In acute non-traumatic limp, X-rays of the hips diagnose slipped upper femoral epiphysis, as such they should be routinely used from the age of 9 years upwards. Below this age they are of little value. Inflammatory markers have utility in risk-stratifying children and selecting a group in whom to proceed with definitive tests to exclude osteomyelitis or septic hip. Children with a short history and minimal symptoms can be managed with appropriate follow up and no investigations.
In children younger than 9 years presenting with recent onset, nontraumatic hip pain, hip x-ray is of limited value. In children 9 years or older, hip x-ray may be useful to exclude slipped upper femoral epiphysis. Fever, weight bearing status, and age may better predict urgent pathology.
s253 and behavioral counselling and a 12-16 week phase of total meal replacement. In a clinical trial with 8,296 participants with obesity, OPTIFAST® 52-week program was associated with a mean weight loss of ≈ 1 kg per week. Methods: An eventdriven decision analytic model was built to estimate the cost-effectiveness of 1-year OPTIFAST® program over a 3-year period in the USA. The baseline model analysis was performed for employees with class I and II obesity (BMI 30.0-40 kg/m2) who underwent treatment with OPTIFAST®, liraglutide 3 mg, naltrexone/bupropion or left without any weight management intervention. The model included productivity loss caused by complications of obesity, such as MI, hypertension, angina pectoris, T2DM among others, as well as treatment. Data sources included published literature, clinical trials, official US price/tariff lists and national population statistics. Results: The model estimates a direct cost saving of US$ 9,488/person over 3 years with OPTIFAST® as compared to "no intervention" in employees with class I and II obesity, (OPTIFAST® costs USD 47,884 vs. 57.372 USD for "no intervention"). As compared to liraglutide and naltrexone/bupropion, OPTIFAST® program is associated with cost savings of USD 13,804 and USD 6,006, respectively (liraglutide cost USD 61,688; naltrexone/bupropion: USD 53,890). Scenario analysis show even more significant cost savings in individuals with severe obesity (class III) and over a longer time perspective (5 and 10 years). ConClusions: The OPTIFAST® program for obesity class I and II provides a cost saving weight management intervention for employees as compared to "no intervention", liraglutide 3 mg, and naltrexone/ bupropion for a US self-insured employer.
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