A297 respectively (P< .05 vs placebo). CONCLUSIONS: These findings suggest that PHEN/ TPM ER-enhanced WL is associated with a reduction in annual medication costs vs placebo in patients with MetS.
cine for use in immunocompetent adults aged 60 years and older, HZ continues to impact the American public and a better understanding of its current incidence is needed. METHODS: This was a retrospective analysis using the Truven Health MarketScan® databases from 2011. Cases were identified by a diagnosis code for HZ (ICD-9-CM: 053.xx) and must have been enrolled as of January 1, 2011, lacked a claim for shingles vaccination or HZ in the 90 days prior to this date, and been deemed immunocompetent according to the study criteria. Annual incidence rates were calculated for the entire population observed in the database as well as by gender and age group; standardized incidence rates were also produced using the 2010 U.S. Census data. RESULTS: The annual incidence rate of HZ across all ages of the study population in 2011 was 4.47 per 1000 person-years (95% CI: 4.45, 4.50). This rate increased monotonically with age, ranging from 0.86 (95% CI: 0.84, 0.88) for those aged ≤ 19 to 12.78 (95% CI: 12.49, 13.07) for immunocompetent enrollees aged 80 and older. The incidence rate was 8.46 (95% CI: 8.39, 8.52) among adults 50 years and older and 10.46 (95% CI: 10.35, 10.56) among those aged 60 years and older. The annual incidence rate of HZ was higher in women than men ((5.25, 95% CI: 5.21, 5.29 and 3.66, 95% CI: 3.62, 3.69), respectively) and was seen across all age groups. When standardized using 2010 U.S. Census data, the annual incidence rate was 4.63 per 1000 person-years (95% CI: 4.61, 4.66). CONCLUSIONS: Herpes zoster remains common among immunocompetent adults with incidence rates of HZ observed to increase with age and be higher in women than men.
Problema: As Diretrizes Curriculares Nacionais para os cursos de Medicina preconizam a rede de saúde como o principal lócus de formação acadêmica, o que permite a integração do ensino ao Sistema Único de Saúde (SUS). Para atender a essa prerrogativa, novas estratégias de ensino-aprendizagem devem ser adotadas pelas instituições em colaboração com o sistema de saúde. Método: Relato de experiência de docente e de residentes de Medicina de Família e Comunidade sobre o desenvolvimento das atividades de estágio de docência em disciplina inicial de um curso de graduação em Medicina. A interação do docente e dos residentes com os estudantes de Medicina foi realizada no formato online em razão da pandemia do SARS-CoV-2. Resultados: Houve o desenvolvimento de atividades de ensino na rede de saúde, com vivências práticas dos princípios do SUS e da Atenção primária à Saúde. Conclusão: A congregação dos conhecimentos dos graduandos e dos médicos residentes uniu as necessidades de aprendizagem e promoveu uma interação criativa e reflexiva entre os jovens médicos e os ingressantes do curso de Medicina. A iniciativa foi relevante para a iniciação à docência dos médicos residentes e para o aprendizado inicial dos graduandos.
To profile the use of an operator in immunobiological supplemental health Fortaleza -Brazil, to identify the most prescribed therapeutic regimens and costs. METHODS: Cross-sectional study in two hospitals accredited service provider, from March to November/2012. Data were recorded by medical expertise in computerized management system (Sabius ® ) performed after the medical consultation. Later, these were entered in Microsoft Excell 2007 and analyzed by pharmacists auditors. The cost was calculated from the value contained in Brasíndice Unit 765, using the Consumer Price Max. The doses used for rheumatoid arthritis Etanercept 50 mg, 40 mg Adalimumab, abatacept 750 mg, 300 mg infliximab, 560 mg Tocilizimabe, Rituximab 1g and Golimumab 50 mg based on a 70 kg adult. RESULTS: We analyzed 64 patients with a mean weight 67 kg, of which 70.31% (n = 45) were women aged 30-59 years whose most frequent indications were rheumatoid arthritis (n = 33, 51.56%) and ankylosing spondylitis (n = 19; 29.69%). The most immunobiological commonly prescribed were Infliximab (n = 36; 56.25%), Tocilizimabe (n = 11, 17.19%), abatacept, and Rituximab (n = 8; 12, 50%) and golimumab (n = 1, 1.56%). It was observed that 67% (n = 43) patients were naïve immunobiological and 33% (n = 21) initiated with anti-TNF, whereas 61.9% (n = 13) moved into one another with immunobiological mechanism of action and 38.1% (n = 8) continued with an anti-TNF, changing only the drug. The average cost of treatment/dose first line
Objectives: European registries of Rheumatoid Arthritis (RA) patients treated by biological agents suggest that 70-80% are maintained in first line at 1 year despite potential insufficient efficacy. Post hoc analyses of certolizumab pegol (CZP) studies indicate that a 3 month clinical response had a high predictive value of the 1 year outcome. The objective was to examine the efficiency of a strategy consisting of early switching from CZP to a second line TNF inhibitor in case of insufficient clinical response at 3 months (3M) in the French setting versus current clinical practices. MethOds: A decision-tree model was built to estimate the clinical outcomes (ACR50 cumulated time) and the direct costs of different cohorts of RA patients over a 2 year period. ACR50 was considered as an RA satisfying clinical outcome. The "3M tight control" strategy consisted of stopping CZP at 3 months in patients not achieving the ACR50 criterion and switching them to other biologics. Three reference cohorts treated with first line CZP, etanercept or adalimumab, respectively, according to current clinical practices were considered as comparators (reference). All TNF inhibitors were assumed to have equal efficacy in first line. Costs were estimated at 2013 French public prices. Results: The proportion of patients achieving ACR50 after a 2 year follow-up was 58% in all reference cohorts and 75% in the "3M tight control" CZP strategy cohort. The costs per patient-year in ACR50 were € 19,326 with the "3M tight control" strategy cohort and € 23,588, € 26,774 and € 30,285 for the CZP, etanercept and adalimumab reference cohorts, respectively. The strategy "3M tight control" had an incremental cost-effectiveness ratio of € 5,605/patient-year in ACR50 versus CZP reference, and was dominant versus etanercept or adalimumab reference. cOnclusiOns: A 3-month tight control management of RA patients with CZP as first line treatment is cost-effective compared to alternatives.
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