scholarly journals Treatment of Periprosthetic Infections: An Economic Analysis

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Daniel Hernández-Vaquero ◽  
Mariano Fernández-Fairen ◽  
Ana Torres ◽  
Ann M. Menzie ◽  
José Manuel Fernández-Carreira ◽  
...  
Keyword(s):  
Periprosthetic Infection ◽  
High Risk Patient ◽  
Antibiotic Use ◽  
Current Data ◽  
Behavioral Changes ◽  
Improved Outcomes ◽  
Patient Groups ◽  
Rational Management ◽  
Periprosthetic Infections

This review summarizes the existing economic literature, assesses the value of current data, and presents procedures that are the less costly and more effective options for the treatment of periprosthetic infections of knee and hip. Optimizing antibiotic use in the prevention and treatment of periprosthetic infection, combined with systemic and behavioral changes in the operating room, the detection and treatment of high-risk patient groups, as well as the rational management of the existing infection by using the different procedures according to each particular case, could allow for improved outcomes and lead to the highest quality of life for patients and the lowest economic impact. Nevertheless, the costeffectiveness of different interventions to treat periprosthetic infections remains unclear.

scholarly journals Economical Analysis on Prophylaxis, Diagnosis, and Treatment of Periprosthetic Infections

2013 ◽  
Vol 7 (1) ◽  
pp. 227-242 ◽  
Author(s):  
Mariano Fernandez-Fairen ◽  
Ana Torres ◽  
Ann Menzie ◽  
Daniel Hernandez-Vaquero ◽  
José Manuel Fernandez-Carreira ◽  
...  
Keyword(s):  
Periprosthetic Infection ◽  
Quality Criteria ◽  
Cost Effective ◽  
Risk Groups ◽  
Antibiotic Use ◽  
Current Data ◽  
Diagnosis And Treatment ◽  
Analytical Technique ◽  
Periprosthetic Infections

The economic burden of periprosthetic infections is enormous, but the number of economic studies dealing with this issue is very scarce. This review tries to know the economic literature existing, assess the value of current data, and recognize the less costly and more effective procedures for prevention, diagnosis and treatment of periprosthetic infections.Forty five studies meeting the inclusion criteria and adhering to the quality criteria used were carefully analyzed to extract the economic data of relevance in evaluating the magnitude of problem and the more cost-effective solutions. However, because the heterogeneity and the low-quality of most of these studies meta-analytical technique has not been possible. Instead, the studies have been reviewed descriptively.Optimizing the antibiotic use in the prevention and treatment of periprosthetic infection, combined with systemic and behavioral changes in the operating room; detecting and treating the high-risk groups; a quick, simple, reliable, safe, and cost-effective diagnosis, and the rationale management of the instituted infection, specifically using the different procedures according to each particular case, could allow to improve outcomes and produce the highest quality of life for patients and the lowest economic impact. Nevertheless, the cost effectiveness of different interventions to prevent and to treat the periprosthetic infection remains unclear.

scholarly journals Arthroscopic treatment of total knee arthroplasty complications

2019 ◽  
Vol 4 (2) ◽  
pp. 33-43 ◽  
Author(s):  
Carlos A. Encinas-Ullán ◽  
E. Carlos Rodríguez-Merchán
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Knee Arthroscopy ◽  
Periprosthetic Infection ◽  
Current Data ◽  
Therapeutic Success ◽  
Soft Tissue Impingement ◽  
Total Knee ◽  
Periprosthetic Infections

The most frequent indications for arthroscopy in patients with total knee arthroplasty (TKA) are soft-tissue impingement, arthrofibrosis (knee stiffness), periprosthetic infection and removal of free bodies or cement fragments. When performing a knee arthroscopy in a patient with a symptomatic TKA, look for possible free/retained bone or cement fragments, which can be anywhere in the joint. Patellar tracking should be evaluated and soft-tissue impingement under the patella or between the femoral and tibial prosthetic components should be ruled out. Current data suggest that knee arthroscopy is an effective procedure for the treatment of some patients with symptomatic TKA. The approximate rates of therapeutic success vary according to the problem in question: 85% in soft-tissue impingement; 90% in arthrofibrosis; and 55% in periprosthetic infections. More clinical studies are needed to determine which patients with symptomatic TKA can be the best candidates for knee arthroscopy. Cite this article: EFORT Open Rev 2019;4:33-43. DOI: 10.1302/2058-5241.4.180035.

Edukasi dan Peningkatan Kualitas Pengelolaan Obat di Rumah Tangga: Studi Kasus di Dusun Sidasari Wetan Desa Kubangkangkung Kawunganten Cilacap (Education and Quality Improvement of Drug Management in Family: A Case Study at Dusun Sidasari Wetan, Kubang

2018 ◽  
Vol 2 (2) ◽  
pp. 93
Author(s):  
Hendri Wasito ◽  
Hening Pratiwi ◽  
Adi Wibowo ◽  
Nia Kurnia Solihat
Keyword(s):  
Quality Improvement ◽  
Home Visit ◽  
Behavioral Changes ◽  
Drug Management ◽  
Educational Effort ◽  
The Family ◽  
Service Activity ◽  
Knowledge And Attitude

Drugs are an important component of health services that are the needs of the community. There is still a lack ofcommunity knowledge of medicines and management especially for family members, hence an educational effort as well asimprovement of quality of drug management in family through training program and mentoring by pharmacist. Thiscommunity service activity aims to determine the knowledge and attitude of the community in managing drugs in the familyand improve the quality of drug management by the community in the family. The activity was conducted in SidasariWetanKubangkangkung Village Kawunganten Cilacap. The workshop on drug management in family was conducted by pharmaciststo the 33 participants. Data collection was done by using questionnaire and observation through home visit. The result of theactivity shows that the increase of knowledge and attitude of the society in managing drugs in the familywere 10% and 7%,respectively. Workshop activities and mentoring by pharmacists can provide benefits and behavioral changes in family drugsmanagement.

Psychosomatic Features, Compliance and Complementary Therapies in Rheumatoid Arthritis

2020 ◽  
Vol 16 (3) ◽  
pp. 215-223
Author(s):  
Rostislav A. Grekhov ◽  
Galina P. Suleimanova ◽  
Andrei S. Trofimenko ◽  
Liudmila N. Shilova
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Interpersonal Relationships ◽  
Behavioral Therapy ◽  
Current Data ◽  
Psychotherapeutic Interventions ◽  
And Coping ◽  
Regulation Of Emotion ◽  
The Impact

This review highlights the issue of psychosomatic conditions in rheumatoid arthritis, paying special attention to new researches and trends in this field. Emerging concepts in all the major parts of the problem are covered consecutively, from the impact of chronic musculoskeletal pain on the emotional state to disease influence over quality of life, socio-psychological, and interpersonal relationships. Chronic pain is closely related to emotional responses and coping ability, with a pronounced positive effect of psychotherapeutic interventions, family and social support on it. Psychosexual disorders, anxiety, depression also commonly coexist with rheumatoid arthritis, leading to further decrease in quality of life, low compliance, and high suicide risk. Influence of psychosomatic conditions on the overall treatment effect is usually underestimated by rheumatologists and general practitioners. Psychosomatic considerations are of great importance for up-to-date management of rheumatoid arthritis, as they strongly influence the quality of life, compliance, and thereby disease outcomes. Two major approaches of psychological rehabilitation exist, both coping with pain through the regulation of emotion and psychotherapeutic intervention, which not only helps patients in coping with the disease, but also aimed at improving the overall adaptation of the patient. It includes techniques of relaxation, cognitive-behavioral therapy, and biofeedback therapy. Current data about the efficacy of the additional correcting therapies for patients with rheumatoid arthritis, both emerging and common ones, are discussed in the review.

scholarly journals The use of Lactobacillus casei DG® prevents symptomatic episodes and reduces the antibiotic use in patients affected by chronic bacterial prostatitis: results from a phase IV study

2021 ◽  
Author(s):  
Tommaso Cai ◽  
Luca Gallelli ◽  
Erika Cione ◽  
Gianpaolo Perletti ◽  
Francesco Ciarleglio ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Symptoms ◽  
Clinical Status ◽  
Well Being ◽  
Antibiotic Use ◽  
Chronic Bacterial Prostatitis ◽  
Symptomatic Recurrence ◽  
Bacterial Prostatitis ◽  
Phase Iv

Abstract Purpose To evaluate the efficacy of Lactobacillus paracasei CNCM I-1572 (L. casei DG®) in both prevention of symptomatic recurrences and improvement of quality of life in patients with chronic bacterial prostatitis (CBP). Methods Patients with CBP attending a single Urological Institution were enrolled in this phase IV study. At enrollment, all patients were treated with antibiotics in agreement with EAU guidelines and then were treated with L. casei DG® (2 capsules/day for 3 months). Clinical and microbiological analyses were carried out before (enrollment, T0) and 6 months (T2) after the treatment. Both safety and adherence to the treatment were evaluated 3 months (T1) after the enrollment. NIH Chronic Prostatitis Symptom Index (CPSI), International Prostate Symptom Score (IPSS) and Quality of Well-Being (QoL) questionnaires were used. The outcome measures were the rate of symptomatic recurrence, changes in questionnaire symptom scores and the reduction of antibiotic use. Results Eighty-four patients were included. At T2, 61 patients (72.6%) reported a clinical improvement of symptoms with a return to their clinical status before symptoms. A time dependent improvement in clinical symptoms with significant changes in NIH-CPSI, IPSS and QoL (mean difference T2 vs T0: 16.5 ± 3.58; − 11.0 ± 4.32; + 0.3 ± 0.09; p < 0.001), was reported. We recorded that L. casei DG® treatment induced a statistically significant decrease in both (p < 0.001) symptomatic recurrence [1.9/3 months vs 0.5/3 months] and antibiotic use [− 7938 UDD]. No clinically relevant adverse effects were reported. Conclusions L. casei DG® prevents symptomatic recurrences and improves the quality of life in patients with CBP, reducing the antibiotic use.

scholarly journals A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

2021 ◽  
pp. 1-22
Author(s):  
Sebastian Jugl ◽  
Aimalohi Okpeku ◽  
Brianna Costales ◽  
Earl J. Morris ◽  
Golnoosh Alipour-Haris ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
The Body ◽  
Medical Cannabis ◽  
High Quality ◽  
Chronic Noncancer Pain ◽  
High Quality Evidence ◽  
Improved Outcomes ◽  
Noncancer Pain ◽  
Study Setting

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016–2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn’s disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson’s disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

scholarly journals A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

2021 ◽  
Vol 18 (13) ◽  
pp. 6796
Author(s):  
Jan Schmidt ◽  
Martina Kunderova ◽  
Nela Pilbauerova ◽  
Martin Kapitan
Keyword(s):  
Systematic Review ◽  
Local Therapy ◽  
Critical Factor ◽  
Antibiotic Use ◽  
Narrative Review ◽  
Antibiotic Prescribing ◽  
Evidence Based ◽  
Antibiotic Overuse ◽  
Clinically Significant

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists' therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients' quality of life, healthcare costs, and antimicrobial resistance development.

scholarly journals Patient-reported symptoms during dialysis: the effect of pre-dialysis extracellular water and change in extracellular water post-dialysis

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Suree Yoowannakul ◽  
Surachet Vongsanim ◽  
Kamonwan Tangvoraphonkchai ◽  
Ahmed Mohamed ◽  
Andrew Davenport
Keyword(s):  
Extracellular Water ◽  
Volume Depletion ◽  
Dialysis Treatment ◽  
Lower Tertile ◽  
Patient Reported ◽  
Low Blood Pressure ◽  
Symptom Scores ◽  
Recovery Times ◽  
Patient Groups

Abstract Background Quality of life for haemodialysis (HD) patients may be affected by symptoms during dialysis treatments, and patient groups have highlighted the need to improve post-dialysis fatigue and dialysis-related symptoms. As changes in extracellular water (ECW) may lead to cramps and other symptoms, we wished to determine whether there was an association between ECW and intra-dialytic symptoms. Methods We reviewed the hospital records of HD patients who completed a self-reported intra-dialytic symptom questionnaire, using a visual analogue scale, who had contemporaneous pre- and postdialysis bioimpedance ECW measurements adjusted to height (aECW). Results We studied dialysis sessions of 506 patients, 314 (62.1%) male, 226 (44.7%) diabetic, mean age 64.6 ± 15.7 years, weight 69.9 ± 17.4 kg, and duration of dialysis treatment 26 (9.6–60.1) months. We divided patients into three groups according to pre-dialysis aECW, and total dialysis symptom scores were greater for those in the lower tertile (25 (10–41) vs middle 18 (8.5–34) vs upper 20 (7–31), p < 0.05). Only feeling cold, dizziness, and low blood pressure were statistically different between the three pre-dialysis aECW groups, and there was no difference in post-dialysis recovery times. We analysed the effect of the fall in aECW pre-to post-dialysis. Patients in the group with the greatest fall in aECW did not report more intra-dialytic symptoms or longer recovery times. Conclusion We found that patients starting dialysis with lower relative ECW were more likely to report intra-dialytic symptoms than those with greater amounts of fluid to remove, and most commonly reported symptoms were associated with intra-vascular volume depletion.

scholarly journals Pharmacokinetics and Pharmacogenetics of Cyclophosphamide in a Neonate and Infant Childhood Cancer Patient Population

2021 ◽  
Vol 14 (3) ◽  
pp. 272
Author(s):  
Shelby Barnett ◽  
Julie Errington ◽  
Julieann Sludden ◽  
David Jamieson ◽  
Vianney Poinsignon ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Childhood Cancer ◽  
Patient Population ◽  
Population Pharmacokinetic Model ◽  
Pharmacokinetic Model ◽  
Drug Clearance ◽  
Current Data ◽  
Population Pharmacokinetic ◽  
Older Children ◽  
Patient Groups

Infants and young children represent an important but much understudied childhood cancer patient population. The pharmacokinetics and pharmacogenetics of the widely used anticancer prodrug cyclophosphamide were investigated in children <2 years of age. Concentrations of cyclophosphamide and selected metabolites were determined in patients administered cyclophosphamide at doses ranging from 100–1500 mg/m2 (5–75 mg/kg), with various infusion times as determined by the standard treatment regimen that each patient was receiving. Polymorphisms in genes including CYP2B6 and CYP2C19 were investigated. Data generated for cyclophosphamide were analysed using a previously published population pharmacokinetic model. Cyclophosphamide pharmacokinetics was assessed in 111 samples obtained from 25 patients ranging from 4–23 months of age. The average cyclophosphamide clearance for the patients was 46.6 mL/min/m2 (ranging from 9.4–153 mL/min/m2), with marked inter-patient variability observed (CV 41%). No significant differences in cyclophosphamide clearance or exposure (AUC) were observed between patient groups as separated by age or body weight. However, marked differences in drug clearance and metabolism were noted between the current data in children <2 years of age and recently published results from a comparable study conducted by our group in older children, which reported significantly lower cyclophosphamide clearance values and metabolite exposures using the same population pharmacokinetic model for analysis. Whilst this study demonstrates no significant differences in cyclophosphamide clearance in patients <2 years, it highlights large differences in dosing protocols across tumour types. Furthermore, the study suggests marked differences in cyclophosphamide clearance in children less than two years of age as compared to older patients.

scholarly journals Perceived family cohesion, social support, and quality of life in patients undergoing treatment for substance use disorders compared with patients with mental and physical disorders

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bente Birkeland ◽  
Bente Weimand ◽  
Torleif Ruud ◽  
Darryl Maybery ◽  
John-Kåre Vederhus
Keyword(s):  
Quality Of Life ◽  
Social Support ◽  
Substance Use ◽  
Substance Use Disorders ◽  
Family Cohesion ◽  
Service Providers ◽  
Cancer Data ◽  
Physical Disorders ◽  
Patient Groups

Abstract Purpose Support from family and other social network elements can be important in helping patients to cope with practical and emotional consequences of diseases. The aim of the study was to examine perception of family and social support and quality of life (QoL) in patients undergoing treatment for substance use disorders (SUDs). We compared them with patients in treatment for mental disorders (MDs) and physical disorders (PDs). Methods We used data from a national multicenter study that recruited patients (N  =  518) from three treatment domains; SUD treatment units, MD treatment units, and PD treatment units (severe neurological conditions or cancer). Data on family cohesion, social support, and QoL were compared across patient groups. In addition, data on health variables was collected. We used a multiple linear regression procedure to examine how health and support variables were associated with QoL. Results Family cohesion and social support in the SUD and MD groups were rated at similarly low levels, substantially lower than in the PD group. The SUD group exhibited a somewhat lower QoL than did the PD group, but their QoL was still in the near-to-normal range. In contrast, the MD group had markedly low QoL. When examining factors associated with QoL, we found that greater family cohesion and social support were positively associated with QoL. Mental distress was the strongest factor, and was negatively associated with QoL (beta − 0.15, 95% CI  =  − 0.17/− 0.14, p  <  0.001). Conclusion Service providers need to be aware of the weaker networks and less regulatory family and/or social support available to patients with SUDs. Providers should focus consistently on the social networks of patients and include patients’ families in treatment processes.

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