Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Modelling health-related quality of life data for economic evaluation of cancer treatments: Applications in lung cancer

INTRODUCTION: The annual economic burden of treating cancer to the National Health Service (NHS) in the United Kingdom (UK) is over £15 billion; and for non small cell lung cancer (NSCLC), one of the leading causes of cancer deaths in the world, this is £2.4 billion. Economic evaluation plays an essential role in assessing the relative value of lung cancer treatments. Modelling (HRQoL) data is fundamental in determining the cost-effectiveness of cancer treatments. This thesis aims to investigate modelling of HRQoL data collected from lung cancer patients for economic evaluation. In particular, the role of modelling to improve utility prediction is investigated. The sensitivity of disease specific and generic HRQoL measures are also explored. In addition, methods to extrapolate utilities beyond cancer progression and identifying a selection procedure from relevant published algorithms are developed. METHODS: Data from two clinical trials and a prospective observational study in NSCLC patients were designed and executed to develop several mapping models (Linear, Non-Linear, Joint, and Bayesian). The sensitivity of EQ-5D-3L and EQ-5D-5L were compared with a cancer specific measure (QLQ-C30). Simulation methods were used to develop an approach for selecting algorithms. RESULTS: Two and three-part Beta-Binomial models improve predictions. Joint models also contribute to improved prediction of utilities. Bayesian Networks may help reduce the over-prediction in poor health states. The EQ-5D-5L offers better mapping and is more sensitive for detecting treatment benefit compared to EQ-5D-3L. It is also viable to develop decision criteria for selecting between several published algorithms. CONCLUSION: Methodological improvements in modelling HRQoL for the economic evaluation of cancer treatments have been demonstrated. Improvements in model structure, prediction and selection are empirically demonstrated

The Epidemiology and Control of Human Influenza in Vietnam

Understanding the epidemiology of human influenza in Viet Nam is important for developing local policies and also for understanding the dynamics of influenza in tropical and subtropical southeast Asia. I have analysed an 18 year time-series of influenza-like-illness (ILI) surveillance data, and assessed the relationship of this time-series with climate variables and with sentinel influenza virus surveillance data. I also conducted a study of influenza A/H1N1 transmission within households. ILI notifications in Viet Nam show a latitudinal gradient, with seasonality in the north but no seasonal pattern observed in low lying areas of central and southern Viet Nam. Seasonality is however observed in the elevated provinces of central Viet Nam, suggesting that the seasonal patterns are driven by climate. Principal component analysis finds that temperature and absolute humidity (AH) are positively correlated and together explain around 59% of total climatic variance, and that there is a strong latitudinal gradient in these variables. Regression tree analysis shows that provinces with strong seasonality of AH have strong ILI seasonality. Although virological surveillance data are limited, increases in ILI notifications are associated with an increase in the proportion of upper respiratory tract swabs that are influenza positive. In a prospective study of H1N1/2009 transmission in a household-based cohort, 11 of 59 household contacts were infected, giving a household secondary infection risk of 18.6% (95%CI 10.7-30.4%), but 5 (45%) did not develop symptoms. Virus genetic sequencing indicated that 10 of the 11 secondary cases (91%) were probably infected within the household rather than from the community. This research provides new insights into the seasonality and climatic determinants of ILI and influenza epidemiology in Viet Nam, and on the transmission of influenza within households. The findings are valuable for national influenza control policies and also add to the current state of knowledge of influenza epidemiology

Added value of acute multimodal CT-based imaging (MCTI) : a comprehensive analysis

Introduction: MCTI is used to assess acute ischemic stroke (AIS) patients.We postulated that use of MCTI improves patient outcome regardingindependence and mortality.Methods: From the ASTRAL registry, all patients with an AIS and a non-contrast-CT (NCCT), angio-CT (CTA) or perfusion-CT (CTP) within24 h from onset were included. Demographic, clinical, biological, radio-logical, and follow-up caracteristics were collected. Significant predictorsof MCTI use were fitted in a multivariate analysis. Patients undergoingCTA or CTA&CTP were compared with NCCT patients with regards tofavourable outcome (mRS ≤ 2) at 3 months, 12 months mortality, strokemechanism, short-term renal function, use of ancillary diagnostic tests,duration of hospitalization and 12 months stroke recurrence