These cost estimates highlight the need to reduce sub-optimal diet via nutritional policies for the primary prevention of cancer. The results may serve as input for economic evaluation of diet-related prevention interventions for cancer burden in the U.S. Policy makers, public health practitioners, and clinicians may use this information to formulate evidence-based strategies for primary prevention of cancer through dietary interventions.
OBJETIVE: to assess the utility of a second 24-hours Holter monitoring for the diagnosis of paroxysmal atrial fibrillation (PAF) in patients with suspected cardioembolic ischemic stroke. METHODS: prospective study of ischemic stroke patients (brain infarction/TIA) treated in a Stroke Center (June 2010-February 2011). A first 24-hours Holter monitoring was performed if PAF was suspected and, if it was negative, a second 24-hours Holter monitoring was performed. Variables analyzed: demographic data, vascular risk factors, stroke severity and etiological subtype, presence of carotid plaques by duplex ultrasound, enlarged left atrial by transthoracic/transesophageal echocardiography and presence of chronic/acute brain infarctions by neuroimaging (CT/MRI). RESULTS: 219 patients included, mean age 69.8 (SD 13.5) years, 55.3% male. 17.8% have previous atrial fibrillation (AF). In 14 (6.4%) patients AF was diagnosed by ECG on admission or by serial ECG in the Stroke Unit. 24-hours Holter was performed in 101 patients to assess the presence of PAF, 85 cases during hospitalization and 16 at the outpatient clinic. This 24-hours Holter diagnosed PAF in 28.7% (29/101) of patients. A second 24-hours Holter was performed at the outpatient clinic in 21 cryptogenic brain ischemia patients. The mean time from the first to the second Holter was 143.3 (SD 72.2) days. This second 24-hours Holter detected PAF in 2 (9.5%) patients. CONCLUSION: a second 24-hours Holter monitoring at the outpatient clinic could detect PAF in almost 10% of cryptogenic ischemic stroke patients.
Objectives: Cervical dystonia (CD), pediatric lower-limb (PLL) and adult upper-limb (AUL) spasticity are disabling conditions. Treatment consists of physiotherapy and botulinum neurotoxin type A (BoNT-A) injections, in some cases, combined with an oral therapy. In the UK, healthcare resource use (RU) for these conditions is not wellreported. The objective was to characterize RU among patients responding to BoNT-A therapy versus BoNT-A non-responders. Methods: An RU questionnaire was administered to a geographically representative sample of UK physicians regularly treating CD (n=12), PLL (n=12) and AUL (n=11). Respondents had experience with different BoNT-As, broadly consistent with UK market trends. Questionnaire results were analysed; ranges of numerical responses were reported. Results: CD patients not responding to BoNTA-As were reported to have higher use of baclofen than responders: 30% (range:5% to 40%) vs. 0% (0% to 10%), with an average daily cost/person of £10.95 (£2.19 to £21.90). Use of other medications (trihexyphenidyl/benzodiazepines/gabapentin/clonazepam) were similarly elevated in BoNT-A non-responders vs. responders. Consistent patterns were reported in PLL and AUL. Use of baclofen in PLL amounted to 90% (80% to 100%) among BoNT-A non-responders vs. 50% (10% to 80%) in responders. In AUL, these estimates were 50% (5% to 100%) vs. 25% (5% to 50%), respectively. Other RU elements (including physiotherapist, specialist, pain clinic, psychologist visits) was reported as comparable among BoNT-A non-and responders. Conclusions: A notable decrease was reported in medication use in BoNT-A responders compared to non-responders. In addition to cost-savings associated with medication avoidance, the potential for adverse events associated with the use of oral medications may also be reduced. Patients who do no respond to BoNT-As can become responders by doing necessary adjustments in the dose, muscles injected, and a BoNT-A choice. An observational study is warranted to validate RU in these patient populations.
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