Bowel transit studies in children: evidence base, role and practicalities

2021 ◽  
pp. flgastro-2020-101719
Author(s):  
Mara Popescu ◽  
Mohamed Mutalib
Keyword(s):  
Functional Constipation ◽  
Cost Effective ◽  
Evidence Base ◽  
Diagnostic Tools ◽  
Clinical Criteria ◽  
Colonic Manometry ◽  
Standard Medical Therapy ◽  
Wireless Motility Capsule ◽  
Specialist Treatment ◽  
Colon Transit

Constipation is common in children and adults with varied worldwide prevalence. The majority of children have functional constipation as defined by Rome clinical criteria and respond favourably to standard medical therapy; up to one-third can develop difficult-to-treat constipation requiring investigation and specialist treatment. Colon function tests aim to assess the neuromuscular integrity, the movement of faeces across the colon and evaluate/predict response to the therapy. The ‘ideal’ test should be practical, non-invasive, widely available and cost-effective. None of the available diagnostic tools is designed to provide a comprehensive assessment of colon function and clinicians often have to combine more than one test to answer different questions. In this review, we aim to assess the strengths and limitations of the commonly available diagnostic investigations (radiopaque marker studies, scintigraphy, wireless motility capsule and colonic manometry) used to assess colon transit in children and to provide guidance on the most appropriate test for particular clinical settings.

scholarly journals Self-fill oxygen technology: benefits for patients, healthcare providers and the environment

Breathe ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Phyllis Murphie ◽  
Nick Hex ◽  
Jo Setters ◽  
Stuart Little
Keyword(s):  
Positive Impact ◽  
Healthcare Providers ◽  
Cost Savings ◽  
Cost Effective ◽  
Evidence Base ◽  
Environmental Benefits ◽  
List Type ◽  
Potential Cost ◽  
Unlimited Supply ◽  
Technology Benefits

“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Educational aimsProvide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.

scholarly journals Contact with treatment services among arrested drug users

2003 ◽  
Vol 27 (6) ◽  
pp. 214-216 ◽  
Author(s):  
Mervyn London ◽  
Juan Canitrot ◽  
Adrian Dzialdowski ◽  
Robert Bates ◽  
Alan Gwynn
Keyword(s):  
Drug Users ◽  
Cost Effective ◽  
Evidence Base ◽  
Opiate Dependence ◽  
Drug Misuse ◽  
Police Custody ◽  
Face To Face ◽  
Treatment Services ◽  
Previous Contact ◽  
Local Research

Aims and MethodTo identify the proportion of arrested drug misusers with prior contact with treatment services, police surgeons' records were examined over a 12-month period and compared with the records of the local drug misuse services. Both referrals and those who attended with face-to-face contact were noted.ResultsSixty-seven per cent of drug-related cases had been referred to services prior to arrest and 58% had attended with face-to-face contact on at least one occasion. Homeless and male drug users were more likely to have had no past contact. Police surgeons treated three-quarters of the cases for opiate dependence. Drug misusers were much more likely to have had past contact with services than arrested alcohol misusers, and were more likely to reoffend.Clinical ImplicationsThe evidence base for motivational enhancement in the transient coercive setting of police custody is not established, and arrest referral schemes might not be cost-effective in areas where most cases have had previous contact with services. Local research may contribute to more informed decisions about these treatment-related criminal justice initiatives.

scholarly journals Extracellular Glycosaminoglycans in Management of Primary Hepatocellular Carcinoma Rather than Alpha Fetoprotein

2016 ◽  
Vol 3 (1) ◽  
Author(s):  
Abdel-Hamid NM ◽  
◽  
Abdel-Fattah SM ◽  
Nazmy MH ◽  
Mahmoud AS ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Hepatocellular Carcinoma ◽  
Extracellular Matrix ◽  
Cancer Progression ◽  
Cost Effective ◽  
Diagnostic Value ◽  
Primary Hepatocellular Carcinoma ◽  
Diagnostic Tools ◽  
Total Sialic Acid ◽  
Design And Methods

Objectives: Extracellular matrix (ECM) is an essential player at various stages of carcinogenesis. Current study aims to evaluate diagnostic value of components of ECM, released to the serum, i.e. total glycosaminoglycans (TGAGs), total sialic acid (TSA) and free glucosamine (FGA) in primary HCC patients solely or confounded by other conditions (i.e. diabetes mellitus (DM), hepatitis C virus (HCV) or bilharziasis (B). Design and Methods: Our study was conducted upon 40 HCC patients: 32 (80%) males, 8 (20%) females, among these samples, patients with ascites, single/or multiple HCC lesions, as shown in demographic Table. Results: Liver and renal indices were significantly disturbed in HCC patients. Significant elevations of AFP, TGAGS and FGA, non-significant increases in TSA in HCC patients compared to normal control. These parameters except AFP showed significant persistent higher levels during cancer progression. AFP showed irrelevant changes to the stages of HCC lesion. HCC patients with HCV, DM or B showed significantly higher levels of AFP than with HCC solely. Both TGAGs and FGA showed the highest diagnostic accuracy over AFP, but TSA showed the lowest value. Conclusion: TGAGs and FGA may be regarded as cost-effective and more accurate diagnostic tools during primary HCC progression, whether solely, or commixed by other diseases.

scholarly journals A review of Nadi Parikshan in various Ayurvedic Samhita with its clinical methods

2020 ◽  
Vol 4 (06) ◽  
Author(s):  
Pooja Babaso Kamble
Keyword(s):  
Diagnostic Tool ◽  
Common Factor ◽  
Research Work ◽  
Cost Effective ◽  
The Other ◽  
Diagnostic Tools ◽  
Healthy Individuals ◽  
Medical Field ◽  
Clinical Methods ◽  
Time Region

Nadi Pariksha is the most effective diagnostic tool known in the medical field. It is cost effective,  accurate,  safe,  and gives quick results. We can conduct Nadi Pariksha on healthy individuals as well as all patients irrespective of stage of the disease also,  and even pregnant woman,  children,  elderly can undergo without any harm or side effects. However,  this technique is not being widely practised at present,  because of lack of training,  practise and knowledge about it in the present day among Ayurveda vaidyas. An iconic factor for identification of a physician,  irrespective of the time,  Region,  Nadi Pariksha can be highlighted as a common factor or even System of Medicine or Civilization of the known world. Thus,  we can perceive that Nadi Pariksha or the pulse examination remains as an effective diagnostic tool since ages. Nadi Pariksha was not been discussed among the Brihatrayees of Ayurveda. Acharya Sharangdhara was the first to document in the doctrines of Ayurveda. Thus Acharya Sharangdhara is considered as ‘The Founder of Nadi Pariksha’in Ayurveda. Nadi Pariksha was titled under the Pancha-Nidana by Acharya Sharangdhara and Ashta Sthana Pariksha by Acharya Yogaratnakara. It was the Foremost among all the other diagnostic tools mentioned by him. Later Acharyas like Acharya Bhava Mishra,  Acharya Yogaratnakara,  Acharya Basavaraja,  Acharya Kanada Maharishi,  and Acharya Ravana have contributed in giving more descriptions and importance. In the recent days Dr. Vasant lad and Dr. Sarvadeva Upadhaya’s research work interest and scope of Nadi Pariksha.

scholarly journals The economics of mental health in the workplace: what do we know and where do we go?

2007 ◽  
Vol 16 (4) ◽  
pp. 294-298 ◽  
Author(s):  
David McDaid
Keyword(s):  
Mental Health ◽  
Grey Literature ◽  
Cost Effective ◽  
Evidence Base ◽  
Poor Mental Health ◽  
Health Interventions ◽  
Economic Evaluations ◽  
Policy Makers ◽  
Productivity Losses ◽  
Mental Health Interventions

AbstractTo provide an overview of the economic impact of poor mental health in the workplace and assess the extent to which economic evaluation has been used to further the case for investment in workplace based mental health programmes. Rapid scoping review of published and grey literature. The socio-economic costs of poor mental health in the workplace are substantial but conservative, as few studies have included productivity losses from work cutback, as well as absenteeism. While few economic evaluations of workplace based mental health interventions were identified, the available evidence base suggests that they have the potential to be highly cost effective. Much of this evidence may be from the US and be less applicable elsewhere; it may also have been solely published in company documents making assessment of methodological quality difficult. The potential economic case for workplace based mental health interventions appears good. More collaboration between policy makers and the private sector would help facilitate rigorous and transparent economic evaluations. A number of evaluations are planned. The challenge is to build on these initiatives, in order to address what remains a major gap in our knowledge on the economics of mental health.

Communicable diseases in humanitarian operations and disasters

2020 ◽  
pp. bmjmilitary-2020-001415 ◽  
Author(s):  
Ronan James Murphy
Keyword(s):  
Communicable Disease ◽  
Evidence Base ◽  
Multidrug Resistant ◽  
Communicable Diseases ◽  
Control Measures ◽  
Diagnostic Tools ◽  
Humanitarian Operations ◽  
The Uk ◽  
Tools And Techniques ◽  
Austere Environments

Military organisations have battled communicable disease for millennia. They have pioneered disease prevention from the Crusades to the World Wars and continue to do so today. Predeployment vaccinations and chemoprophylaxis are effective in preventing communicable disease, as is reliable vector destruction and bite prevention, especially in the era of multidrug resistant organisms. These measures are unlikely to be fully possible in disasters, but reactive vaccination and efforts to reduce exposure to communicable disease should be a priority. Communicable diseases can be challenging to diagnose—the UK Defence Medical Services have become familiar with tools such as multiplex PCR and mass spectrometry. These have the potential to accurately identify organisms and sensitivity patterns in austere environments. Management of communicable diseases depends on accurate diagnosis and has a largely well-established evidence base but can be limited by a lack of resources and skills in an austere setting, therefore telemedicine can assist diagnosis and treatment of infections by projecting specialist skill. Systems such as EpiNATO2 are useful in monitoring diseases and identifying trends in order to establish control measures. Many of these tools and techniques are effective in austere environments and offer learning opportunities for those providing care in similar settings. Further research is ongoing into diagnostic tools as well as remote management.

OP02 A Managed Access Approach To Appraising New Cancer Drugs In England

2017 ◽  
Vol 33 (S1) ◽  
pp. 1-2
Author(s):  
Linda Landells ◽  
Martyn Burke ◽  
Meindert Boysen
Keyword(s):  
Cost Effective ◽  
Integrated Approach ◽  
Evidence Base ◽  
Phase Iii ◽  
Appraisal Committee ◽  
Cancer Drugs ◽  
Cancer Treatments ◽  
Considerable Uncertainty ◽  
Health Technologies ◽  
Current Price

INTRODUCTION:The changing regulatory landscape brings new challenges to Health Technology Assessment (HTA). Marketing authorizations are being granted as the evidence base evolves to facilitate timely patient access to promising health technologies. Consequently, some products come to HTA bodies sooner in their development cycles with less evidence, which ultimately leads to greater uncertainty in decision making. A key challenge for payer and HTA bodies is providing access to promising medicines while the evidence is still emerging, in a financially sustainable way.METHODS:Changes to the Cancer Drugs Fund (CDF) have resulted in a managed access fund for cancer medicines in England. The National Institute for Health and Care Excellence (NICE) can now recommend a treatment for use within the CDF if there is plausible potential to satisfy the criteria for routine use in the National Health Service (NHS) at its current price, but the evidence is not robust enough and associated with significant uncertainty. Further evidence is then generated in clinical trials, through observational data collection, or a combination of the two, while the drug's price reflects the decision uncertainty. At the end of the managed access period, NICE reviews the guidance to determine if the treatment can be recommended for routine commissioning.RESULTS:The first treatment recommended for use within the new CDF was osimertinib for non-small cell lung cancer (1). At the time of NICE appraisal, there was considerable uncertainty in osimertinib's clinical and cost effectiveness because only short-term phase II trial results were available. NICE's independent appraisal committee considered there was plausible potential for osimertinib to be cost effective and identified that an ongoing phase III trial would provide longer-term data addressing the key uncertainties.CONCLUSIONS:An integrated approach between payer and HTA decision-maker has significantly changed how cancer treatments in England are appraised. This collaborative way of working heralds a more sustainable approach to introducing promising cancer treatments.

scholarly journals Challenges in synthesising cost-effectiveness estimates

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Gemma E. Shields ◽  
Jamie Elvidge
Keyword(s):  
Cost Effectiveness ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Cost Effective ◽  
Evidence Base ◽  
Decision Makers ◽  
Economic Evaluations ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Study Designs

AbstractEconomic evaluations help decision-makers faced with tough decisions on how to allocate resources. Systematic reviews of economic evaluations are useful as they allow readers to assess whether interventions have been demonstrated to be cost effective, the uncertainty in the evidence base, and key limitations or gaps in the evidence base. The synthesis of systematic reviews of economic evaluations commonly takes a narrative approach whereas a meta-analysis is common step for reviews of clinical evidence (e.g. effectiveness or adverse event outcomes). As they are common objectives in other reviews, readers may query why a synthesis has not been attempted for economic outcomes. However, a meta-analysis of incremental cost-effectiveness ratios, costs, or health benefits (including quality-adjusted life years) is fraught with issues largely due to heterogeneity across study designs and methods and further practical challenges. Therefore, meta-analysis is rarely feasible or robust. This commentary outlines these issues, supported by examples from the literature, to support researchers and reviewers considering systematic review of economic evidence.

Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it?

2019 ◽  
Vol 45 (5) ◽  
pp. 346-350 ◽  
Author(s):  
Mila Stefanova Zemyarska
Keyword(s):  
Assisted Reproductive Technologies ◽  
Cost Effective ◽  
Reproductive Technologies ◽  
Conclusive Evidence ◽  
Diagnostic Tools ◽  
In Vitro Fertilisation ◽  
Unborn Child ◽  
Effective Adjunct ◽  
Psychological Benefit

In vitro fertilisation (IVF) ‘add-ons’ are therapeutic or diagnostic tools developed in an endeavour to improve the success rate of infertility treatment. However, there is no conclusive evidence that these interventions are a beneficial or effective adjunct of assisted reproductive technologies. Additionally, IVF add-ons are often implemented in clinical practice before their safety can be thoroughly ascertained. Yet, patients continue to request and pay large sums for such additional IVF tools. Hence, this essay set out to examine if it is ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it. In order to determine what is ethical—namely, morally good and righteous, the question was considered in relation to three key values of medical ethics—autonomy, beneficence and non-maleficence. It was determined that providing IVF add-ons might be morally acceptable in specific circumstances, if true informed consent can be given, there is a potential of cost-effective physiological or psychological benefit and the risk of harm is minimal, particularly with regard to the unborn child.

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