BackgroundIn vitro diagnostic (IVD) investigations are indispensable for routine patient management. Appropriate testing allows early-stage interventions, reducing late-stage healthcare expenditure (HCE).AimTo investigate HCE on IVDs in two developed markets and to assess the perceived value of IVDs on clinical decision-making. Physician-perceived HCE on IVD was evaluated, as well as desired features of new diagnostic markers.MethodsPast and current HCE on IVD was calculated for the US and Germany. A total of 79 US/German oncologists and cardiologists were interviewed to assess the number of cases where: physicians ask for IVDs; IVDs are used for initial diagnosis, treatment monitoring, or post-treatment; and decision-making is based on an IVD test result. A sample of 201 US and German oncologists and cardiologists was questioned regarding the proportion of HCE they believed to be attributable to IVD testing. After disclosing the actual IVD HCE, the physician’s perception of the appropriateness of the amount was captured. Finally, the association between physician-rated impact of IVD on decision-making and perceived contribution of IVD expenditure on overall HCE was assessed.ResultsIVD costs account for 2.3% and 1.4% of total HCE in the US and Germany. Most physicians (81%) believed that the actual HCE on IVDs was >5%; 19% rated the spending correctly (0–4%, p<0.001). When informed of the actual amount, 64% of physicians rated this as appropriate (p<0.0001); 66% of decision-making was based on IVD. Significantly, more physicians asked for either additional clinical or combined clinical/health economic data than for the product (test/platform) alone (p<0.0001).ConclusionsOur results indicate a poor awareness of actual HCE on IVD, but a high attributable value of diagnostic procedures for patient management. New markers should deliver actionable and medically relevant information, to guide decision-making and foster improved patient outcomes.
BackgroundCancer of unknown primary (CUP) is a distinct clinicopathological entity with poor prognosis, frequently resistant to chemotherapy. Comprehensive genomic profiling (CGP) by next‐generation sequencing potentially identifies novel treatment options for CUP patients. The objective of this study was to determine incidence and survival trends and to discuss the value of CGP in CUP patients.MethodsAge‐standardized incidence rates (ASR) per 100 000 were calculated for 2935 CUP patients from 1981 to 2014 using cancer registry data of the canton of Zurich, Switzerland. Kaplan–Meier survival curves were estimated for sex, age, and histological groups. Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HR). A literature review was conducted to assess the current use of CGP in CUP patients.ResultsASR of CUP increased from 10.3 to 17.6 between 1981 and 1997 and decreased to 5.8/100 000 in 2014. Mean overall survival remained stable. Mortality was significantly lower for patients with squamous cell carcinoma (HR 0.48 [95% CI, 0.41‐0.57]) and neuroendocrine carcinoma (0.75 [0.63‐0.88]) and higher for unclassified neoplasms (1.25 [1.13‐1.66]) compared to adenocarcinomas. The literature review identified 10 studies using CGP of CUP tissue. Clinically relevant mutations were identified in up to 85% of CUP patients, of which 13%‐64% may benefit from currently available drugs.ConclusionsCUP incidence decreased probably due to improved diagnostics, but mortality did not improve over the last 34 years. CGP testing may help to identify molecular signatures in CUP patients and enable targeted treatment.
For successful peripheral nerve regeneration, a complex interplay of growth factors, topographical guidance structure by cells and extracellular matrix proteins, are needed. Aligned fibrous biomaterials with a wide variety in fiber diameter have been used successfully to support neuronal guidance. To better understand the importance of size of the topographical features, we investigated the directionality of neuronal migration of sensory ND7/23 cells on aligned electrospun poly(lactic-glycolic acid) PLGA fibers in the range of micrometer and submicrometer diameters by time-lapse microscopy. Cell trajectories of single ND7/23 cells were found to significantly follow topographies of PLGA fibers with micrometer dimensions in contrast to PLGA fibers within the submicrometer range, where cell body movement was observed to be independent of fibrous structures. Moreover, neurite alignment of ND7/23 cells on various topographies was assessed. PLGA fibers with micrometer dimensions significantly aligned 83.3% of all neurites after 1 day of differentiation compared to similar submicrometer structures, which orientated 25.8% of all neurites. Interestingly, after 7 days of differentiation ND7/23 cells on submicrometer PLGA fibers increased their alignment of neurites to 52.5%. Together, aligned PLGA fibers with micrometer dimensions showed a superior influence on directionality of neuronal migration and neurite outgrowth of sensory ND7/23 cells, indicating that electrospun micro-PLGA fibers might represent a potential material to induce directionality of neuronal growth in engineering applications for sensory nerve regeneration.
Die kontinuierliche Zunahme chronisch kranker und immer älter werdender Patientinnen und Patienten sowie die zunehmende Verknappung hausärztlicher Ressourcen, stellt das Gesundheitswesen vor immer grössere Herausforderungen im Management dieses Patientenkollektivs [1]. Neue Ansätze sind gefragt und werden im Rahmen von sogenannten Chronic Care Management(CCM)-Modellen seit Längerem diskutiert und eingesetzt [2-4]. Auch in der Schweiz werden solche Modelle bereits angewandt [5-7]. Dabei spielt die interprofessionelle Zusammenarbeit, genauer die Abstimmung zwischen den Gesundheitsfachpersonen, und die Qualität der Zusammenarbeit eine grosse Rolle
Die Herausforderungen in der Betreuung chronisch KrankerWeltweit nimmt die Zahl der chronischen Erkrankungen stetig zu [1]. 2012 machten sie weltweit bereits über zwei Drittel der Todesfälle aus und führten zu hohen menschlichen, sozialen und ökonomischen Kosten [1]. Die Schweiz bildet dabei keine Ausnahme, und WHO, OECD sowie der Bund warnen vor einer weiteren Zunahme der Zahl von Patientinnen und Patienten mit chronischen Erkrankungen [2, 3]. Verhaltensbedingte Risikofaktoren wie ungesunde Ernährung und Bewegungsmangel haben einen grossen Anteil an deren Entstehung [1, 3]. Daher sind bei chronischen Krankheiten wie Diabetes mellitus, Adipositas oder Herz-Kreislauf-Erkrankungen langfristige Veränderungen des Ernährungsverhaltens auch in der ersten Stufe der Therapie enthalten [2, 4-7]. Ambulante Ernährungsberatung wird klassischerweise in Ernährungsberatungspraxen oder Ambulatorien von Spitälern erbracht. Diese örtliche Distanz zur Hausarztpraxis bringt jedoch Barrieren für eine optimale Zusammenarbeit mit Aufgrund der steigenden Zahl chronisch Kranker sind neue Ansätze gefragt, um diese Menschen möglichst effizient und effektiv zu betreuen. Dabei spielen interprofessionelle Zusammenarbeiten und technologische Möglichkeiten eine wichtige Rolle. Ein Beispiel dazu ist die technologisch unterstützte Ernährungsberatung, integriert in die lokale Arztpraxis. Viele Patienten wünschen sich, ergänzend zur klassischen Ernährungsberatung vor Ort, eine Fernberatung.
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