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12小时1次(前3剂),维持剂量6 mg/kg q24 h治疗,试验组给予负荷剂量12 mg/kg,每12小时1次(前3剂),维持剂量12 mg/kg,每24小时1次治疗,比较两组患者替考拉宁血药谷浓度(Cmin)及达标率、临床疗效、疗效指标及药物不良反应发生情况。结果试验组患者替考拉宁血药Cmin水平及达标率、临床治愈率高于对照组(P<0.05);试验组治愈患者体温恢复时间、白细胞计数(WBC)恢复时间、C反应蛋白(CRP)恢复时间、住院时间优于对照组(P<0.05),咳嗽咳痰消失时间与对照组比较,差异无统计学意义(P>0.05);两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论对MRSA肺部感染合并低蛋白血症患者提高替考拉宁给药剂量临床疗效显著,能够提高血药浓度,加速临床症状缓解,且不增加不良反应发生。     

A case-control comparison of direct healthcare-provider medical costs of chronic idiopathic constipation and irritable bowel syndrome with constipation in a community-based cohort

Objective: Patients with constipation account for 3.1 million US physician visits a year, but care costs for patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) compared to the general public have received little study. The study aim was to describe healthcare utilization and compare medical costs for patients with IBS-C or CIC vs matched controls from a community-based sample.

Methods: A nested case-control sample (IBS-C and CIC cases) and matched controls (1:2) for each case group were selected from Olmsted County, MN, individuals responding to a community-based survey of gastrointestinal symptoms (2008) who received healthcare from a participating Rochester Epidemiology Project (REP) provider. Using REP healthcare utilization data, unadjusted and adjusted standardized costs were compared for the 2- and 10-year periods prior to the survey for 115 IBS-C patients and 230 controls and 365 CIC patients and 730 controls. Two time periods were chosen as these conditions are episodic, but long-term.

Results: Outpatient costs for IBS-C ($6,800) and CIC ($6,284) patients over a 2-year period prior to the survey were significantly higher than controls ($4,242 and $5,254, respectively) after adjusting for co-morbidities, age, and sex. IBS-C outpatient costs ($25,448) and emergency room costs ($6,892) were significantly higher than controls ($21,024 and $3,962, respectively) for the 10-year period prior. Unadjusted data analyses of cases compared to controls demonstrated significantly higher imaging costs for IBS-C cases and procedure costs for CIC cases over the 10-year period.

Limitations: Data were collected from a random community sample primarily receiving care from a limited number of providers in that area.

Conclusions: Patients with IBS-C and CIC had significantly higher outpatient costs for the 2-year period compared with controls. IBS-C patients also had higher ER costs than the general population.     

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.     

Cost-effectiveness analysis of implementing an antimicrobial stewardship program in critical care units

Aims: To evaluate the cost-effectiveness of antimicrobial stewardship (AS) program implementation focused on critical care units based on assumptions for the Spanish setting.

Materials and methods: A decision model comparing costs and outcomes of sepsis, community-acquired pneumonia, and nosocomial infections (including catheter-related bacteremia, urinary tract infection, and ventilator-associated pneumonia) in critical care units with or without an AS was designed. Model variables and costs, along with their distributions, were obtained from the literature. The study was performed from the Spanish National Health System (NHS) perspective, including only direct costs. The Incremental Cost-Effectiveness Ratio (ICER) was analysed regarding the ability of the program to reduce multi-drug resistant bacteria. Uncertainty in ICERs was evaluated with probabilistic sensitivity analyses.

Results: In the short-term, implementing an AS reduces the consumption of antimicrobials with a net benefit of €71,738. In the long-term, the maintenance of the program involves an additional cost to the system of €107,569. Cost per avoided resistance was €7,342, and cost-per-life-years gained (LYG) was €9,788. Results from the probabilistic sensitivity analysis showed that there was a more than 90% likelihood that an AS would be cost-effective at a level of €8,000 per LYG.

Limitations: Wide variability of economic results obtained from the implementation of this type of AS program and short information on their impact on patient evolution and any resistance avoided.

Conclusions: Implementing an AS focusing on critical care patients is a long-term cost-effective tool. Implementation costs are amortized by reducing antimicrobial consumption to prevent infection by multidrug-resistant pathogens.     

医疗保险是否改善了老年人的慢性病医疗状况? ——基于CHARLS数据的实证分析

本文基于中国健康与养老追踪调查(CHARLS)数据,利用Heckman样本选择模型、二阶段最小二乘模型(2SLS)等方法,在高血压、糖尿病等慢性病纳入医保门诊报销的背景下,实证检验了医疗保险对我国城乡老年人慢性病医疗状况的影响.研究发现:(1)医疗保险显著增加了老年人慢性病的门诊和住院医疗费用,且城市和男性老年人的支出明显高于农村和女性老年人,但医疗保险对老年人慢性病住院医疗支出增长的影响呈减弱趋势;(2)医疗保险显著提高了老年人慢性病医疗服务利用率,增加了老年人及时就医的概率;(3)医疗保险显著降低了老年人慢性病的自付比例,减轻了老年人的医疗负担.     

两种基因类型的丙肝传染病混合模型的动力学分析

鉴于中国丙肝患者中所含基因类型主要分为2种,且在临床上有急性和慢性之分,为了更好的研究基因类型对丙肝的影响,针对急性和慢性2种基因类型丙肝进行生物数学建模,分析讨论其相应平衡态的存在性及稳定性。结果表明,基本再生数较大的丙肝会长期存在,而基本再生数较小的丙肝会逐渐消亡,当且仅当基本再生数相等时,2种基因类型的丙肝才可能共存。数值模拟分析验证了该结果的正确性。因此,对不同基因类型的患者进行分类治疗是必要的。     

“When Life Gives You Lemons”: Using Cross-Sectional Surveys to Identify Chronic Poverty in the Absence of Panel Data

At the core of poverty eradication is the need to eliminate that poverty that is persistent over time (chronic poverty). Unfortunately, traditional approaches to identifying chronic poverty require longitudinal data that is rarely available. In its absence, this paper proposes an alternative approach that only requires 1 year of cross-sectional data on monetary and non-monetary poverty. It puts forth two conjectures and contends that the combined profile of a household as both income poor and multidimensionally poor can be used as a proxy of that household being chronically income poor. To explore the viability of this approach, we use a probit model and longitudinal data for three Latin American countries to estimate households’ probabilities of remaining in income poverty based on their past income and multidimensional poverty statuses. We find empirical support for the approach that is significant, consistent across countries, and robust to various controls and periods of analysis.     

具有交叉感染的2种菌株对逼近模型分析

为了研究具有一般接触率和用于治疗的SIS对逼近模型及其动力学性质,针对2种菌株是否可以独立生存,建立了一个在规则网络上2种菌株有交叉感染的SIS对逼近传染病模型。根据二项分布,利用节点的状态相关系数得到一个12维系统,计算出模型的基本再生数,得出无病平衡点的局部稳定性,进而获得了无病平衡点不稳定的阀值。通过理论分析和数值模拟得出模型的无病平衡点无条件存在,即不稳定。在研究了2种菌株独立存在以及共同生存的条件后,可以看出2种菌株可以独立生存,也可以相互感染。高维(12维)系统的引入,使得对逼近模型既能模拟疾病的传播机制又能捕捉到疾病传播所在种群的网络结构,因此将对逼近模型应用到多菌株疾病的传播中具有一定价值。