• Title, Summary, Keyword: clinical benefit

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Cost-Benefit Analysis of Clinical Pharmacokinetic Consultation Service of Theophylline (테오필린에 대한 약물동력학 자문서비스의 비용-편익분석)

  • Han, Euna;Yang, Bong-Min;Lee, Eui-Kyung
    • Quality Improvement in Health Care
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    • v.7 no.2
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    • pp.168-179
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    • 2000
  • Background : Economic evaluation of clinical pharmacokinetic consultation services for theophylline, which is being widely used recently, is considered in patients for both proper care and cost efficiency. Mathods : This is a cost-benefit analysis of clinical pharmacokinetic consultation service for theophylline. Trial groups were chosen from 2 general hospitals which was performing clinical pharmacokinetic consultation- services in 1998. Control group was chosen from another one general hospital. The analysis includes 25 patients (sample patients) for trial group and 17 patients for control group. Results : On the basis of incremental analysis, it is estimated that the total (direct and indirect) annual costs of the clinical, pharmacokinetic services of theophylline for the patients in the trial group was about \65 million, whereas total annual benefits from those services was estimated to be about \551 million. The net benefits incurred to the sample patients, thus calculated, was about \485 million per year. In the analysis, we assumed that indirect benefits accruing to those services were non-existent. If that amount was included, the estimated net benefits would be much greater than the calculated one. Conclusion : We found that clinical pharmacokinetic consultation services for theophylline could produce more marginal benefits than marginal costs by those services from the social point of view. More controlled prospective trial in the future would be helpful for affirmation of the results of this study.

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The Intelligent Clinical Laboratory as a Tool to Increase Cancer Care Management Productivity

  • Mohammadzadeh, Niloofar;Safdari, Reza
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.6
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    • pp.2935-2937
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    • 2014
  • Studies of the causes of cancer, early detection, prevention or treatment need accurate, comprehensive, and timely cancer data. The clinical laboratory provides important cancer information needed for physicians which influence clinical decisions regarding treatment, diagnosis and patient monitoring. Poor communication between health care providers and clinical laboratory personnel can lead to medical errors and wrong decisions in providing cancer care. Because of the key impact of laboratory information on cancer diagnosis and treatment the quality of the tests, lab reports, and appropriate lab management are very important. A laboratory information management system (LIMS) can have an important role in diagnosis, fast and effective access to cancer data, decrease redundancy and costs, and facilitate the integration and collection of data from different types of instruments and systems. In spite of significant advantages LIMS is limited by factors such as problems in adaption to new instruments that may change existing work processes. Applications of intelligent software simultaneously with existing information systems, in addition to remove these restrictions, have important benefits including adding additional non-laboratory-generated information to the reports, facilitating decision making, and improving quality and productivity of cancer care services. Laboratory systems must have flexibility to change and have the capability to develop and benefit from intelligent devices. Intelligent laboratory information management systems need to benefit from informatics tools and latest technologies like open sources. The aim of this commentary is to survey application, opportunities and necessity of intelligent clinical laboratory as a tool to increase cancer care management productivity.

Clinical factors affecting the outcome of arthocentesis

  • Andrabi, Syed Wakeel;Malik, Altaf H.;Shah, Ajaz A.
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.45 no.1
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    • pp.9-14
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    • 2019
  • Objectives: This study aimed to evaluate the effect of clinical factors on the outcome of arthrocentesis in the treatment of temporomandibular joint (TMJ) internal derangement. Materials and Methods: Fifty patients with TMJ internal derangement underwent arthrocentesis using ringer's lactate. The present study evaluated the contribution of the clinical variables of age, time since onset, visual analogue scale (VAS) pain level, and range of motion (ROM) on the outcomes of TMJ arthrocentesis: age (${\leq}25\;years$, >25 and ${\leq}40\;years$, >40 and ${\leq}60\;years$), VAS pain level (${\leq}5$, >5 and ${\leq}7$, >7 and ${\leq}10$), and ROM (<25 and ${\geq}25mm$). Odds ratios (ORs) were used to describe the proportional benefit of each variable the on successful outcome of arthrocentesis. For the OR to be clinically relevant or even clinically noticeable, we assumed that the OR would need to be larger than 2. Results: Mean preoperative pain score was $6.49{\pm}1.560$ and at 6 months postoperative was $0.46{\pm}1.147$ with an average decrease of pain score 6 (P<0.001). The mean preoperactive maximum mouth opening was $26.14{\pm}4.969mm$ and mean maximum mouth opening at 6-month inerval was $38.92{\pm}3.392mm$. The mean increase in the mouth opening was a mean difference of 12.78 mm (P<0.001). Logistic regression showed that the maximum benefit occurred in patients aged <25 years (OR, 12.01; P=0.012), a VAS pain level of >7 (OR, 11.25; P=0.039), and a maximum vertical opening of <25 mm (OR, 7.70; P=0.038). Conclusion: Lavage of the superior joint space with ringer's lactate resulted in significant reduction in pain and improvement in mouth opening. Patients with a greater inflammatory component and younger patients benefitted more from arthrocentesis. Evaluation of these clinical variables helped in predictive modelling, which may provide clinicians with the opportunity to identify "at-benefit" patients early and initiate specific treatment.

Acupuncture as Adjuvant Therapy for Sleep Disorders in Parkinson's Disease

  • de Amorim Aroxa, Fabio Henrique;de Oliveira Gondim, Ihana Thais Guerra;Santos, Elba Lucia Wanderley;de Sales Coriolano, Maria das Gracas Wanderley;Asano, Amdore Guescel C.;Asano, Nadja Maria Jorge
    • Journal of Acupuncture & Meridian Studies
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    • v.10 no.1
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    • pp.33-38
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    • 2017
  • There are few studies which attest the efficacy of acupuncture on treatment of sleep disturbs in Parkinson disease. The aimed of this randomized clinical trial was to evaluate the effects of acupuncture on sleep disturbs of 22 patients with diagnosis of idiopathic Parkinson disease (Hoehn-Yahr 1 to 3) who have assistance on the Pro-Parkinson Program of Clinical Hospital at Federal University of Pernambuco in Brazil. All participants were evaluated by Parkinson Disease Sleep Scale (PDSS) before and after 8 weeks. The experimental group was submitted to 8 sections (once a week) which had duration of 30 minutes. The control group had no intervention. The intervention was executed using the acupuncture points LR3 (Taichong), SP6 (Sanyinjiao), LI4 (Hegu), TE5 (Wai-Guan), HT7 (Shenmen), PC6 (Neiguan), LI11 (Quchi), GB20 (Fengchi). Paired analyses were obtained by Wilcoxon test and independent analyses were made according to Mann-Whitney test. This study presented a potential therapeutic benefit of acupuncture on sleep disturbs of Parkinson's disease patients. This study showed a possible therapeutic benefit through acupuncture in sleep disorders in patients with PD. However, we propose new studies related to the effects of acupuncture on the clinical symptoms and evolution of the disease.

A Study on "Compendium of Matria Medica(本草綱目)"'s Influence to "Secret Works of Universal Benefit(廣濟秘笈)" - Focused on Experience by Simple Formulae using Korean herbs - ("본초강목(本草綱目)"이 "광제비급(廣濟秘笈)"에 미친 영향 분석 - "향약단방치험(鄕藥單方治驗)"을 중심으로 -)

  • Oh, Chae-Kun;Yoon, Chang-Yeol
    • Journal of Korean Medical classics
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    • v.22 no.3
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    • pp.337-346
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    • 2009
  • "Secret Works of Universal Benefit" was compiled by Lee Gyeonghwa(李景華, 1721-?) in Choseon Dynasty. Experience by Simple Formulae using Korean herbs in Secret Works of Universal Benefit was recorded Hangul name[鄕名], main medicinal effect and how to use etc. of 50 Korean herbs[鄕藥] to give aid to country people who didn't have medical knowledge. Secret Works of Universal Benefit have passed on traditional Korean medicine as selecting 50 Korean herbs and recording Hangul name. Though most of Experience by Simple Formulae using Korean herbs[鄕藥單方治驗] was quoted "Compendium of Matria Medica", it reflected developing of Korean traditional herb science[本草學] as selecting herbs, arranging frequent symptoms, changing main effect of herbs, and adding clinical experiences.

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FDG-PET in Gynecologic Cancer (부인암에서 FDG-PET의 역할)

  • Ryu, Sang-Young
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.1
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    • pp.46-52
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    • 2002
  • Whole-body positron emission tomography (PET) imaging with 18-F deoxyglucose (FDG) is a molecular imaging modality that detects metabolic alteration in tumor cells. In various human cancers, FDG-PET shows a potential clinical benefit in screening, tumor characterization, staging, therapeutic follow-up and detecting recurrence. In gynecologic cancers, FDG-PET is also known to be effective in characterization of adnexal masses, detection of recurrence, and lymph node invasion. This review discusses the clinical feasibility and future clinical application of this imaging modality in patients with cervical cancer, ovarian cancer, and other gynecologic cancers.

The Effectiveness Evaluation of Helicopter Ambulance Transport among Neurotrauma Patients in Korea

  • Park, Kyoung Duck;Seo, Sook Jin;Oh, Chang Hyun;Kim, Se Hyuk;Cho, Jin Mo
    • Journal of Korean Neurosurgical Society
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    • v.56 no.1
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    • pp.42-47
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    • 2014
  • Objective : Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. Methods : This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. Results : Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). Conclusion : In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.

Understanding of Clinical Trials and Application to the Real Practice (임상시험의 단계별 이해 및 실제)

  • Choi, SungKu
    • Korean Journal of Biological Psychiatry
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    • v.19 no.4
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    • pp.153-158
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    • 2012
  • Understanding of a clinical trial is essential in developing clinical guideline and adopting evidence based practice. In designing and executing clinical trials, following ethical requirements should be considered : social value, scientific validity, fair subject selection, informed consent, favorable risk-benefit ratio, institutional review board, and respect for human subjects. According to the stage of drug development, purpose of trials, accumulated scientific data, clinical trials for drug development are classified as phase 1, 2, 3, and 4. Phases of clinical trials can be overlapped and the judgment of entering into the next phase should be considered highly strategically. In reading, evaluating and interpreting clinical trial reports, various skills and challenges exist. Patient sample composition, trial duration, selection of endpoints, responders and non-responders, placebo effect, patient recruitment, and extrapolation to the real world are the examples of those challenges. Treatment success will come from the well balanced approach of evidence based decision making and consideration of specific single case.

Efficacy of Exemestane After Nonsteroidal Aromatase inhibitor Use in Metastatic Breast Cancer Patients

  • Kim, Sun-Hye;Park, In-Hae;Lee, Hye-Won;Lee, Keun-Seok;Nam, Byung-Ho;Ro, Jung-Sil
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.3
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    • pp.979-983
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    • 2012
  • Background : Previous studies have suggested a lack of complete cross-resistance between steroidal (exemestane) and non-steroidal aromatase inhibitors (nSAI). Methods : Eighty-eight metastatic breast cancer (MBC) patients who received 25 mg of exemestane orally once a day at the National Cancer Center, Korea, between 2003 and 2009, were reviewed retrospectively. All patients had received nSAI for metastatic disease prior to exemestane therapy. Results : The median age was 52 years (range, 33-79), and 13 (14.8%) patients were premenopausal who concomitantly received GnRH agonist. Exemestane was given as a second- (80.7%) or third-line (19.3%) hormone therapy. The clinical benefit (CB) rate (complete response + partial response + stable disease ${\geq}$ 24 weeks) was 30.7%, with a median CB duration of 10.0 months (range, 6.3-78.7). The median progression-free survival (PFS) was 3.0 months (95% confidence interval [CI], 1.99-4.01) and the overall survival (OS) 21.5 months (95% CI, 17.96-25.04), with a median followup of 50.3 months. Patients who achieved CB had longer OS than those patients who did not (29.6 vs 17.9 months; P=0.002). On univariate analysis of predictive factors, patients who had achieved CB from previous nSAI tended to show lower CB rate (24.6% vs 44.4%, respectively; P=0.063) and shorter PFS (2.8 vs 4.8 months, respectively; p=0.233) than patients who had not. Achieving CB from previous nSAI became independent predictive factor for CBR to exemestane on multivariable analysis (Odds ratio = 2.852, P = 0.040). Conclusions : Exemestane after nSAI failure was effective in prolonging CB duration. The drug's efficacy seemed to be inferior in patients who had benefit from previous nSAI use.

Factors Associated with Favorable Outcome of Topiramate Migraine Prophylaxis in Pediatric Patients

  • Yoo, Il Han;Kim, WooJoong;Kim, Hunmin;Lim, Byung Chan;Hwang, Hee;Chae, Jong-Hee;Choi, Jieun;Kim, Ki Joong
    • Journal of clinical neurology
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    • v.13 no.3
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    • pp.281-286
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    • 2017
  • Background and Purpose There are few studies that have investigated predictive factors related to migraine prophylaxis of which produced inconsistent results. The aim of this study was to identify factors that can predict the treatment response to topiramate prophylaxis in pediatric patients with migraine. Methods One hundred and thirteen patients who were older than 7 years and received topiramate for at least 3 months were recruited from the Seoul National University Bundang Hospital outpatient clinic from 2005 to 2014. A positive response was defined as a reduction of more than 50% in the number of migraine episodes after topiramate treatment. Proposed predictive factors such as migraine characteristics including severity and frequency were assessed, as were other data on sex, disease duration, associated symptoms, family history, and impairment of daily activities. Results Seventy patients (61.9%) responded to prophylactic treatment with topiramate. Patients who experienced significant impairment in daily activities showed significant benefit from the treatment (p=0.004). Sex, the severity, frequency, and duration of migraine episodes, disease duration, treatment duration, age at onset, and associated symptoms were not significantly related to a response to topiramate treatment. Conclusions Migraine characteristics and associated symptoms were not significantly related to a response to topiramate treatment. However, patients with significant impairment in daily activities showed significant benefit from the treatment, and so prophylactic topiramate treatment should be strongly encouraged in this patient group.