异丙托溴铵联合布地奈德混悬液雾化吸入治疗上呼吸感染后慢性咳嗽的临床疗效

目的探讨异丙托溴铵联合布地奈德混悬液雾化吸入治疗上呼吸感染后慢性咳嗽的临床疗效。方法将我院就诊的162例上呼吸感染后慢性咳嗽患者进行随机分组,对照组患者雾化吸入盐酸氨溴索注射液治疗,试验组患者采用复方异丙托溴铵联合布地奈德混悬液治疗,对两组患者的疗效进行评价。结果试验组患者总有效率和显效率明显高于对照组,差异有统计学意义(P<0.05)。结论异丙托溴铵联合布地奈德混悬液雾化吸入治疗上呼吸感染后慢性咳嗽疗效确切,具有较好的安全性和可靠性。     

当前腹腔感染诊治的难题与对策分析

腹腔感染是临床治疗中的常见问题,发病率正在逐年升高.对于腹腔感染处理的重要性是不言而喻的,其关键 措施主要包括了复苏、控制和切断感染源以及进行抗感染治疗等.本文着重阐述了当前临床治疗过程中腹腔感染的诊治 所存在的基本问题,介绍了做好腹腔感染诊治的基本对策,对临床治疗过程中方案选择的基本原则和药物使用的基本规 范做出了一定的说明.     

慢性高眼压动物模型视网膜中睫状神经生长因子及其受体的表达

目的观察慢性高眼压动物模型视网膜中CNTF及CNTFRα的定位及表达变化。方法选取健康新西兰大白兔为实验对象建立兔慢性高眼压模型。选取造模成功的24只(48眼)兔慢性高眼压眼,随机分为4组慢性高眼压模型组,每组6只(12眼),分别存活7、14、21、28d。另设正常兔6只(12眼)为假手术对照组(简称对照组)。免疫组织化学染色方法测定兔视网膜中CNTF及CNTFRα的定位及表达变化。结果在对照组中,RGCs层均有大量的CNTF及CNTFα存在,在其它各层也存在散在颗粒状分布的CNTF及CNTFRα。慢性高眼压损伤后,CNTF及CNTFRα在视网膜各层显著增加,并呈弥漫性分布,造模后7、14d与正常对照组比较相差非常显著(P<0.01)。在造模后7d,是CNTF及CNTFRα在视网膜各层表达的高峰,在造模后28d两者的表达均显著高于正常对照组(CNTF:P<0.05;CNTFR:P<0.05)。结论慢性高眼压损伤导致视网膜CNTF和CNTFRα表达量的增加和分布的改变。     

US budget impact of increased payer adoption of the Flexitouch advanced pneumatic compression device in lymphedema patients with advanced chronic venous insufficiency and multiple infections

Aims: To assess the budget impact to a US commercial health plan of providing access to the Flexitouch (FLX) advanced pneumatic compression device (Tactile Medical) to lymphedema (LE) patients with either comorbid chronic venous insufficiency (CVI) or frequent infections.

Methods: Budget impact was calculated over 2 years for a hypothetical US payer with 10-million commercial members. Model inputs were derived from published sources and from a case-matched analysis of Blue Health Intelligence (BHI) claims data for the years 2012–2016. To calculate the budget impact, the Status Quo budget (i.e. total cost for LE and sequelae-related medical treatment) was compared to the budget under each of three Alternate Payer Policy scenarios which assumed that a sub-set of patients was redistributed from their initial treatment groups to a group that received FLX. Model outputs included cumulative payer costs, net budget impact, and breakeven point. Sensitivity analyses were performed to assess the impact of model inputs on results.

Results: Increasing access to FLX yielded a favorable budget impact in every scenario. For LE patients with comorbid CVI, the three alternate scenarios resulted in cumulative 2-year budget impacts of –$52,841, –$173,317, and –$375,601, respectively. For LE patients with comorbid frequent infections, the three alternate scenarios resulted in cumulative 2-year budget impacts of –$192,729, –$259,339, and –$613,179, respectively.

Limitations: Use of claims data assumes accurate coding and does not allow one to control for disease severity or treatment adherence. Also, the distribution of patients between treatment arms was determined using claims data from a specific payer organization, and could differ for health plans with different coverage policies.

Conclusions: While previous studies have illustrated cost savings with adoption of FLX, US commercial health plans may also achieve tangible cost savings by expanding access to FLX for LE patients with comorbid CVI and multiple infections.     

Cost-effectiveness of TYRX absorbable antibacterial envelope for prevention of cardiovascular implantable electronic device infection

Aims: Infection is a major complication of cardiovascular implantable electronic device (CIED) therapy that usually requires device extraction and is associated with increased morbidity and mortality. The TYRX Antibacterial Envelope is a polypropylene mesh that stabilizes the CIED and elutes minocycline and rifampin to reduce the risk of post-operative infection.

Methods: A decision tree was developed to assess the cost-effectiveness of TYRX vs standard of care (SOC) following implantation of four CIED device types. The model was parameterized for a UK National Health Service perspective. Probabilities were derived from the literature. Resource use included drug acquisition and administration, hospitalization, adverse events, device extraction, and replacement. Incremental cost-effectiveness ratios (ICERs) were calculated from costs and quality-adjusted life-years (QALYs).

Results: Over a 12-month time horizon, TYRX was less costly and more effective than SOC when utilized in patients with an ICD or CRT-D. TYRX was associated with ICERs of £46,548 and £21,768 per QALY gained in patients with an IPG or CRT-P, respectively. TYRX was cost-effective at a £30,000 threshold at baseline probabilities of infection exceeding 1.65% (CRT-D), 1.95% (CRT-P), 1.87% (IPG), and 1.38% (ICD).

Limitations and conclusions: Device-specific infection rates for high-risk patients were not available in the literature and not used in this analysis, potentially under-estimating the impact of TYRX in certain devices. Nevertheless, TYRX is associated with a reduction in post-operative infection risk relative to SOC, resulting in reduced healthcare resource utilization at an initial cost. The ICERs are below the accepted willingness-to-pay thresholds used by UK decision-makers. TYRX, therefore, represents a cost-effective prevention option for CIED patients at high-risk of post-operative infection.     

海南中老年亚健康状况及其饮食行为调查研究

目的:调查海南中老年亚健康状况及饮食行为,提出合理的建议。方法:采用横断面调查法,对2018年12月至2020年5月海南某地区1000名中老年群体的健康状况进行调查,提出合理的建议。结果:中老年群体中高血压占比最高20.3%;其次为高血脂;BMI 24.0~27.9 kg·m^-2占比64.5%;海南中老年人饮食行为评分中,15~19分人数最多,共计401例,占比40.1%。结论:海南大部分中老年群体处于亚健康状态,需加强其对自身健康状况的关注程度。     

Economic evaluations in migraine: systematic literature review and a novel approach

Abstract

Background: For novel migraine therapies, economic evaluations will be required to understand the trade-offs between additional health benefit and additional cost. The purpose of this study was to conduct a systematic literature review (SLR) to identify previous economic evaluations in migraine from the United Kingdom or Irish perspective to critically appraise these evaluations and to propose, if necessary, a novel modelling approach that can be used for future economic evaluations of migraine therapies.

Methods: An SLR was conducted to identify previous economic evaluations of preventive migraine treatments. Key opinion leaders were consulted to determine the criteria for a robust migraine economic evaluation. Economic evaluations identified in the SLR were appraised against these criteria, and a novel cost-effectiveness model structure was then proposed.

Results: Eight records reporting on published economic evaluations were identified and critically appraised for general quality. Expert consultation provided 6 recommendations on the ideal model structure for migraine that is both clinically and economically meaningful. A decision-tree plus Markov structure was then developed as a cost-effectiveness model for migraine therapies where each health state is associated with a patient distribution across monthly migraine day (MMD) frequencies.

Conclusions: Future migraine economic evaluations should allow for assessments across the full spectrum of migraine, a response-based stopping rule, and the estimation of benefits and resource costs based on MMD frequency. The approach proposed in this paper captures all of the desired elements for an economic evaluation of migraine therapy and is suitable to assess new migraine therapies.     

从全球视角分析在新冠肺炎疫情下如何保障食物和营养安全

流行性传染病的爆发往往伴随着食物与营养安全的风险。本文首先从全球视角回顾流行性传染病爆发对食物与营养安全的经验与教训,其次分析新冠肺炎疫情对中国食物和营养安全的潜在冲击,最后对如何在防范新冠肺炎疫情下保障中国和全球居民的食物和营养安全提出政策建议。本文分析指出,短期内中国食物与营养相对安全,但需要警惕疫情对中长期食物安全的影响。鉴于新冠肺炎疫情传播呈现全球化趋势,为防范全球食物和营养安全的系统性风险,需要加强全球合作,采取包括保障食物供应链畅通、保持贸易开放、减少对农业生产的冲击及关注贫困人口等综合应对措施。