Patient education materials (PEMs) are a powerful tool to improve patient comprehension and disease self-management. However, poor health literacy is a well-established barrier for PEMs to serve their purpose. 1 The average American reads at an 8th grade level; however, the National Institute of Health (NIH) recommendation for PEMs is at the 6th grade level. 2 Dermatology PEMs routinely have reading levels above the national recommendations. 3,4 This is unsurprising, as dermatology involves complex terminology that is often an unavoidable component of patient education-referred to hereafter as "educational content" (ie, use of "melanoma" in a PEM about concerning moles). 5 Low health literacy has led to improper use of medications and overall increased morbidity. 4 This poses a particularly significant challenge in the pediatric population, as appropriately caring for a child's skin needs is contingent on effective communication between physician and parent. Outlining a detailed method for generating dermatology PEMs that balances the delicate interplay between readability and educational content stands to greatly benefit physician-patient communication. This study aimed to assess and optimize pediatric dermatology PEMs to identify which specific changes are most effective at lowering reading level without diluting educational content.
Objective Compare the cost-effectiveness of subcutaneous immunotherapy (SCIT) and aqueous sublingual immunotherapy (SLIT) as treatment modalities for adult patients with allergic rhinitis and conjunctivitis who undergo testing and qualify for allergen immunotherapy (AIT). Methods A systematic review was performed to identify key statistics for analysis, including the compliance and efficacy rates for each treatment. The body of literature on this topic is highly heterogeneous, so ranges were obtained and assumptions stated clearly where they were made. Charges were derived from average commercial payor charges from a single hospital institution. A hypothetical 100 patients are examined for the study. Results A cost-effectiveness sensitivity analysis was then performed using a decision tree model to compare the modalities. A sensitivity and threshold analysis was then performed to assess the strength of recommendations after identifying results at baseline. Discussion Assuming an 80% compliance rate with allergen immunotherapy and an estimated efficacy (assumed to be clinically significant improvement in symptoms) of 70% for SLIT and 80% for SCIT, at the 12-month mark, the baseline total cost to the payor of SLIT per successful treatment outcome is $1196 while the charge of SCIT per successful treatment outcome is $2691. Our analysis favors SLIT as the more cost-effective modality per successful outcome. Implications for Practice When compared to SCIT, SLIT is economically favorable and should be considered the financially conscious option for patients with >40% adherence to therapy.
Ornithine transcarbamylase (OTC) deficiency is an incredibly rare disease in the subgroup of urea cycle disorders. Although typically seen in the neonate shortly after initiating high protein feeds (human breastmilk or infant formula), patients with partial/heterozygous deficiencies can often be diagnosed later in life with unique sequelae. One such manifestation is sudden, transient vision loss shortly after an initial episode of hyperammonemia in a patient without a known diagnosis of OTC deficiency. Only two such occurrences are documented in academic literature and both share many similar presenting features hinting that a hidden, but the consistent pathophysiologic mechanism of this disease is at play. Scarce research is available to propose a concise explanation; however, recent advancements in the literature point toward the brain's inability to uptake glucose and convert it into glutamate in patients with partial OTC deficiency as a likely explanation.
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