A45Objectives: Patients undergoing cardiac surgery (CS) routinely receive intravenous (IV) crystalloids perioperatively (during and immediately post-surgery). A study using a large US electronic health record database, reported an association between the use of low-chloride IV crystalloids and improved outcomes. Here we examine the association between perioperative crystalloid choice and treatment costs among adults undergoing CS. MethOds: Patients who underwent CS between January 2009-June 2013 and received ≥ 500 mL of IV crystalloids within 1 day post-surgery, survived ≥ 1 day, and had recorded data on charges were included. Main exclusion criteria were hospital stay > 30 days and receipt of > 1 L IV fluids on the day before surgery. Patients were categorized as receiving either 0.9% saline exclusively as their primary IV fluid, Lactated Ringer's (LR), or a calcium-free balanced crystalloid (Plasma-Lyte (CF-BAL)). Outcomes were compared in three propensity-matched cohorts and included total cost, cost/day/patient, and length-of-stay (LOS). Costs were calculated using published cost-to-charge ratios. Results: In the propensitymatched cohorts (CF-BAL versus saline (n= 298 patients); CF-BAL versus LR (n= 516); LR versus saline (n= 2,930)), CF-BAL was associated with significantly lower total costs than either saline
OBJECTIVES: HCV infection in Egypt is one of the highest in the World. The objective of the study is to support Egyptian decision makers by comparing different treatment rates with the recent approved Hep C antiviral agents, and its implications on prevalence progress and associated costs. METHODS: The analysis was based on a 17-year Markov model.Patients would progress through the various HCV stages from F0 to F3 followed by cirrhosis. Following cirrhosis to other progressive stages up to hepatocellular carcinoma and liver related death. Patients could be cured spontaneously in state F0 or as a result of antiviral therapy in any state from F0 to cirrhosis at a cure rate of 92% in stages F0-F3 and a cure rate of 80% in the stage of cirrhosis. Cured patients would transition to the mortality risk of the age-matched general population. In each cycle, new incident patients were also introduced at a rate of approximately 128,000 or 2%. RESULTS: Treating 8% of the infected cases each year (450K viremic cases/year) would bring the prevalence to 1 million by 2030. A treatment rate of 1% (65Kcases/yr) or 5% (300Kcases/yr) would bring the prevalence to 5.5 million and 2.5 million respectively by 2030. Total annual costs would start at $1.3Billion in the first year of treatment for the 8% treatment rate but would decrease to $580million/yr by 2030. The 5% and 1% rates would start at $900million & $550million. CONCLUSIONS: A treatment rate of 450Kcases/yr would bring the prevalence to 1 million by 2030. Costs would be significantly high during the first 5 years, but eventually would dop as the disease burden decreases. Alternative scenarios wouldn't eliminate the disease by 2030. A screening policy need to be in place & health infrastructure assessed in preparation for the rising numbers of patients receiving treatment PIN45
Acupuncture use was nearly six times more common among chiropractic users than in the overall population (2.2% vs. 0.37%); similarly, nearly half (42.5%) of acupuncture users also had a claim for chiropractic. Over one-in-five patients (21.0%) with general joint or back pain used chiropractic, of which 2.65% also used acupuncture. CONCLUSIONS: Despite trends suggesting increased use of chiropractic and acupuncture, their use remains very low in commercial health insurance plans, including patients with inflammation and pain-related conditions. While still very low, acupuncture use was more common among chiropractic users than in the overall population.
were compared to respective baseline values using a paired t-test. Results: The full cohort consisted of 311 subjects, with 210 subjects in the ≥ 4months and 167 subjects in the ≥ 6months persistence groups. For all subjects, average age was 49.7 and subjects were predominantly white (77.5%) and female (83.0%). Average BMI was 40.7 kg/m2, and weight was 114.8 kg. At baseline, 74.9%, 19.9% and 5.1% of subjects had normoglycemia, prediabetes, and diabetes, respectively. Average baseline values for HbA1c and blood pressure were 5.8% and 127/77 mmHg. There was a significant change in body weight 6 months after initiation of treatment in persistent subjects (≥ 6months: -8.1 kg, p< 0.001). Weight loss was also significant for subjects persistent on treatment for ≥ 4months (-6.9 kg, p< 0.001) and in all subjects, regardless of persistence (-7.5 kg, p-value< 0.001). Percentage change in body weight from baseline for the ≥ 6months group was -7.1%, with 63.4% and 35.2% of subjects having lost ≥ 5% and > 10% body weight, respectively. Overall percentage change in body weight was also observed in the ≥ 4months group (-6.2%) and in all subjects (-6.6%). For the ≥ 6months treatment group, there was a statistically significant change in HbA1c (-0.35%, p< 0.001) and SBP (-3.0 mmHg, p< 0.01), but not DBP (0.1 mmHg, p= 0.90). ConClusions: In a real-world setting, liraglutide 3.0 mg, when combined with diet and exercise, was associated with clinically meaningful weight loss and with improvements in cardiometabolic markers. PSY11 Model-BaSed evaluation of the efficacY and SafetY of BuroSuMaB, a fullY huMan anti-fGf23 Monoclonal antiBodY, in adoleScent X-linked hYPoPhoSPhateMia (Xlh)
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