Background and Purpose Recombinant tissue plasminogen activator (rtPA) is one of the proven therapies that improve the outcome of patients with acute ischemic stroke (AIS). In 2009, the Ministry of Health and Welfare, Executive Yuan, Republic of China, launched the project “Hospital Emergent Capability Accreditation by Level-Stroke (HECAL-Stroke)” to improve AIS treatment in Taiwan. The current study was performed to determine whether the project launched by the government was effective in promoting rtPA therapy among AIS patients. Methods All participating hospitals were verified and designated as “heavy duty (HD),” “moderate duty (MoD),” or “medium duty (MeD)” according to the stroke center criteria. Four annual indices (rates of treatment, protocol adherence, in-time treatment, and complications) were recorded from 2009 to 2014 as outcome measures. The data were analyzed using the χ2 test for significance. Results The number of certified hospitals progressively increased from 74 to 112 during the 6-year period and finally consisted of 33 HD, 9 MoD and 70 MeD hospitals in 2014. The annual intravenous rtPA treatment rate increased significantly from 3.0% in 2009 to 4.5% in 2014. The protocol adherence rates were 95.7% in the HD group, 92.4% in the MoD group and 72.8% in the MeD group. The annual in-time treatment rate significantly improved from 26.0% in 2009 to 60.1% in 2014. The overall symptomatic intracranial hemorrhagic rate after rtPA treatment was 8.6%. Conclusions Initiation of the HECAL-Stroke project by the government significantly improved rtPA treatment in Taiwan.
Data on Norway's preparedness and surveillance -available from bodies and sites (URLs) comprise some of the following, The Norwegian Public Health Institute (fhi.no), The Directorate of Health (helsedirektoratet.no)including the general information given at The Norwegian Governmental Official site -(pandemi.no). The projections and scenarios given by these governmental bodies have been compared with data from Norwegian sources -as well as from -promedmail.org and WHO data, as of October 25, 2009 -from who.int/csr.Results: From the end of April 2009 to the end October 25, 2009 13 deaths were recorded. Many of these individuals had predisposing illnesses/ conditions, which may have contributed to a fatal outcome. The known impact has been 13 recorded deaths, so far, -not 13 000 deaths -i.e. one thousandth -in contrast to the worst-case scenario. Conclusion:The documentation above highlights uncertainties concerning projections made in an early epidemic/pandemic phase. It also might give reasons for caution -when extrapolating small data sets -in order to give short/intermediate term projections, to health professionals, as well as to the public in general.
Background and objectives: Haemophilus influenzae type b (Hib) vaccination is not a routine immunization service in Korea yet. This study was performed to estimate the disease burden of Hib and the cost-benefit of providing Hib vaccine to children in Korea.Method: We used the Rapid Assessment Tools (RATs) of WHO to estimate the pre-vaccination Hib incidence and mortality; one based on meningitis incidence in community and the other based on under 5 year mortality statistics in 2004. The fatality and sequelaes of Hib diseases were obtained from multi-center based registry data. The direct and indirect cost of Hib were calculated from the National Health Insurance data (hospitalization and outpatient cost) in 2004, National Health and Nutrition Survey(transport cost to hospitals), Report of Ministry of Labor (indirect cost of work loss and death) in 2004. Sensitivity analysis was done.Results: The annual incidence of Hib meningitis was 10.8(95% CI: 3.8-15.0) per 100,000 children <5 years and the case fatality rate was 6%. The average treatment cost for an Hib meningitis case was about US $ 2,157. For a fatal case, the average life time discounted economic loss was about US $ 849,085. The Total annual cost of Hib diseases was about US $ 42.5 million. The break-even vaccine price, where the annual vaccination costs equal annual Hib disease burden averted was US $ 23.3 per dose in base case scenario with 3% discount rate. In sensitivity analysis, due to the wide confidence interval of meningitis incidence rate, the burden of Hib was from 15.9 million to 58.6 million. Conclusion:In base case scenario, the routine Hib vaccination to children would be cost-benefit in Korea.
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