Ketorolac vs. morfina nel trattamento del dolore acuto in pazienti traumatizzati: un’analisi di minimizzazione dei costi

Aim of this study is to develop an economic valuation comparing ketorolac vs. morphine for the treatment of sharp pain caused by heavy limb injury, in traumatology ward and in first aid ward. As cost minimization analysis, this economic valuation has been based on clinical results of Rainer et al. (2000). Ketorolac and morphine have the same efficacy in calming the pain; the greatest difference in the clinical outcomes is about the morphine side effects (nausea, vomiting and phlebitis). Assuming the hospital point of view with a differential costs perspective, the ketorolac patients showed two consequences than could generate lower resources consumption: less side effects and the reduction of time permanence in first aid ward. Considering the drug cost, the administration cost and the side effects treatment costs, the expenditure for every single morphine patient is L. 23.385, vs L. 4.875 for a ketorolac patient, with a difference of L. 18.510

A Budget Impact and Cost-Effectiveness Analysis of Blood Glucose Monitoring System in One Italian Region

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How should I treat a patient with significant angina and a severe left anterior descending artery stenosis beyond the insertion of a left internal mammary artery jump graft (diagonal to LAD)?

BACKGROUND: A 60-year-old man with a history of previous coronary artery bypass grafting (saphenous vein grafting [SVG] to native right coronary artery [RCA] and sequential left internal mammary artery [LIMA] jump grafting to his native first diagonal [D1] and left anterior descending [LAD] arteries), who had developed a previous ischaemic cerebrovascular accident following femoral angiography, re-presented with further ischaemic cardiac symptoms.\ud \ud INVESTIGATIONS: Physical examination, electrocardiography, biochemistry including high-sensitive troponin, echocardiography, and trans-radial angiography.\ud \ud DIAGNOSIS: Severe native 3 vessel disease including ostial occlusion of the LAD, distal left circumflex and obtuse marginal (LCX/OM) disease and proximal RCA occlusion; occluded SVG to RCA, and evidence of a critical stenosis in the mid LAD distal to the insertion of the tortuous LIMA jump graft (diagonal to LAD).\ud \ud TREATMENT: PCI to mid LAD lesion via LIMA jump graft from left trans-radial approach

Switching from an EFV-Based STR to a RPV-Based STR is Effective, Safe and Improves HIV Patients Health Status

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L’iperuricemia cronica con e senza deposito di urato

Background L\u2019iperuricemia cronica con e senza deposito di urato monosodico nei tessuti \ue8 una malattia sistemica e pu\uf2 essere considerata un fattore di rischio indipendente per lo sviluppo di molteplici complicanze quali sindrome metabolica, ipertensione, malattia cardiovascolare e malattia renale. In Italia, si calcola che le persone affette da iperuricemia cronica con e senza deposito di urato siano circa 1 milione, ma il dato \ue8 probabilmente sottovalutato. L\u2019impatto economico della patologia non \ue8 quindi trascurabile e la sua valutazione assume sempre pi\uf9 importanza sia in termini di costi diretti che di costi indiretti dovuti alle complicanze dell\u2019iperuricemia cronica. Queste brevi premesse sono sufficienti per comprendere come la gestione del paziente con iperuricemia meriti un approfondimento e riflessione multidisciplinare al fine di migliorare il processo clinico-assistenziale nelle diverse realt\ue0 regionali e a livello nazionale. Con questo obiettivo \ue8 stato sviluppato il progetto ARTU - Appraisal board Round Table for Uricemia, una tavola di lavoro multidisciplinare che si propone di valutare il quadro attuale e le prospettive future in ambito della gestione del paziente con iperuricemia, integrando, nel processo di miglioramento, le competenze di tutti i professionisti coinvolti. La tavola rotonda a livello lombardo ha unito i pareri e le competenze provenienti da clinici dalla medicina specialistica (cardiologia, nefrologia, geriatria), dalla medicina generale e dal mondo farmacoeconomico. La discussione \ue8 stata incentrata sull\u2019approfondimento e condivisione di contenuti di fondamentale importanza per la conoscenza e gestione della patologia, ed indirizzata a segnalare i punti pi\uf9 critici e quelli ancora interrogativi a cui trovare una risposta. In tal senso la redazione di un documento di consensus firmato da un team di Key Opinion Leader potrebbe essere un primo step significativo a livello nazionale. La tavola rotonda ha avuto quali temi cardine: gli aspetti epidemiologici della patologia, l\u2019analisi della letteratura scientifica a disposizione in merito all\u2019impatto clinico ed economico della patologia, la valutazione delle linee guida e raccomandazioni di riferimento disponibili, la diagnosi e terapia, gli aspetti pratici, organizzativi e farmacoeconomici

Shadow cost of oral corticosteroids-related adverse events: A pharmacoeconomic evaluation applied to real-life data from the Severe Asthma Network in Italy (SANI) registry

Background Asthma is one of the most common non-communicable respiratory diseases, affecting about 6% of the general population. Severe asthma, even if afflicts a minority of asthmatics, drives the majority of costs of the disease. The aim of this study is to create a pharmacoeconomic model to predict the costs of corticosteroid-related adverse events in severe asthmatics and applying it to the first published epidemiologic data from the Severe Asthma Network in Italy (SANI) registry. Methods The analysis was conducted from the perspective of the Italian National Healthcare System (INHS). Model inputs, derived from literature, included: asthma epidemiology data, frequency of adverse events, percentage of severe asthma treated with OCS and adverse event cost (Diagnosis-Related Group (DRG) national tariffs). We estimated costs per different patient groups: non-asthma controls, mild/moderate and severe asthmatics. Final results report estimated direct cost per patient and total direct cost for overall target population, showing economic impact related to corticosteroid complication. Results Based on epidemiological data input, in Italy, asthmatic subjects resulted about 3,999,600, of which 199,980 with severe asthma. The number of patients with severe asthma OCS-treated was estimated at 123,988. Compared to the non-asthma control cohort and to that with moderate asthma annual cost per severe asthmatic patient resulted respectively about \u20ac892 and \u20ac606 higher, showing a corticosteroids shadow cost ranging from 45% to 30%. Applying the cost per patient to the target population identified for Italy, the budget impact model estimated a total annual cost related to OCS-related adverse events of \u20ac242.7 million for severe asthmatics. In respect with non-asthmatic and moderate population, an incremental expenditure of about \u20ac 110.6 million and \u20ac75.2, respectively, were shown. Conclusions Our study provides the first estimates of additional healthcare costs related to corticosteroid induced adverse events in severe asthma patient. Budget impact model results highlighted the relevant economic impact of OCS-related adverse events in severe asthma patients. The future extrapolation of additional data from SANI registry will support the development of a model to investigate the role of corticosteroids sparing drugs

Search for direct production of charginos and neutralinos in events with three leptons and missing transverse momentum in √s = 7 TeV pp collisions with the ATLAS detector

A search for the direct production of charginos and neutralinos in final states with three electrons or muons and missing transverse momentum is presented. The analysis is based on 4.7 fb−1 of proton–proton collision data delivered by the Large Hadron Collider and recorded with the ATLAS detector. Observations are consistent with Standard Model expectations in three signal regions that are either depleted or enriched in Z-boson decays. Upper limits at 95% confidence level are set in R-parity conserving phenomenological minimal supersymmetric models and in simplified models, significantly extending previous results

Jet size dependence of single jet suppression in lead-lead collisions at sqrt(s(NN)) = 2.76 TeV with the ATLAS detector at the LHC

Measurements of inclusive jet suppression in heavy ion collisions at the LHC provide direct sensitivity to the physics of jet quenching. In a sample of lead-lead collisions at sqrt(s) = 2.76 TeV corresponding to an integrated luminosity of approximately 7 inverse microbarns, ATLAS has measured jets with a calorimeter over the pseudorapidity interval |eta| < 2.1 and over the transverse momentum range 38 < pT < 210 GeV. Jets were reconstructed using the anti-kt algorithm with values for the distance parameter that determines the nominal jet radius of R = 0.2, 0.3, 0.4 and 0.5. The centrality dependence of the jet yield is characterized by the jet "central-to-peripheral ratio," Rcp. Jet production is found to be suppressed by approximately a factor of two in the 10% most central collisions relative to peripheral collisions. Rcp varies smoothly with centrality as characterized by the number of participating nucleons. The observed suppression is only weakly dependent on jet radius and transverse momentum. These results provide the first direct measurement of inclusive jet suppression in heavy ion collisions and complement previous measurements of dijet transverse energy imbalance at the LHC.Comment: 15 pages plus author list (30 pages total), 8 figures, 2 tables, submitted to Physics Letters B. All figures including auxiliary figures are available at http://atlas.web.cern.ch/Atlas/GROUPS/PHYSICS/PAPERS/HION-2011-02

Operation and performance of the ATLAS semiconductor tracker

The semiconductor tracker is a silicon microstrip detector forming part of the inner tracking system of the ATLAS experiment at the LHC. The operation and performance of the semiconductor tracker during the first years of LHC running are described. More than 99% of the detector modules were operational during this period, with an average intrinsic hit efficiency of (99.74±0.04)%. The evolution of the noise occupancy is discussed, and measurements of the Lorentz angle, δ-ray production and energy loss presented. The alignment of the detector is found to be stable at the few-micron level over long periods of time. Radiation damage measurements, which include the evolution of detector leakage currents, are found to be consistent with predictions and are used in the verification of radiation background simulations