柴胡舒肝散和乌及散治疗胆汁反流性胃炎肝胃不和患者的临床疗效

目的：探究柴胡舒肝散和乌及散治疗胆汁反流性胃炎肝胃不和患者的临床疗效。方法收集河北平泉县中医院2006年4月至2012年12月收治的96例胆汁反流性胃炎肝胃不和患者的临床资料,按随机数字表法将患者分为观察组与对照组,各48例。对照组患者给予多潘立酮和奥美拉唑胶囊治疗,观察组患者采用柴胡疏肝散和乌及散治疗,比较两组患者的临床疗效。结果观察组患者临床治疗的总有效率明显高于对照组,差异有统计学意义（P＜0.05）。结论柴胡舒肝散和乌及散治疗胆汁反流性胃炎肝胃不和型患者的临床疗效明显。     

高胆固醇饮食对昆明小鼠血清总胆固醇的影响

目的检测高胆固醇饮食对小鼠血脂水平的影响。方法采用高胆固醇饲料饲养KM小鼠3个月,第0、1、2、3月尾静脉取血,常规检测血清总胆固醇水平变化。结论:成功建立高胆固醇小鼠模型,在高胆固醇饮食条件下,KM小鼠总胆固醇水平升高(p<0.05),并与时间呈正相关。     

Bias-corrected estimates of reduction of post-surgery length of stay and corresponding cost savings through the widespread national implementation of fast-tracking after liver transplantation: a quasi-experimental study

Background: Fast-tracking is an approach adopted by Mayo Clinic in Florida’s (MCF) liver transplant (LT) program, which consists of early tracheal extubation and transfer of patients to surgical ward, eliminating a stay in the intensive care unit in select patients. Since adopting this approach in 2002, MCF has successfully fast-tracked 54.3% of patients undergoing LT.

Objectives: This study evaluated the reduction in post-operative length of stay (LOS) that resulted from the fast-tracking protocol and assessed the potential cost saving in the case of nationwide implementation.

Methods: A propensity score for fast-tracking was generated based on MCF liver transplant databases during 2011–2013. Various propensity score matching algorithms were used to form control groups from the United Network of Organ Sharing Standard Analysis and Research (STAR) file that had comparable demographic characteristics and health status to the treatment group identified in MCF. Multiple regression and matching estimators were employed for evaluation of the post-surgery LOS. The algorithm generated from the analysis was also applied to the STAR data to determine the proportion of patients in the US who could potentially be candidates for fast-tracking, and the potential savings.

Results: The effect of the fast-tracking on the post-transplant LOS was estimated at approximately from 2.5 (p-value?=?0.001) to 3.2 (p-value?liver transplant patients was estimated to be at least $78 million during the 2-year period.

Conclusion: The fast-track program was found to be effective in reducing post-transplant LOS, although the reduction appeared to be less than previously reported. Nationwide implementation of fast-tracking could result in substantial cost savings without compromising the patient outcome.     

健脾调肝法治疗2型糖尿病胃肠功能紊乱患者的临床价值

目的探讨常规西药联合健脾调肝法治疗2型糖尿病胃肠功能紊乱患者的临床价值。方法选取2019年3月至2021年1月盘锦市人民医院收治的102例2型糖尿病胃肠功能紊乱患者作为研究对象,按随机数字表法分为对照组与观察组,各51例。对照组患者单纯接受常规西药治疗,观察组患者在对照组基础上接受健脾调肝法(应用以葛根、党参、茯苓、炒白术、当归、鸡内金等中药组成的健脾理气疏肝方)治疗,比较两组治疗有效率、空腹血糖(FBG)、餐后2h血糖(2h PBG)以及糖化血红蛋白(Hb A1c)、胃排空率、肠鸣音。结果观察组治疗有效率高于对照组,差异有统计学意义(P<0.05);治疗后,观察组患者FBG、2h PBG、Hb A1c水平低于对照组,差异有统计学意义(P<0.05);治疗后,观察组胃排空率、肠鸣音高于对照组,差异有统计学意义(P<0.05)。结论健脾调肝法治疗2型糖尿病胃肠功能紊乱疗效显著,应用价值较高。     

Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

Aims: This study aimed to estimate the cost of platelet transfusion in patients with chronic liver disease (CLD)-associated thrombocytopenia undergoing an elective procedure in the United States.

Materials and methods: The study was conducted in two parts: development of a conceptual framework identifying direct, indirect and intangible costs of platelet transfusion, followed by the estimation of the total cost of platelet transfusion in patients with CLD-associated thrombocytopenia before an elective procedure in the United States using the conceptual framework and cost data obtained from a literature search. The cost of the entire care required to raise a patient’s platelet count before the procedure was considered.

Results: The final conceptual framework included the costs of generating the supply of platelets, the platelet transfusion itself, adverse events associated with platelet transfusion and refractoriness to platelet transfusion. When costs were accounted for in all the framework cost categories, the total direct cost of a platelet transfusion in a patient with CLD and associated thrombocytopenia was estimated to be in the range of $5258 to $13,117 (2017?US dollars) in the United States. The largest portion of costs was incurred by the transfusion event itself ($3723 to $4436) and the cost of refractoriness ($874 to $7578), which included the opportunity cost of a delayed procedure and subsequent platelet transfusions with human leukocyte antigen-matched platelets.

Limitations and conclusions: Although we were unable to include all cost components identified in the conceptual framework in our total cost estimate, thus likely underestimating the true total cost, and despite the data gaps and challenges limiting our estimate of the full cost of a platelet transfusion in patients with CLD-associated thrombocytopenia undergoing an elective procedure in the United States, this study outlines a comprehensive conceptual framework for estimating the cost elements of a platelet transfusion in these patients.     

还原型谷胱甘肽联合多烯磷脂酰胆碱治疗急性药物性肝损伤的临床疗效

目的：探讨还原型谷胱甘肽联合多烯磷脂酰胆碱治疗急性药物性肝损伤的临床疗效。方法随机抽取2012年4月至2014年4月本院接诊的110例急性药物性肝损伤患者作为研究对象,按照随机数字表法将其分为两组,对照组患者予以多烯磷脂酰胆碱治疗,观察组患者在其基础上加用还原型谷胱甘肽治疗,4周后比较两组患者的肝功能指标天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、血清总胆红素（TBiL）的变化及临床疗效。结果治疗后,观察组患者总有效率高于对照组,组间比较差异有统计学意义（P＜0.05）;观察组各项肝功能指标低于对照组,治疗期间两组患者耐受性较好,均未发生明显不良反应。结论还原型谷胱甘肽联合多烯磷脂酰胆碱治疗急性药物性肝损害疗效明显,可有效改善患者的肝功能水平,且患者耐受性良好。     

Evaluating medical resource utilization and costs associated with thrombocytopenia in chronic liver disease patients

Abstract

Objective:

Thrombocytopenia (TCP), defined as platelet counts <150,000/µL, is a common complication of severe chronic liver disease (CLD). This retrospective study estimated the prevalence of thrombocytopenia in a large population of CLD patients and compared medical resource utilization and medical care costs by TCP status.

Methods:

A retrospective analysis was conducted on a longitudinal administrative claims database from a large US commercial health plan. Patients assigned CLD diagnosis codes from January 1, 2000–December 31, 2003 were identified; annual ambulatory visits, ER visits, inpatient stays, and general and CLD-related medical care costs for patients with vs without TCP (identified using diagnosis codes and platelet count data if available) were compared.

Results:

Of 56,445 patients with an ICD-9-CM diagnosis for CLD, 1289 (2.3%) had a diagnosis for TCP. CLD patients with vs without a TCP diagnosis had >2.5-times the annual number of liver disease-related ambulatory visits (3.6 vs 1.4; odds ratio [OR]?=?2.6, p?<?0.01); were 13-times more likely to have a liver-related inpatient stay (OR?=?13.0, p?<?0.01); were nearly 4-times more likely to have a liver-related ER visit (OR?=?3.9, p?<?0.01); had 3.5-fold greater mean annual overall medical care costs ($43,560 vs $12,270, p?<?0.01); and had 7-fold greater annual liver disease-related medical care costs ($9940 vs $1420, p?<?0.01). Similar results were seen for patients with platelet count data indicating TCP.

Limitations:

CLD and TCP are not always diagnosed, nor is diagnosis uniform or standardized; administrative claims data are subject to coding errors, and individuals covered are not necessarily representative of the general US population. The number of CLD patients in this study with TCP (n?=?1289) is small relative to that expected in the general US population.

Conclusions:

In this analysis, CLD patients with TCP used significantly more medical resources and incurred significantly higher medical care costs than those without TCP.     

肝硬化病人饮食护理影响因素的调查及对策

目的:调查肝硬化病人饮食护理的影响因素。方法:采用自行问卷式调查方法对60例患者和9名护理人员进行调查。结果;调查显示患者及护理人员掌握的知识无显著差异,肝硬化患者的知识95%来源于医护人员。结论:对肝硬化患者实施饮食护理非常重要,但在实际中存在缺陷,对此提出相应的护理对策。     

A cost-utility analysis of prolonged-release tacrolimus relative to immediate-release tacrolimus and ciclosporin in liver transplant recipients in the UK

Background: Calcineurin inhibitors (CNIs) represent the cornerstone of immunosuppressive therapy after liver transplantation. A recent network meta-analysis (NMA) evaluated the relative efficacy of CNIs ciclosporin, prolonged-release (PR) tacrolimus, and immediate-release (IR) tacrolimus in adult liver transplant recipients based on randomized and large observational trials published since 2000. Based on the NMA findings, the present study evaluated the cost-utility of PR tacrolimus relative to ciclosporin or IR tacrolimus in liver transplant recipients in the UK.

Methods: A Markov model was developed to evaluate the cost-utility of immunosuppressive regimens in liver transplant recipients, capturing costs associated with immunosuppression, retransplantation, acute rejection (AR), and cytomegalovirus infection. Mortality, graft loss, and AR odds ratios were derived from the NMA. Costs were taken from the British National Formulary and the NHS National Tariff and expressed in 2016 pounds sterling. Future costs and effects were discounted at 3.5% annually.

Results: Over 25 years, PR tacrolimus resulted in increased life expectancy and quality-adjusted life expectancy (QALE) relative to IR tacrolimus and ciclosporin. Relative to ciclosporin, QALE increased by 1.17 quality-adjusted life years (QALYs) with PR tacrolimus while costs increased by GBP £4645, yielding an incremental cost-effectiveness ratio (ICER) of £3962 per QALY gained. Relative to IR tacrolimus, QALE increased by 0.78 QALYs and costs by £1474, resulting in an ICER of £1889 per QALY gained. Sensitivity analysis showed the analysis to be most sensitive to dosing assumptions.

Conclusions: Based on a UK-specific analysis of the projected cost-utility of PR tacrolimus relative to IR tacrolimus and ciclosporin, PR tacrolimus was cost-effective, improving life expectancy and QALE relative to both IR tacrolimus and ciclosporin, yielding ICERs below £20 000 per QALY gained. The main limitations of the study were data source heterogeneity and omitting the economic and clinical effects of treating aspects of recurrent liver disease.     

The burden associated with thrombocytopenia and platelet transfusions among patients with chronic liver disease

Abstract

Background: Thrombocytopenia (TCP), a common complication of chronic liver disease (CLD), can cause uncontrolled bleeding during procedures. As such, CLD patients with TCP and platelet counts <50,000/μL often receive prophylactic platelet transfusions before invasive procedures. However, platelet transfusions are associated with clinical complications, which may result in increased healthcare utilization and costs.

Objective: This retrospective database analysis describes the clinical and economic burden in CLD patients with TCP, CLD patients without TCP, and CLD patients with TCP who receive platelet transfusions.

Methods: Adult CLD patients with or without TCP were identified in the IBM MarketScan Commercial Claims and Medicare Supplemental data from 1 January 2012 to 31 December 2015. CLD patients with or without TCP were propensity-score matched (1:1) for the analysis of annual healthcare utilization and costs. Platelet transfusions among CLD patients with TCP were identified using procedure codes.

Results: Of the 601,626 patients with CLD, 8,292 (1.4%) patients with TCP were matched to patients without TCP. Among CLD patients with TCP, 981 (11.8%) patients received ≥1 platelet transfusions and met inclusion/exclusion criteria. Compared to patients without TCP, CLD patients with TCP had more complications, including higher prevalence of neutropenia (11.4% vs 2.9%) and bleeding events (21.4% vs 10.9%), greater resource utilization including greater average hospital admissions (1.2 vs 0.7, p?<?.01), greater average ER visits (2.1 vs 1.3, p?<?.01), higher average outpatient office visits (20.1 vs 18.4, p?<?.01), and higher average healthcare costs including total costs (p?<?.01), inpatient costs (p?<?.01), ER visit costs (p?<?.01), and outpatient office visit costs (p?<?.01). The mean annual total costs in CLD and TCP patients with platelet transfusions were $206,396.

Conclusions: CLD patients with TCP, and particularly those who received platelet transfusions, experienced significantly greater clinical and economic burden compared to CLD patients without TCP. Safer and more cost-effective treatments to increase platelets are necessary.