Ryynanen, Olli-Pekka;Leppanen, Timo;Kekolahti, Pekka;Mervaala, Esa;Toyras, Juha
Healthcare Informatics Research
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v.24
no.4
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pp.346-358
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2018
Objectives: The association between obstructive sleep apnea (OSA) and mortality or serious cardiovascular events over a long period of time is not clearly understood. The aim of this observational study was to estimate the clinical effectiveness of continuous positive airway pressure (CPAP) treatment on an outcome variable combining mortality, acute myocardial infarction (AMI), and cerebrovascular insult (CVI) during a follow-up period of 15.5 years ($186{\pm}58$ months). Methods: The data set consisted of 978 patients with an apnea-hypopnea index (AHI) ${\geq}5.0$. One-third had used CPAP treatment. For the first time, a data-driven causal Bayesian network (DDBN) and a hypothesis-driven causal Bayesian network (HDBN) were used to investigate the effectiveness of CPAP. Results: In the DDBN, coronary heart disease (CHD), congestive heart failure (CHF), and diuretic use were directly associated with the outcome variable. Sleep apnea parameters and CPAP treatment had no direct association with the outcome variable. In the HDBN, CPAP treatment showed an average improvement of 5.3 percentage points in the outcome. The greatest improvement was seen in patients aged ${\leq}55$ years. The effect of CPAP treatment was weaker in older patients (>55 years) and in patients with CHD. In CHF patients, CPAP treatment was associated with an increased risk of mortality, AMI, or CVI. Conclusions: The effectiveness of CPAP is modest in younger patients. Long-term effectiveness is limited in older patients and in patients with heart disease (CHD or CHF).
Objectives : The purpose of this study is to review the thread embedding treatment studies of obesity in Traditional Chinese Medicine. Methods : We reviewed 59 studies on cat-gut-embedding treatment of obesity which were published from 2005 to 2012. The studies were searched using the data base-CAJ(China Academic Journals; 中國期刊全文數據庫)(2005~2012). Results : Selected 59 studies were divided into 27 case series and 32 control studies. The number of studies has increased since 2005, more rapidly in 2011~2012. Most case series reported were about effectiveness of thread embedding monotherapy treating obesity. Control studies reported were about effectiveness of thread embedding treatment compared with acupuncture, electroacupuncture, and medicine. Most studies on thread embedding treatment of obesity showed that its effectiveness was very good. Conclusions : There have been many reports of thread embedding treatment studies of obesity in Traditional Chinese Medicine. We believed that these studies could be applied to the clinical practice and basic research in Korea.
The purpose of this study was to assess the effectiveness of myofascial release(MFR) technique and Taping therapy on the pain level in whiplash injury patients. Pain level were assessed prior treatment, after first treatment, after second treatment, after third treatment, after fourth treatment, and after fifth treatment. All 6 times were calculated pain level. To find out the effectiveness of MFR and Taping therapy, we were divide two groups. The one group was consisted of 25 patients that were treated with H/P, electrical therapy and MFR, and the other group was consisted of 25 patients that were treated with H/P, electrical therapy, and Taping therapy. The results were as follow: 1. There were statistical significance on the pain level in MFR group during all treatment periods(p<0.05). 2. There were statistical significance on the pain level in Taping group all during treatment periods(p<0.05). 3. Taping group had more statistical significance than MFR group on the pain level during all treatment periods(p<0.05). Consequently, this study suggest that Taping therapy has a very effectiveness to the whiplash injury patients.
Objectives We aimed to examine health-related economic analysis of available interventions on idiopathic short stature (ISS). Methods Eight studies were reviewed from English, Korean, and Chinese databases which were published up to December 24, 2020. Effectiveness, utility, and cost data were extracted from the studies and descriptive analysis of the individual studies was conducted Results Five studies were chosen. In the two economic evaluation studies, the incremental cost-effectiveness ratio (ICER) of growth hormone (GH) treatment was presented by performing cost-effectiveness analysis based on the deterministic decision tree approach for the GH and untreated group. Final adult height and direct medical costs were analyzed as effectiveness and cost outcomes. In 1 review article, an ICER of GH was presented based on systematic review on the effects of the GH treatment. In the two clinical trials, the effectiveness and cost of the 12 months Oriental medicine combination treatment were presented in comparison with the GH treatment alone. There were no literatures that provided utility data of available intervention on ISS. Conclusions The results of this study will be used as basic data for the economic analysis of Oriental medicine treatment on ISS in the future.
Human African Trypanosomiasis (HAT) also known as sleeping sickness, is a neglected tropical vector borne disease caused by trypanosome protozoa transmitted by bites of infected tsetse fly. The basic reproduction number, R0 derived using the next generation matrix method which shows that the disease persists in the population if the value of R0 > 1. The numerical simulations of optimal control model carried out to determine the control strategy that can combat HAT under the minimum cost. The results indicate that, the use of both education campaign, treatment and insecticides are more efficient and effective to eliminate HAT in African community but too costly. Furthermore, the cost-effectiveness of the control measures (education campaign, treatment and insecticides) were determined using incremental cost-effectiveness ratio (ICER) approach and the results show that, the use of education and treatment of infected people as the best cost effective strategy compared to other strategies.
Experimental approaches on the effectiveness of thimerosal to control growth of Nosema apis (Zander, 1909) were carried out in the rearing honey bees. The rearing honey bees were artificially infected with various levels of spore isolated from local honey bees. The results obtained were summarized as follows: 1. In the experiments of therapeutic chemicals for Nosema disease, 0.01% and 0.02% thimerosal of sucrose-honey mixture was the most effective agent but the each concentration of amprolium, furazolidone, hygiene, sulfadimethoxine and terramycin did not show the any effects 2. It showed very high therapeutic effectiveness (over than 90%) that the treatment of three times every other day after the treatment of three times consecutive every day with 0.01% thimerosal, or the treatment of three times consecutive every day with 0.02% thimerosal. 3. When 0.02% thimerosal was administered three times consecutive every day to honey bees at the 4th day before artificial inoculation of N. apis, it showed very high degree (100%) of prevalence control effectiveness, and it also showed high degree (over than 90%) in administration at the 7th day before, and over than 80% at the 10th day before. Then authors found that thimerosal has the prevalence control effectiveness as well as the treatment effectiveness. 4. In the rearing honey bee colony, 0.02% thimerosal showed the high degree (over than 80%) of therapeutic effectiveness with the various levels which contained from the light decree of infection to the severe degree of it.
Objectives The purpose of this study is to review the effectiveness of acupuncture treatment in irritable bowel syndrome (IBS). Methods We reviewed 8 randomized controlled trials (RCT) of acupuncture treatment in IBS which were published from 2008 to 2018 in PubMed. The acupoints, methods of assessment, treatment, results and adverse events were analyzed. Results There were 8 RCT of acupuncture treatment in IBS. The most commonly used acupoints were 天樞 (ST25), and 上巨虛 (ST37). Frequently used assessments in IBS were Bristol scale, visual analogue scale, IBS-symptom severity score, quality of life, and symptom scale. 3 out of 8 studies, the acupuncture treatment group showed significant effectiveness than that of the control group. Conclusions All of the studies have not shown that the acupuncture treatment was effective in relieving IBS symptoms. More clinical studies are needed to prove the effectiveness of the acupuncture treatment in IBS.
Background: There is no standard treatment for patients with platinum-resistant or refractory epithelial ovarian cancer. Single agent chemotherapies have evidence of more efficacy and less toxicity than combination therapy. Most are very expensive, with appreciable toxicity and minimal survival. Since it is difficult to make comparison between outcomes, economic analysis of single-agent chemotherapy regimens and best supportive care may help to make decisions about an appropriate management for the affected patients. Objective: To evaluate the cost effectiveness of second-line chemotherapy compared with best supportive care for patients with platinum-resistant or refractory epithelial ovarian cancer. Materials and Methods: A Markov model was used to estimate the effectiveness and total costs associated with treatments. The hypothetical patient population comprised women aged 55 with platinum-resistant or refractory epithelial ovarian cancer. Four types of alternative treatment options were evaluated: 1) gemcitabine followed by BSC; 2) pegylated liposomal doxorubicin (PLD) followed by BSC; 3) gemcitabine followed by topotecan; and 4) PLD followed by topotecan. Baseline comparator of alternative treatments was BSC. Time horizon of the analysis was 2 years. Health care provider perspective and 3% discount rate were used to determine the costs of medical treatment in this study. Quality-adjusted life-years (QALY) were used to measure the treatment effectiveness. Treatment effectiveness data were derived from the literature. Costs were calculated from unit cost treatment of epithelial ovarian cancer patients at various stages of disease in King Chulalongkorn Memorial Hospital (KCMH) in the year 2011. Parameter uncertainty was tested in probabilistic sensitivity analysis by using Monte Carlo simulation. One-way sensitivity analysis was used to explore each variable's impact on the uncertainty of the results. Results: Approximated life expectancy of best supportive care was 0.182 years and its total cost was 26,862 Baht. All four alternative treatments increased life expectancy. Life expectancy of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 0.510, 0.513, 0.566, and 0.570 years, respectively. The total cost of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 113,000, 124,302, 139,788 and 151,135 Baht, respectively. PLD followed by topotecan had the highest expected quality-adjusted life-years but was the most expensive of all the above strategies. The incremental cost-effectiveness ratios (ICER) of gemcitabine followed by BSC, PLD followed by BSC, gemcitabine followed by topotecan and PLD followed by topotecan was 344,643, 385,322, 385,856, and 420,299 Baht, respectively. Conclusions: All of the second-line chemotherapy strategies showed certain benefits due to an increased life-year gained compared with best supportive care. Moreover, gemcitabine as second-line chemotherapy followed by best supportive care in progressive disease case was likely to be more effective strategy with less cost from health care provider perspective. Gemcitabine was the most cost-effective treatment among all four alternative treatments. ICER is only an economic factor. Treatment decisions should be based on the patient benefit.
Kim, Seon-Hye;Kim, Hye-Ryeon;Sung, Won-Suk;Cho, Hyun-Seok;Moon, So-Ri;Keum, Dong-Ho;Lee, Seung-Deok;Kim, Eun-Jung
Journal of Acupuncture Research
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v.36
no.1
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pp.12-20
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2019
Background: This study was conducted to verify the effectiveness and effectiveness-related factors of Korean medicine (KM) treatment for patients who have been involved in traffic accidents (TA). Methods: The medical records of 150 TA patients hospitalized in Dongguk University Bundang Oriental Medicine Hospital from September 2017 to May 2018 were reviewed. Medical records included information on patient demographic characteristics, TA situations, use of KM treatment, clinical characteristics, 4 scales [numeric rating scale (NRS), visual analogue scale (VAS), EuroQol-visual analogue scale (EQ-VAS) and neck disability index (NDI)]. Statistical analyses were performed to determine the effectiveness and effectiveness-related factors of treatment. Results: The 150 patients (almost 1:1 gender ratio) were typically in their 40's (26.67%), had rear impact to their vehicle (37.33%), were in the driver's seat (70.00%), and without head trauma and loss of consciousness (83.33%). The main symptoms were neck pain (60.66%) and lower back pain (54.00%). All 150 patients showed significant improvement after KM treatment. 4 scales significantly improved when the treatment started within 3 days from the accident and patients were hospitalized longer and took more diverse treatments. The patients experiencing a higher initial pain level (NRS 8-10, $VAS{\geq}70$) showed significant improvement of NRS and VAS scores with faster and longer inpatient treatments than the other patients. The patients with higher initial pain levels ($VAS{\geq}70$) also showed significant improvement in EQ-VAS scores. Conclusion: KM treatment was effective for TA patients in this study. Treatment initiation time, hospitalization period, treatment diversity and initial pain level are related to the degree of improvement of a patient's symptoms.
Objectives : 19 patients diagnosed with chronic paranasal sinitis among the patients who visited to Kyunghee University Oriental Medical Center Department of Acupuncture and moxibustion from July, 1999 through July, 2000. Methods : The needle used in the treatment was 16cm in length and 0.375mm in radius. Using the straight needling method the choana was acupunctured straightly, and the opening of maxcillary sinus was acupunctured obliquely with the oblique needling method. Resuits : Looking at the effectiveness of this nasal acupuncture treatment, excellent was found in 4 cases(21%), good in 13 cases(68.4%), and unchanged in 2 cases(10.5%). The effectiveness totals up to 17 cases (89.4%) which is considerably high. Conclusions : Nasal acupuncture treatment can be used with high effectiveness in treatment of the chronic paranasal sinitis.
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