25 research outputs found
PHARMACOECONOMIC EFFECTIVENESS OF NAFTIDROFURYL IN PATIENTS WITH ISCHEMIC STROKE
The study objective is to conduct a pharmacoeconomic analysis of naftidrofuryl effectiveness in patients with ischemic stroke.Materials and methods. The work is based on the results of clinical studies of effectiveness, tolerability, and safety of naftidrofuryl in patients who suffered an ischemic stroke. The study design included data on 1000 patients of 45 and older with first-time acute cerebrovascular disease of ischemic type.Results. Direct medical costs for the chosen patient cohort per the Standard of stroke treatment current at the time of the study were 730 575 189 rubles, in case of naftidrofuryl inclusion they were 476 467 620 rubles. Cost minimization is 254 107 569 rubles. Indirect nonmedical costs associated with temporary incapacity for work for treatment per the Standard of stroke treatment were 124 156 950 rubles, and 64 559 180 rubles for naftidrofuryl use which demonstrates the drug’s economic benefit. Budget impact analysis has shown that the possible savings constitute 7.59 %.Conclusion. Inclusion of naftidrofuryl into treatment of patients with ischemic stroke is justified as it decreases duration of rehabilitation. This leads to a positive economic effect expressed as decreased direct and non-direct medical costs
Pharmacoeconomic analysis of naftidrofuryl for treatment of ischemic stroke
Strokes are one of the most important causes of death and disability both worldwide and in Russian Federation (RF). This disease requires intensive, prolonged treatment and rehabilitation and thus is associated with considerable temporary disability, as well as significant rate of permanent complete disability. Available information indicates that vasodilators affecting peripheral arteries can play a favorable role in treating ischemic strokes, which are the most widespread form of this pathology. However, this type of pharmaceutical is currently not represented in RF standards pertaining to treatment of ischemic strokes. Thus it is expedient to assess the pharmacoeconomics of introducing naftidrofuryl, a member of aforementioned group, into RF treatment and rehabilitation standards for ischemic stroke Aim. To perform the pharmacoeconomic analysis of including naftidrofuryl into the RF standards for treatment and rehabilitation of patients suffering from ischemic stroke by means of performing Cost Minimization Analysis (CMA) and Budget Impact Analysis (BIA). Methodology. The analysis was performed by constructing decision trees for two simulated cohorts. One cohort received only standard treatment and rehabilitation while the other was also receiving naftidrofuryl in addition to standard treatment and rehabilitation. Both direct and indirect costs were accounted. The source of data on the clinical effectiveness was taken from randomized controlled trials and meta-analyzes, which examined the efficacy, safety and tolerability of naftidrofuryl. Analysis of data sources has found that, while there is not enough information to ascertain naftidrofuryl effect on hard clinical endpoints, naftidrofuryl demonstrates an ability to reduce time required to obtain clinical results, thus reducing treatment time and hospital stay. Existing standards were used to calculate expenditures associated with diagnosing, treating, and rehabilitating stroke patients in each simulated group. CMA, BIA and sensitivity analysis were performed. Result. The CMA index for naftidrofuryl was found to be minus 250,630 millions, indicating significant cost reduction. BIA indicated budget savings of 7,59% in the naftidrofuryl group, which amounts to 59,471 mln rubles per 100,000 of population. Sensitivity analysis confirmed these results, indicating stability both in case of price increase and in case of negative alteration of assumptions underlying the model. Conclusion. Including naftidrofuryl in RF national standards for treatment and rehabilitation of patients with ischemic strokes would allow reducing healthcare organization spending as well as overall budgetary burden
Neuroplasticity, music, and human brain
Introduction. Studying the influence of music on the human brain is one of the key topics in neuroscience as it allows extending our understanding of brain neuroplasticity.
This study aimed to investigate structural brain organization in professional musicians.
Materials and methods. We investigated 27 brains (i.e. 54 hemispheres) of male musicians, female musicians, male non-musicians, and female non-musicians by magnetic resonance imaging. All study participants were aged 20 to 30 years and did not have any mental or neurological disorders. Gray matter volume and cortex thickness in different cortical structures of the right and left hemispheres were measured.
Results. We found major changes in the brain structure in professional musicians (both male and female) vs. non-musicians. We found differences in the macroscopic structure of the triangular region in the Broca’s motor speech area in musicians’ brain. Increases in gray matter volume in the brain of musicians and its individual cortical structures were shown in the superior temporal region, Broca’s motor speech area, hippocampus, superior parietal lobule, and other structures. We found increased thickness of cortical structures in musicians vs. non-musicians.
Conclusions. Practicing music regularly was shown to change structural brain organization; we found significant increases in gray matter volume and cortex thickness in various cortical structures in the right and left brain hemispheres of musicians vs. non-musicians
Modern Attachment Theory: The Central Role of Affect Regulation in Development and Treatment
Modifiable risk factors and current approaches to the treatment of dementia
The problem of dementia is acquiring greater social and medical significance in the modern world. According to the WHO, in 2010, the global number of people suffering from dementia was 35.6 million, and today the number is estimated as 44 million. [1] By 2030, the number of patients will double to reach 65.7 million people, and in 2050 - 115.4 million. [2] Among the factors for the development of cognitive deficits, the leading are cerebrovascular and neurodegenerative brain lesions. The most common cause of dementia is Alzheimer's disease (60-70% of cases), while the second place is given to vascular dementia. Given the scale of the epidemic and therapeutic challenges, it is important to consider the factors for the disease. Their management could reduce the risk or delay the onset of disease
Vascular depression and cognitive dysfunction
Vascular depression is a very frequent and serious complication of cerebrovascular diseases. Vascular factors play an important role in the development of affective disorders. Depression, in turn, also has a negative impact on the course of cardiovascular disease, contributing to its progression, worsens quality of life in patients, reduces functional activity, increases mortality, and increases the risk of stroke. The diagnosis of vascular depression is confirmed by MRI detection of leukoaraiosis; in this case, deep white matter hyperintensities are of importance. The very important features of vascular depression are the presence of CI and an increased risk of dementia
Sleep disorders and Alzheimer’s disease
Alzheimer’s disease (AD), one of the leading causes of dementia worldwide, is commonly accompanied by behavioral and psychopathological disorders. The earliest observed symptoms of AD include sleep disorders, the incidence of which varies from 25 to 60%. Sleep problems and sleep disorders can develop as one of the symptoms accompanying cognitive impairment, but can also be associated with an increased risk of cognitive decline and with a higher risk of dementia. Anti-dementia therapy is of great importance in preventing and treating sleep disorders in patients with AD. Akatinol memantine is one of the drugs with proven efficacy in such patients
Post-stroke cognitive impairment and treatment options
Cognitive impairment is a widespread serious complication of ischemic stroke requiring intensive medication treatment. Citicoline is a medicine with proven efficacy in ischemic stroke and vascular cognitive impairment. The article provides an overview of trials on the use of citicoline in patients with cognitive impairment and vascular dementia
Alzheimer's disease and diabetes mellitus
Recently, healthcare specialists have put great emphasis on the relationship between Alzheimer's disease and diabetes. There are many common pathogenic mechanisms underlying both diseases: insulin resistance, hyperinsulinemia, chronic hyperglycemia, acute hypoglycemic episodes, microangiopathy, inflammation, dyslipidemia, etc. It is assumed that there is a direct link between insulin and Alzheimer's disease. Insulin regulates β-amyloid synthesis as well as tau phosphorylation. Cognitive impairment and dementia associated with diabetes can also be mediated through vascular factors including, primarily, development of microangiopathy. Еру vascular and neurodegenerative components can be mutually intensified. One of the key elements in the pathogenesis of cognitive degradation is impaired cholinergic transmission. Acetylcholinesterase inhibitors are the drugs of choice for the treatment of both Alzheimer's disease and vascular dementia. The effectiveness of donepezil (Alzepil) has been proved in numerous trials: it is characterized by the best tolerability compared with other cholinergic drugs and is the only drug in the group recommended for use in severe stages of Alzheimer's disease
Pre-stroke cognitive impairment and its impact on medication adherence
Adherence to long-term medication is one of the most important components of effective therapy. Many factors have a substantial influence on medication adherence; a special role among them is played by cognitive impairment (CI). Objective: to identify whether poststroke patients have pre-stroke cognitive deficit and to assess its impact on adherence to long-term medication. Patients and methods. A total of 103 patients with acute ischemic stroke in the carotid system were examined. The mean age of the patients was 64.18±10.24 years. The Montreal Cognitive Assessment (MoCA) was applied to assess cognitive functions; the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was used to determine the presence of pre-stroke cognitive decline. Data concerning vascular risk factors were collected for all the patients. Medication adherence was retrospectively evaluated using the Morisky–Green scale. Results and discussion. Our study showed that only 44.7% of patients were adherent to long-term medication before the stroke. Patients who were engaged in manual labor during their lives were significantly more poorly compliant. Chronic heart failure was also responsible for a reduction in medication adherence. Pre-stroke cognitive deficit was present in 53.4% of the examinees. Unlike patients with normal cognitive function, the majority of patients with pre-stroke CI were non-adherent to medication (28.1 and 71.9%, respectively). At the same time, the adherence to long-term medication depended on the severity of cognitive deficit. Conclusion. The results of the investigation suggest that CI has a considerable impact on adherence to long-term therapy. To improve primary stroke prevention, cognitive functions should be evaluated in all patients with vascular diseases who receive long-term drug treatment. When CI is identified, there is a need for targeted drug treatment and its proper monitoring