Economic Evaluation of Positron Emission Tomography (PET) in Non Small Cell Lung Cancer (NSCLC), CHERE Working Paper 2007/6

Background: There are several perceived benefits from introducing positron emission tomography (PET) scanning into the staging of non small lung cancer (NSCLC). However, its greatest primary benefit is the role it can potential perform in reducing the number of unnecessary diagnostic examinations and futile surgeries. Objectives: To evaluate the economic impact and cost effectiveness of PET scanning in the management of potentially operable NSCLC patients using a cost-utility model. Methods: A literature review was conducted to find relevant studies and appropriate parameters to construct a decision model. Two strategies were compared. The first strategy was a conventional work up (CWU) consisting of an x-ray, a chest computer tomography (CT) scan and brochoscopy; the second strategy consisted of a CWU plus a whole body PET scan. These two strategies were applied to two sub-groups of NSCLC patients; those that had received a positive result on their CT scan and those that got a negative result on their CT scan. The cost-effectiveness of each strategy was dependent on a number of variables that were taken from a literature review. Costs were based on the Australian diagnostic related groups, a cost calculation for a chemotherapy course and values obtained from the literature. The life expectancy and utility scores were also taken from the literature and combined to create an incremental quality adjusted life year (QALY) value for PET for each of the patient groups. Results: The mean costs in CT negative and CT positive patients were lower in the CWU strategy, costing $A 20,427 and$A 23,578 per patient respectively compared to the PET strategy ($A 20,826 and$A 24,083 per patient respectively). The mean QALYs for both the CT positive and CT negative patients were higher in PET with 2.91 and 2.11 respectively compared to the CWU of 2.88 and 2.09. The incremental cost effectiveness ratio (ICER) for the CT negative strategy was $A 14,581 and$A 52,039 for the CT positive strategy. Conclusion: The PET strategy in CT negative and CT positive patients appears to be cost effective, however, there is much uncertainty surrounding this base result, particularly in CT positive patients.PET, non-small-cell lung cancer, economic evaluation

Applications of sport science in monitoring fatigue and managing recovery

This presentation shall (1) overview current concepts in monitoring athletes training response and stress/fatigue state; (2) describe the practical applications of sport science in monitoring fatigue and managing recovery; and (3) provide an overview of methods utilised by the Indonesian Olympic Team for the Games of the XXIX Olympiad, Beijing, China

Applications of sport science in monitoring fatigue and managing recovery

This presentation shall (1) overview current concepts in monitoring athletes training response and stress/fatigue state; (2) describe the practical applications of sport science in monitoring fatigue and managing recovery; and (3) provide an overview of methods utilised by the Indonesian Olympic Team for the Games of the XXIX Olympiad, Beijing, China

Podcasts as an eLearning educational tool

One of the most interesting and valuable uses of Podcasting in Education is the concept of student-centred created content incorporating Technology Enriched Learning that allows students to be fully exposed to an online environment. A major advantages of education podcasts is the portability and convenience they offer, allowing students to access industry-relevant topic content anytime, anywhere, with very little effort. Student feedback has reiterated that podcasts are a valuable eLearning educational tool, which can support teaching and learning in an online environment

Supplement use in sport & fitness: controversial or conventional?

Ingestion of multi-nutrient supplements aimed at enhancing performance has become common practice as part of athletes and fitness client's regular training and/or competition preparation. Although there is limited information available, global industry analysis market research reported yearly expenditure on nutritional supplements in the United States alone at US$20.7 billion in 2012 and is expected to grow by 9.0$ 37.7 billion in 2019. Athletes and fitness clients are perceived to be the greatest consumers of supplements as they aim to exploit nutritional ergogenic benefits, such as enhance acute muscular performance, optimise exercise-induced hormonal response, and promote post-exercise recovery. In recent times, supplement use in sport and fitness has been highlighted in the press and media for what has been deemed 'Controversial' practice following the release of the ACC Report on Organised Crime and Drugs in Sport. This lead to revelations that professional athletes and fitness clients may be using substances unrelated to therapeutic nutrition such as anti-obesity and anti-ageing drugs. However, are such findings really that surprising given that supplement use is embedded in both professional sport and the fitness world as athletes and clients look to gain the 'competitive edge'? A more ‘Conventional’ approach to supplementation may be one that follows a therapeutic nutrition model, focusing on the provision of nutrients to maintain and/or restore optimal health and function. In this presentation Dr Bird will provide examples from professional sport and fitness, providing an overview some of the lesser known nutritional supplements

Profile of training load in elite badminton players during an intensified pre-Olympic training camp and Olympic competition

INTRODUCTION: Coaches must carefully monitor their athletes' acute responses during intensified training camps in the lead up to competition as appropriate training dose is required to optimise performance potential while reducing the risk of developing non-functional overreaching. The session-RPE (sRPE) method has been widely used in training load quantification for various types of training across multiple sports, as determined by multiplying a sessional rating of perceived exertion (RPE: Borg category-ratio 10 [CR-10]) by the session duration (minutes). To date, no studies have quantified training load or periodisation profiles in elite badminton players during Olympic competition. Therefore, the purpose of this study was to 1) quantify training load of elite badminton players during an intensified training camp and Olympic competition using the sRPE method; and 2) describe periodisation strategies employed by Indonesian Olympic coaches. METHODS: Ten Olympic badminton players' (male: n=5 and female: n=5) competing in six events (Men's Singles [MS]; Women's singles [WS]; Men's doubles [MD]; Women's doubles [WD]; Mixed doubles [XD1* and XD2]) completed a 9-day intensified training camp (ITC; Sau Paulo, Brazil) immediately followed by Olympic Games competition (OGC; Rio de Janeiro, Brazil) over 6–9 days, with each event having their own coach. Player characteristics for male and female players were, respectively: mean age 28.4 yrs (SD, 2.8) and 28.4 yrs (SD, 1.5); height 180.0 cm (SD, 6.4) and 164.4 cm (SD, 2.9); weight 79.1 kg (SD, 6.6) and 60.0 kg (SD, 5.5). Athletes were of elite level comprising of Olympic Games Medallists (2008 Gold and Silver); current World and Asian Champions. Quantification of the training load (AU) was performed by the sRPE method for every training session/match during the ITC and OGC. Players were asked 30 min after each session/match to ensure that their RPE referred to the intensity of the whole activity rather than the most recent activity intensity. A two-way ANOVA was used to determine any significant changes during the training/competition periods. Statistical analyses were performed using a SPSS (Version 22.0; Chicago, IL). Alpha was set at p<0.05. Data are presented as mean ± SD with Delta percent change in training load relative to the previous day training load. The example profile presented is that of XD1*, Olympic Gold medallists. RESULTS: Training loads between male and female during the ITC were significantly higher (p<0.001) compared to OGC, respectively (ITC: 999 ± 375 and 1004 ± 407 AU; and OGC: 723 ± 252 and 745 ± 245 AU). No differences were observed between male and female players or event across the training/competition period. A clear difference in the periodisation strategy of daily training load dose was evident for the six coaches during the OGC. The profile of XD1* clearly represented a repeat step-type reduction in training load over the OGC (Day 2: –25%; Day 3: –24% Day 4: +36%; Day 5: –33%; Day 6: –32%; Day 7: –25%; Day 8: +50%; Day 9: –15%; Day 10: –11%). DISCUSSION: As expected, training load for ITC was significantly higher than OGC, however individual players' training loads did not differentiate from each other. Differences in the six coaches' periodisation strategy were evident during the OGC. Daily training load profiles for coaches of XD1* and XD2 employed a step-type reduction over 3-days, followed by an increased training dose on day 4. This profile was repeated twice over the remaining days of the OGC. In contrast, coaches of MS and WS displayed an exponential reduction. Alternatively, coaches of MD and WD employed a combination of a step-type/exponential reduction. PRACTICAL APPLICATIONS: The sRPE method enabled the training load quantification and determination of periodisation models in elite badminton players during an ITC and OGC. As acute training responses are directly linked to the magnitude of daily change in training load, coaches must consider the importance of the desired daily training load in meeting the periodisation model, thereby optimising the athletes' performance potential

Continuing professional development: Medico-legal aspects of epilepsy

AbstractGenerally protection against possible litigation and good clinical practice go hand in hand. Situations in which the law has special relevance for people with epilepsy, those who work with them, and their clinicians are reviewed with special reference to the topics of driving, employment, duties of social carers, the clinician’s everyday role, the responsibilities of researchers and epilepsy and the criminal law. What constitutes professional negligence is discussed, with special reference to the United Kingdom. Clinicians are advised to think clearly, write clearly, communicate clearly and have a good relationship with their patients