The trend of carrying out a systematic review of systematic reviews has just been concentrated in clinical-effectiveness. In aspect of cost-effectiveness, there has not been any review of reviews implemented in economic evaluation of hepatitis. The aim of this study is to appraise qualitatively a range of systematic reviews of economic evaluation in case of hepatitis based on PRISMA guidelines. A systematic search was made on Medline, Science Direct, and Cochrane Library databases till August 2016. Search terms used were "review" OR ("literature" , "systematic") AND "economic evaluation" OR ("cost effectiveness" , "cost benefit" , "cost utility" , "cost minimization") AND "hepatitis" OR ("hep*" , "H?V"). A total of 25 articles researching economic evaluations of hepatitis were identified. Approximately three-forth of articles (n=18; 72%) are classified in "Intermediate" , following by "Bad" with five papers (20%). The categories "Very Bad" and "Good" share the last two papers. None of papers achieves the "Excellent". Seventeen is the most popular point gained by seven papers (28%). In short, PRISMA was proved to be an effective instrument due to its important role in assessing included reviews. Even though there are various systematic reviews of economic evaluation published, their qualities are not synchronous and the number of studies which was really carried out based on PRISMA is modest.
Objective: Systematic reviews of economic analysis are necessary for assessing reports and making a decision. A systematic review of systematic reviews is mean of summarizing the current evidence across specialties of the same or very similar intervention, to provide a synthesis treatment effect. The aim of this study was to explore and to assess the quality of systematic reviews conducted hepatitis economic evaluation.Methods: This study was designed as a systematic review following the AMSTAR guideline through Medline, Cochrane, and Science Direct databases. It was scoped in publication period of 2001 and 2016 in international journals. The quality assessment of the included studies was based on AMSTAR checklist. Two authors did the appreciation independently and all the different results were solved by discussion to give the conclusion.Results: 851 publications found, only 25 studies of those met the inclusion criteria. These studies consisted of 5 studies for vaccination and 20 for non-vaccination. There were only 16% (n=4) based on PRISMA guideline; and twenty-one studies (64%) were not showing about the method of the systematic review or not based on any guideline. Only three articles has published in 2016 with a high standard. Conclusion:According to the results of the appraisal AMSTAR checklist, this review shows clearly the current situation and an urgent need for an increase of quality of hepatitis virus review studies based on health economic evaluation.
Isotretinoin, an oral retinoid derived from vitamin A, is one of the most effective medications in the treatment of severe acne vulgaris. However, it carries serious risks due to the teratogenic nature of the drug. The iPledge national programme in the USA has been founded to reduce and prevent adverse isotretinoin reactions and complications by ensuring its safe use by patients. Owing to the strict monitoring parameters of isotretinoin, an increased workload is placed on prescribing physicians for accurate and timely iPledge authorization, comprehensive counselling, laboratory testing and many patient follow-up visits. The most commonly reported reasons for delay were iPledge-related, including issues navigating the iPledge website, missed pick-up windows, and missed or delayed doctor appointments or laboratory tests. To remedy the difficulties with isotretinoin monitoring, physicians can look to clinical pharmacists as a valuable asset to their practice. Because clinical pharmacists are well trained in isotretinoin dispensing and iPledge regulation and consultation, they can play a crucial role in the management and education of patients with severe acne vulgaris. This retrospective, longitudinal case study takes place at a multispeciality clinic with internal medicine, rheumatology and dermatology. At this multispecialty clinic, a clinical pharmacist will be integrated into the practice with complete patient appointments and isotretinoin follow-ups under the training and direction of a dermatological specialist. The initial evaluation, diagnosis and prescribing of isotretinoin will be completed by the physician. The clinical pharmacist will follow-up the patients in subsequent visits in conjunction with the physician. The study population is approximately 50 patients with existing diagnoses of severe acne vulgaris. The inclusion criteria will include patients with acne who complete a clinical pharmacist visit for isotretinoin acne treatment from September 2022 to March 2023. At each follow-up clinical pharmacist visit, patients receive management and counselling on medications, a review of laboratory values, iPledge verification, and monitoring of symptoms and quality of life. Primary outcomes are patient symptoms and quality of life, acne grade and severity and side-effects; secondary outcomes are navigation of the iPledge website, number of misses in pick-up windows and doctor appointment adherence. The preliminary results showed significant improvement in primary and secondary outcomes. Patient acne grade decreased, while satisfaction increased; there was also a decreased risk of missed pick-up windows and improved doctor appointment adherence compared with the national standard. In addition, a clinical pharmacist-led iPledge programme can substantially reduce the time required for administrative work on managing isotretinoin while maintaining the same quality of care for patients with severe acne.
Purpose Frailty and type 2 diabetes mellitus (T2DM) can occur concurrently and are increasingly prevalent in older populations. There is a marked variability in frailty progression between men and women. This study aimed to investigate sex differences in the prevalence and factors associated with frailty in older outpatients with T2DM. Methods This multicentre cross-sectional study included 638 outpatients (aged ≥60 years; mean age 71.9±7.2 years; male 55.5%) and was conducted from January 2019 to July 2020. Frailty was assessed using the Fried frailty phenotype. Factors associated with frailty were assessed using a logistic regression analysis. Results The overall frailty prevalence was 28.2% (men, 26.8%; women, 29.9%; P=0.388). In the adjusted model, the factors associated with greater odds of being frail were older age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.05-1.11; P<0.001) and body mass index (BMI) less than 20 kg/m2 (OR, 1.96; 95% CI, 1.16-3.32; P=0.012). Higher education (OR, 0.64; 95% CI, 0.42-0.98; P=0.041) and productive work (OR, 0.11; 95% CI, 0.03-0.36; P<0.001) were protective factors against frailty. Frailty was associated with all four factors in women, but only with older age and productive work in men.Conclusion Women were more likely to be frail compared with men with T2DM, although the difference was not significant. While older age and BMI less than 20 kg/m2 can increase the odds of frailty, and higher education and productive work can decrease the odds of frailty in women, only age and productive work were associated with frailty in men with T2DM.
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