scholarly journals Clinical Use of Tolerogenic Dendritic Cells-Harmonization Approach in European Collaborative Effort

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Anja Ten Brinke ◽  
Catharien M. U. Hilkens ◽  
Nathalie Cools ◽  
Edward K. Geissler ◽  
James A. Hutchinson ◽  
...  
Keyword(s):  
Dendritic Cells ◽  
Cost Effective ◽  
Administration Route ◽  
European Cooperation ◽  
Information Models ◽  
Tolerogenic Dendritic Cells ◽  
Specific Objective ◽  
Number Of Patients ◽  
Loss Of Tolerance

The number of patients with autoimmune diseases and severe allergies and recipients of transplants increases worldwide. Currently, these patients require lifelong administration of immunomodulatory drugs. Often, these drugs are expensive and show immediate or late-occurring severe side effects. Treatment would be greatly improved by targeting the cause of autoimmunity, that is, loss of tolerance to self-antigens. Accumulating knowledge on immune mechanisms has led to the development of tolerogenic dendritic cells (tolDC), with the specific objective to restrain unwanted immune reactions in the long term. The first clinical trials with tolDC have recently been conducted and more tolDC trials are underway. Although the safety trials have been encouraging, many questions relating to tolDC, for example, cell-manufacturing protocols, administration route, amount and frequency, or mechanism of action, remain to be answered. Aiming to join efforts in translating tolDC and other tolerogenic cellular products (e.g., Tregs and macrophages) to the clinic, a European COST (European Cooperation in Science and Technology) network has been initiated—A FACTT (action to focus and accelerate cell-based tolerance-inducing therapies). A FACTT aims to minimize overlap and maximize comparison of tolDC approaches through establishment of minimum information models and consensus monitoring parameters, ensuring that progress will be in an efficient, safe, and cost-effective way.

The Effectiveness of Three Psychotherapies of Different type and Length in the Treatment of Patients Suffering from Anxiety Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. s777-s777
Author(s):  
P. Knekt ◽  
O. Lindfors ◽  
T. Maljanen
Keyword(s):  
Anxiety Disorder ◽  
Work Ability ◽  
Psychodynamic Psychotherapy ◽  
Cost Effective ◽  
Term Therapy ◽  
Short Term ◽  
Number Of Patients ◽  
Axis I

IntroductionData on the comparative effect of short and long-term psychotherapy in anxiety disorder is scarce.AimTo compare the effectiveness of two short-term therapies and one long-term psychotherapy in the treatment of patients with anxiety disorder.MethodsAltogether 50 outpatients with anxiety disorder as the only axis I diagnosis, were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT) and were followed for 5 years. The outcome measures were psychiatric symptoms, working ability, need for psychiatric treatment, remission, and cost-effectiveness.ResultsDuring the first year of follow-up, no significant differences in the effectiveness between the therapies were noted. During the following 3 years, LPP and SFT more effectively reduced symptoms, improved work ability, and elevated the remission rate than SPP. No significant differences between LPP and SFT were seen. At the end of the follow-up, the use of auxiliary treatment was lowest in the SFT group whereas remission rates or changes in psychiatric symptom or work ability did not differ between the groups. The average total direct costs were about three times higher in the LPP group than in the short-term therapy groups.ConclusionsThe difference in effectiveness of LPP and SFT was negligible, whereas SPP appeared less effective. Thus, the resource-oriented SFT may be a cost-effective option in this selected patient group, while unconsidered allocation of patients to LPP does not appear to be cost-effective. Given the small number of patients, no firm conclusions should, however be drawn based on this study.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals A Functional Threshold for Long-Term Use of Hand and Arm Function Can Be Determined: Predictions From a Computational Model and Supporting Data From the Extremity Constraint-Induced Therapy Evaluation (EXCITE) Trial

2009 ◽  
Vol 89 (12) ◽  
pp. 1327-1336 ◽  
Author(s):  
Nicolas Schweighofer ◽  
Cheol E. Han ◽  
Steven L. Wolf ◽  
Michael A. Arbib ◽  
Carolee J. Winstein
Keyword(s):  
Controlled Trial ◽  
Hand Function ◽  
Cost Effective ◽  
Phase Iii ◽  
Future Research ◽  
Therapy Evaluation ◽  
Effective Interventions ◽  
Term Change ◽  
Number Of Patients

Background Although spontaneous use of the more-affected arm and hand after stroke is an important determinant of participation and quality of life, a number of patients exhibit decreases in use following rehabilitative therapy. A previous neurocomputational model predicted that if the dose of therapy is sufficient to bring performance above a certain threshold, training can be stopped. Objective The aim of this study was to test the hypothesis that there exists a threshold for function of the paretic arm and hand after therapy. If function is above this threshold, spontaneous use will increase in the months following therapy. In contrast, if function is below this threshold, spontaneous use will decrease. Methods New computer simulations are presented showing that changes in arm use following therapy depend on a performance threshold. This prediction was tested by reanalyzing the data from the Extremity Constraint-Induced Therapy Evaluation (EXCITE) trial, a phase III randomized controlled trial in which participants received constraint-induced movement therapy for 2 weeks and were tested both 1 week and 1 year after therapy. Results The results demonstrate that arm and hand function measured immediately after therapy predicts, on average, the long-term change of arm use. Above a functional threshold, use improves. Below this threshold, use decreases. Limitations The reanalysis of the EXCITE trial data provides a “group” threshold above which a majority of patients, but not all, improve spontaneously. A goal of future research is to provide the means to assess when patients reach their individual threshold. Conclusion Understanding of the causal and nonlinear relationship between limb function and daily use is important for the future development of cost-effective interventions and prevention of “rehabilitation in vain.”

scholarly journals Automated Arrhythmia Detection Based on RR Intervals

Diagnostics ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 1446
Author(s):  
Oliver Faust ◽  
Murtadha Kareem ◽  
Ali Ali ◽  
Edward J. Ciaccio ◽  
U. Rajendra Acharya
Keyword(s):  
Learning Algorithm ◽  
Cost Effective ◽  
Arrhythmia Detection ◽  
Rr Interval ◽  
Deep Learning Algorithm ◽  
Number Of Patients ◽  
Life Threatening ◽  
Term Monitoring ◽  
Fold Cross Validation

Abnormal heart rhythms, also known as arrhythmias, can be life-threatening. AFIB and AFL are examples of arrhythmia that affect a growing number of patients. This paper describes a method that can support clinicians during arrhythmia diagnosis. We propose a deep learning algorithm to discriminate AFIB, AFL, and NSR RR interval signals. The algorithm was designed with data from 4051 subjects. With 10-fold cross-validation, the algorithm achieved the following results: ACC = 99.98%, SEN = 100.00%, and SPE = 99.94%. These results are significant because they show that it is possible to automate arrhythmia detection in RR interval signals. Such a detection method makes economic sense because RR interval signals are cost-effective to measure, communicate, and process. Having such a cost-effective solution might lead to widespread long-term monitoring, which can help detecting arrhythmia earlier. Detection can lead to treatment, which improves outcomes for patients.

Abstract TP374: Risk Assessment Scale for the Consideration of Long-Term Alternate Means of Nutrition

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Omoniyi Ayanbadejo ◽  
Melissa Hogan ◽  
Wendy Giglio ◽  
Lee Guterman
Keyword(s):  
At Risk ◽  
Neurological Disease ◽  
Vital Signs ◽  
Cost Effective ◽  
Barium Swallow ◽  
Number Of Patients ◽  
Nutritional Needs ◽  
Peg Tube ◽  
Risk Of Aspiration

Objectives: The decision to utilize percutaneous enteral feeding for hospital patients after stroke or as a result neurological disease is based on qualitative measures. There is no defined protocol for the evaluation of patients who may require alternative means of feeding such as a PEG tube. We developed a quantitative scale HOGLIO scale.We developed a quantitative scale to determine which patients with neurologic disease/deficits will require Percutaneous Enteral Gastrostomy. The scale identifies patients at risk for aspiration by applying a score based on patient’s (a) level of arousal as measure by the Observational Scale Level of Arousal (OSLA),(b)respiratory status as measured by peripheral capillary oxygen saturation (c)aspiration risk as measured by formal bedside swallow evaluation/instrumental assessment (d)Long term nutritional needs as measured by patient’s ability to meet nutritional needs orally. Methods: We conducted a prospective registry review of patients with consultation for speech and swallow on the stroke ward at our comprehensive stroke Center, between June-July 2019. The following variables were collected for each patients; Age ,NIH score, OSLA score, HOGLIO score, vital signs ,medication list and per oral diet status. Result: The patients ranged in age from 21-85 years with mean age of 63.6 years. Patients with H score > 10 need PEG. We found that the strongest correlation between the need for PEG and H score was in the level of consciousness .Our preliminary data indicate that score greater than 10 is a good indicator for PEG.A high score on the Level of Arousal testing appears to be indicative of a need for PEG, as is a failed barium swallow, and a failed bedside swallowing test. Conclusion: Historically patients with neurological disease are at risk of aspiration. The PEG tube can be used to improve nutrition and meet metabolic needs of patients at higher risk of aspiration. It is cost effective and associated with lower complications compared to parenteral nutrition. The pilot study may suggest a relationship between HOGLIO score, risk of aspiration and need for an alternative route of nutrition such as PEG. We propose to carry out our study on a larger number of patients to further understand the relationships.

Physical and Psychological Benefits of Written Emotional Expression

2015 ◽  
Vol 20 (4) ◽  
pp. 242-251 ◽  
Author(s):  
Éva Kállay
Keyword(s):  
Mental Health ◽  
Expressive Writing ◽  
Mental Health Problems ◽  
Cost Effective ◽  
Health Problems ◽  
Future Research ◽  
Psychological Benefits ◽  
Cost Effective Treatment ◽  
Meta Analyses

Abstract. The last several decades have witnessed a substantial increase in the number of individuals suffering from both diagnosable and subsyndromal mental health problems. Consequently, the development of cost-effective treatment methods, accessible to large populations suffering from different forms of mental health problems, became imperative. A very promising intervention is the method of expressive writing (EW), which may be used in both clinically diagnosable cases and subthreshold symptomatology. This method, in which people express their feelings and thoughts related to stressful situations in writing, has been found to improve participants’ long-term psychological, physiological, behavioral, and social functioning. Based on a thorough analysis and synthesis of the published literature (also including most recent meta-analyses), the present paper presents the expressive writing method, its short- and long-term, intra-and interpersonal effects, different situations and conditions in which it has been proven to be effective, the most important mechanisms implied in the process of recovery, advantages, disadvantages, and possible pitfalls of the method, as well as variants of the original technique and future research directions.

Antithrombotic Therapy for DVT/PE

1997 ◽  
Vol 17 (03) ◽  
pp. 161-162
Author(s):  
Thomas Hyers
Keyword(s):  
Molecular Weight ◽  
Low Molecular Weight Heparin ◽  
Oral Anticoagulants ◽  
Cost Effective ◽  
Therapeutic Agents ◽  
Great Promise ◽  
Term Therapy ◽  
Low Molecular Weight ◽  
Long Term Therapy

SummaryProblems with unfractionated heparin as an antithrombotic have led to the development of new therapeutic agents. Of these, low molecular weight heparin shows great promise and has led to out-patient therapy of DVT/PE in selected patients. Oral anticoagulants remain the choice for long-term therapy. More cost-effective ways to give oral anticoagulants are needed.

Ixekizumab in the Management of Non-Selected Out Patients with Moderate to Severe Psoriasis -New Data and Personal Clinical Experience

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Clinical Experience ◽  
Personal Experience ◽  
Therapeutic Response ◽  
Systemic Disease ◽  
Severe Psoriasis ◽  
Adequate Treatment ◽  
Scalp Psoriasis ◽  
Number Of Patients ◽  
Genital Psoriasis

Introduction: Too many patients with moderate to severe psoriasis do not receive adequate treatment. This means a vast undersupply in the treatment of patients with psoriasis. Only biologics fulfill the whole range of the treatment of psoriasis – psoriasis does not affect only skin but the whole organism: It is a systemic disease! Between the biologics are evident differences concerning the effect. Discussion: Based on broad personal experience in the management of patients with moderate to severe psoriasis new data from clinical studies with ixekizumab are examined. This contains new data on long-term-efficacy of ixekizumab, effectiveness in special localizations (scalp psoriasis, nail psoriasis, palmoplantar psoriasis, genital psoriasis) as well as safely data and experience on patients switched to ixekizumab from other biologics. Personal clinical experience is based on >300 non-selected outpatients with moderate to severe psoriasis, >250 patients on biological therapies, > 50 patients with ixekizumab. Conclusions: Focusing on a relevant number of patients switched from secukinumab to ixekizumab due to first or secondary loss of efficacy significant differences between both IL-17A-inhibitors mainly in terms of efficacy and speed of therapeutic response are shown. Finally the correlation between PASI-90-/PASI-100 response and significant changes in DLQI are highlighted.

Strategic planning in grassland farming: Principles andapplications

1997 ◽  
pp. 191-197
Author(s):  
W.J. Parker ◽  
N.M. Shadbolt ◽  
D.I. Gray
Keyword(s):  
Strategic Planning ◽  
Performance Indicators ◽  
Cost Effective ◽  
Key Performance Indicators ◽  
Strategic Plans ◽  
Effective Manner ◽  
Farm Business ◽  
Pastoral Farming ◽  
Financial Environment

Three levels of planning can be distinguished in grassland farming: strategic, tactical and operational. The purpose of strategic planning is to achieve a sustainable long-term fit of the farm business with its physical, social and financial environment. In pastoral farming, this essentially means developing plans that maximise and best match pasture growth with animal demand, while generating sufficient income to maintain or enhance farm resources and improvements, and attain personal and financial goals. Strategic plans relate to the whole farm business and are focused on the means to achieve future needs. They should be routinely (at least annually) reviewed and monitored for effectiveness through key performance indicators (e.g., Economic Farm Surplus) that enable progress toward goals to be measured in a timely and cost-effective manner. Failure to link strategy with control is likely to result in unfulfilled plans. Keywords: management, performance

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