRQoL improvements. Two studies reported that ESA-treated patients had lower costs and HRU compared to untreated patients. One study found that aiming for higher vs lower Hb targets led to reduced HRU, while two other reported that this led to a reduction in cost-effectiveness.

Limitations: Heterogeneity of study designs and outcomes; a meta-analysis could not be performed.

Conclusions: ESA-treated patients undergoing dialysis incurred lower costs, lower HRU, and had better HRQoL relative to ESA-untreated patients. However, treatment to higher Hb targets led to modest HRQoL improvements compared to lower Hb targets.