scholarly journals The significance of NNT parameter for the evaluation of therapy effectiveness

2016 ◽  
Vol 16 (4) ◽  
pp. 175-179
Author(s):  
Andrzej Potemkowski ◽  
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Clinical Trial ◽  
Magnetic Resonance ◽  
Magnetic Resonance Images ◽  
Disability Progression ◽  
Advantages And Disadvantages ◽  
Number Of Patients ◽  
Clinical Trial Results ◽  
The Impact

Clinical trials provide a practicing clinician with an abundance if not excess of data to draw on when comparing treatment methods and deciding the potentially optimal therapeutic option for a given patient. NNT, or number needed to treat, has been identified as one of the parameters useful for assessing the effectiveness of therapy. It represents the number of patients who must undergo a given health-care intervention instead of another one to see a difference in the effectiveness of obtaining a desired outcome within a set timeframe. NNT is a derivative of absolute risk reduction (ARR) or initial risk and its relative reduction. It represents the relative superiority of a given treatment. NNT is primarily used for comparing the advantages and disadvantages of alternative health-care interventions, and its assessment is important for estimating the clinical value of statistically significant clinical trial results. Utilization of NNT allows to predict therapy outcome both in terms of its effectiveness and tolerance. Also, clinical trial results presented in the form of NNT may be easily shared with patients, their families, and the institutions deciding the availability of a given drug. In multiple sclerosis, clinical trial results have been concerned with the impact of therapeutics on decrease of annualized relapse rate (ARR) and reduction of lesions visible in magnetic resonance images as well as slowing of disability progression. Analyses of first-line multiple sclerosis treatments reveal their NNT referred to prevention of relapses, disability progression and lesions in magnetic resonance image to vary significantly. Similar differences exist across NNT values established for second-line treatments or the oral therapies being currently introduced. The data clearly show that when evaluating clinical trial results, it is not enough to consider only given parameters, as they must all be critically and constructively analysed. NNT’s importance is also stressed as a clear parameter to be used for the evaluation of economic outcomes in healthcare.

Unfunded Public Employee Health Care Benefits and GASB No. 45

2007 ◽  
Vol 21 (3) ◽  
pp. 245-263 ◽  
Author(s):  
Elizabeth K. Keating ◽  
Eric S. Berman
Keyword(s):  
Health Care ◽  
Financial Reporting ◽  
Full Range ◽  
Financial Reports ◽  
Employment Benefits ◽  
Care Plans ◽  
Advantages And Disadvantages ◽  
Government Accounting ◽  
The Government ◽  
The Impact

The Government Accounting Standards Board (GASB) recently released Statement No. 45, Accounting and Financial Reporting by Employers for Post-Employment Benefits Other Than Pensions and its companion Statement No. 43 for pooled stand-alone health care plans, which will profoundly affect American governmental finance. The goal of this article is to encourage governments to consider carefully a full range of options in funding and restructuring other post-employment benefits (OPEB). This article will review Statement No. 45's potential impact on governments and review existing disclosures in financial reports as well as bond offering statements. The article will discuss the statement's impact on budgets and governmental operations, including collective bargaining. Funding options under Statement No. 45 will be detailed, including the advantages and disadvantages of irrevocable trusts and OPEB bonds. The article will also discuss the impact of Medicare Part D subsidies received by governments, as well as the bond rating implications of policy decisions surrounding OPEB. As the largest government entities are just now implementing GASB Statement No. 45, estimates of the magnitude of unfunded OPEB liabilities are limited as are the strategies likely to be adopted to cover these obligations. This article offers a summary of the unfunded OPEB liabilities reported by states and major cities and suggests some measures for assessing the ability of these entities to address these costs.

scholarly journals Paradigm Shift in Clinical Practice of Sexual Health in Men During COVID-19 Pandemic

2021 ◽  
pp. 263183182110323
Author(s):  
Aditya Prakash Sharma ◽  
Japleen Kaur ◽  
Ravimohan S. Mavuduru ◽  
Shrawan K. Singh
Keyword(s):  
Health Care ◽  
Sexual Health ◽  
Surgical Procedures ◽  
Care Center ◽  
Tertiary Care ◽  
Health Care Seeking ◽  
Care Seeking ◽  
Health Seeking ◽  
Number Of Patients ◽  
The Impact

Sexual health-care seeking behavior and practices have been affected during COVID-19 pandemic. The impact of COVID-19 on this subspecialty is far reaching. This study aimed to assess the impact of COVID-19 on health-care seeking practice pertaining to sexual health in men in our tertiary care center and review the relevant literature regarding impact of COVID-19 on sexual health seeking practice and challenges faced. Outpatient data was analyzed from January 2019 to April 2021. Patients awaiting surgical procedures due to COVID were documented. A narrative synthesis of literature based on systematic search using the keywords sexual health, sexual health seeking, sexual health practice, andrology, and COVID with operators “AND” and “OR” was carried out in three search engines PubMed, Scopus, and Embase. The study outcomes were obtained by comparing data of outpatient attendance and compiling the reviewed literature. The mean attendance fell significantly from 95.11±11.17 to 17.25±13.70 persons (P <.0001) per outpatient clinic, March 2020 being the reference point. Teleconsultation has taken over physical consultation. In 98/949 cases, teleconsult could not be provided despite registration. Over 25 patients were waiting for surgical procedures pertaining to andrology due to shut down of elective services. Similar trends have been reported from other countries. Number of patients seeking consultation for sexual health problems has dramatically decreased during COVID-19 era. Establishment of data safe teleconsultation facility and its widespread advertisement is needed to encourage patients to seek consult.

scholarly journals Multigrid Nonlocal Gaussian Mixture Model for Segmentation of Brain Tissues in Magnetic Resonance Images

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Yunjie Chen ◽  
Tianming Zhan ◽  
Ji Zhang ◽  
Hongyuan Wang
Keyword(s):  
Magnetic Resonance ◽  
Gaussian Mixture Model ◽  
Mixture Model ◽  
Gaussian Mixture ◽  
Magnetic Resonance Images ◽  
Intensity Inhomogeneity ◽  
Mr Images ◽  
Proposed Model ◽  
Brain Mr Images ◽  
The Impact

We propose a novel segmentation method based on regional and nonlocal information to overcome the impact of image intensity inhomogeneities and noise in human brain magnetic resonance images. With the consideration of the spatial distribution of different tissues in brain images, our method does not need preestimation or precorrection procedures for intensity inhomogeneities and noise. A nonlocal information based Gaussian mixture model (NGMM) is proposed to reduce the effect of noise. To reduce the effect of intensity inhomogeneity, the multigrid nonlocal Gaussian mixture model (MNGMM) is proposed to segment brain MR images in each nonoverlapping multigrid generated by using a new multigrid generation method. Therefore the proposed model can simultaneously overcome the impact of noise and intensity inhomogeneity and automatically classify 2D and 3D MR data into tissues of white matter, gray matter, and cerebral spinal fluid. To maintain the statistical reliability and spatial continuity of the segmentation, a fusion strategy is adopted to integrate the clustering results from different grid. The experiments on synthetic and clinical brain MR images demonstrate the superior performance of the proposed model comparing with several state-of-the-art algorithms.

Cerebellar Dysfunction in Multiple Sclerosis: Considerations for Research and Rehabilitation Therapy

2021 ◽  
pp. 154596832110654
Author(s):  
Erin M. Edwards ◽  
Nora E. Fritz ◽  
Amanda S. Therrien
Keyword(s):  
Multiple Sclerosis ◽  
Motor Control ◽  
Motor Impairment ◽  
Future Research ◽  
Disability Progression ◽  
Cerebellar Dysfunction ◽  
Motor Disability ◽  
Rehabilitation Outcomes ◽  
Critical Knowledge ◽  
The Impact

Introduction. Cerebellar pathology is common among persons with multiple sclerosis (PwMS). The cerebellum is well recognized for its role in motor control and motor learning and cerebellar pathology in multiple sclerosis is associated with enhanced motor impairment and disability progression. The Problem. To mitigate motor disability progression, PwMS are commonly prescribed exercise and task-specific rehabilitation training. Yet, whether cerebellar dysfunction differentially affects rehabilitation outcomes in this population remains unknown. Furthermore, we lack rehabilitation interventions targeting cerebellar dysfunction. The Solution. Here, we summarize the current understanding of the impact of cerebellar dysfunction on motor control, motor training, and rehabilitation in persons with multiple sclerosis. Recommendations. Additionally, we highlight critical knowledge gaps and propose that these guide future research studying cerebellar dysfunction in persons with multiple sclerosis.

Evaluation of Health Care Services Provided in Political Public Meetings in Turkey: A Forgotten Detail in Politics

2018 ◽  
Vol 33 (6) ◽  
pp. 607-613
Author(s):  
Mehmet Ali Ceyhan ◽  
Gültekin Günhan Demir ◽  
Gamze Babur Güler
Keyword(s):  
Health Care ◽  
Political Parties ◽  
Health Care Services ◽  
Heat Index ◽  
Election Campaign ◽  
Medical Conditions ◽  
Public Meetings ◽  
Care Services ◽  
Number Of Patients ◽  
The Impact

AbstractBackgroundPolitical parties in Turkey execute political public meetings (PPMs) during their election campaign for members of the parliament (MoP). A great number of people attend these meetings. No guidelines exist regarding preparation and organization of health care services provided during these meetings. Furthermore, there is no study evaluating health care problems encountered in previous PPMs.ObjectivePolitical parties arranged PPMs in 2015 during the election campaign for general election of MoP. The present study aimed to investigate the context of health care services, the distribution of assigned health staff, as well as the number and the symptoms of patients admitted in health care tents in these PPMs.MethodsTwo general elections for MoP were done in Turkey on June 7, 2015 and November 1, 2015. Health care services were provided by the City Emergency Medical Services Department (CEMSD) in the cities. Demographic characteristics, symptoms, comorbid conditions, treatment, discharge, and hospital transfer of the patients were obtained from patient medical registration records. Information about the distribution and the number of the assigned staff was received from local CEMSDs. The impact of variables such as the number of attendees, heat index, humidity, and the day of the week on the number of patients and the patient presentation rate (PPR) were analyzed.ResultsA total of 97 PPMs were analyzed. The number of total attendees was 5,265,450 people. The number of patients seeking medical help was 1,991. The PPR was 0.5 (0.23-0.91) patients per 1,000 attendees. Mean age of the patients was 40 (SD=19) years old while 1,174 (58.9%) of the patients were female. A total of 1,579 patients were treated in the tents and returned to the PPM following treatment. Two-hundred and three patients were transferred to a hospital by ambulance. Transfer-to-hospital ratio (TTHR) was 0.05 (0.0-0.13) patients per 1,000 attendees. None of the patients suffered sudden cardiac death (SCD) or cardiac arrest. Medical conditions were the main cause for admission. The most common symptoms were dizziness, low blood pressure, fatigue, and hypertension, respectively. The most commonly used medical agents included pain killers and myorelaxants. The number of attendees, heat index, and weekend days were positively correlated with the number of the patients.Conclusion: The majority of medical conditions encountered in PPMs are easily treatable in health care tents settled in the meeting area. The number of attendees, heat index, and weekend days are factors associated with the number of patients.CeyhanMA, DemirGG, GülerGB. Evaluation of health care services provided in political public meetings in Turkey: a forgotten detail in politics. Prehosp Disaster Med. 2018;33(6):607–613.

scholarly journals Multiple Sclerosis Of The Spinal Cord: Is Gadolinium Irreplaceable In Assessing Lesion Activity?

2013 ◽  
Vol 59 (3) ◽  
pp. 158-161
Author(s):  
Constantina Andrada Treabă ◽  
M Buruian ◽  
Rodica Bălașa ◽  
Maria Daniela Podeanu ◽  
I P Simu ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Signs And Symptoms ◽  
Magnetic Resonance Images ◽  
Type I ◽  
Focal Lesions ◽  
Spinal Cord Lesions ◽  
Active Lesion

Abstract Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake. Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement. Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p > 0.5 for both). Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

scholarly journals Patient Income Level and Cancer Clinical Trial Participation

2013 ◽  
Vol 31 (5) ◽  
pp. 536-542 ◽  
Author(s):  
Joseph M. Unger ◽  
Dawn L. Hershman ◽  
Kathy S. Albain ◽  
Carol M. Moinpour ◽  
Judith A. Petersen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Universal Access ◽  
Participation Rate ◽  
Treatment Decision ◽  
Trial Participation ◽  
Lower Income ◽  
Clinical Trial Participation ◽  
Clinical Trial Results ◽  
The Impact

Purpose Studies have shown an association between socioeconomic status (SES) and quality of oncology care, but less is known about the impact of patient SES on clinical trial participation. Patients and Methods We assessed clinical trial participation patterns according to important SES (income, education) and demographic factors in a large sample of patients surveyed via an Internet-based treatment decision tool. Logistic regression, conditioning on type of cancer, was used. Attitudes toward clinical trials were assessed using prespecified items about treatment, treatment tolerability, convenience, and cost. Results From 2007 to 2011, 5,499 patients were successfully surveyed. Forty percent discussed clinical trials with their physician, 45% of discussions led to physician offers of clinical trial participation, and 51% of offers led to clinical trial participation. The overall clinical trial participation rate was 9%. In univariate models, older patients (P = .002) and patients with lower income (P = .001) and education (P = .02) were less likely to participate in clinical trials. In a multivariable model, income remained a statistically significant predictor of clinical trial participation (odds ratio, 0.73; 95% CI, 0.57 to 0.94; P = .01). Even in patients age ≥ 65 years, who have universal access to Medicare, lower income predicted lower trial participation. Cost concerns were much more evident among lower-income patients (P < .001). Conclusion Lower-income patients were less likely to participate in clinical trials, even when considering age group. A better understanding of why income is a barrier may help identify ways to make clinical trials better available to all patients and would increase the generalizability of clinical trial results across all income levels.

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