Long-term cost-utility analysis of remote monitoring of older patients with pacemakers: the PONIENTE study

Background: Cost-effectiveness studies on pacemakers have increased in the last years. However the number of long-term cost-utility studies is limited. The objective of this study was to perform a cost-utility analysis comparing remote monitoring (RM) versus conventional monitoring (CM) in hospital of older patients with pacemakers, 5 years after implant. Methods: Under a controlled, not randomized, nor masked clinical trial, 83 patients with pacemakers were initially selected. After five years of follow-up, a total of 55 patients (CM = 34; RM = 21) completed the study. A cost-utility analysis of RM in terms of costs per gained quality-adjusted life years (QALYs) was conducted. The costs from the Public Health System (PHS) as well as patients and their relatives were taken into account for the study. The robustness of the results was verified by the probabilistic analyses through Monte-Carlo simulations. Results: After a five-year follow-up period, total costs were lower in the RM group by 23.02% than in the CM group (€274.52 versus €356.62; p = 0.033) because of a cost saving from patients’ perspective (€59.05 versus €102.98; p = 0.002). However, the reduction of in-hospital visits derived from RM exhibited insignificant impact on the costs from the PHS perspective, with a cost saving of 15.04% (€215.48 vs. €253.64; p = 0.144). Costs/QALYs obtained by the RM group were higher as compared to the CM group, although there were no significant differences. The incremental cost-effectiveness ratio of CM in comparison to RM became positive (€301.16). Conclusions: This study confirms RM of older patients with pacemakers appears still as a cost-utility alternative to CM in hospital after 5 years of follow-up. Trial registration: ClinicalTrials.gov: (Identifier: NCT02234245). Registered 09 September 2014 - Prospectively registered.This study has been funded by Instituto de Salud Carlos III through the project "No. PI17/02056" (Co-funded by European Regional Development Fund/European Social Fund "A way to make Europe"/"Investing in your future") and by the General Secretariat for Research, Development and Innovation, Regional Government of Andalusia (Spain), with Project Reference No. PI/0256/2017, under the research call "Development and Innovation Projects in the Field of Biomedicine and Health Sciences". The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors performed all research related activities independently

Comparative Effectiveness of Remote Monitoring of People with Cardiac Pacemaker versus Conventional: Quality of Life at the 6 Months

Fundamentos: El uso del seguimiento remoto (SR) de personas portadoras de marcapasos (MP) es limitado en comparación con la modalidad hospitalaria (SH), siendo escasa la evidencia científica que muestre su efectividad. El objetivo de este estudio fue comparar la calidad de vida en personas con diferentes modalidades de seguimiento. Métodos: Ensayo clínico controlado, no aleatorizado ni enmascarado, con recogida de datos pre y post-implante del marcapasos durante los 6 meses de seguimiento. Se seleccionó a todos los pacientes mayores de 18 años a los que se les implantó un marcapasos en el periodo de estudio (n=83), siendo asignados al grupo SR (n=30) o al grupo SH (n=53), en función de sus características personales y preferencias. Se analizaron las características basales y número de visitas al hospital, y se administró el cuestionario EuroQol-5D (EQ-5D) para evaluar la calidad de vida relacionada con la salud y el Duke Activity Status Index (DASI) para valorar la capacidad funcional. Resultados: No hubo diferencias significativas entre ambos grupos en relación al análisis basal, EQ-5D (SR:0,7299; SH:0,6769) y DASI (SR:21,41; SH:19,99) iniciales. A los 6 meses la calidad de vida mejoró enBackground: The use of remote follow-up (RF) of people with pacemakers (PM) is limited in comparison to the hospital modality (HS), being still poor the scientific evidence that shows their comparative effectiveness. The aim of this study was to compare the quality of life in individuals with different modalities of follow-up. Methods: Controlled, not randomized nor masked clinical trial, with data collection at pre and post-implantation of pacemakers during the 6 months follow-up. All patients over 18 years-old who were implanted a PM during the study period were selected (n=83), and they were assigned to RF (n=30) or HF (n=53) groups according to their personal characteristics and patient’s preferences. Baseline characteristics and number of visits to the hospital were analysed, the EuroQol-5D (EQ5D) questionnaire was administered to evaluate the health-related quality of life, and Duke Activity Status Index (DASI) to assess the functional capacity. Results: There were no significant differences between both groups in relation to the baseline analysis, EQ5D (RF:0.7299; HF:0.6769) and DASI (RF:21.41; HF:19.99). At 6 months the quality of life was improved in both groups (EQ5D RF:0.8613; HF:0.8175; p=0,439) still without significant differences between them. DASI score was similar to baseline (20.51 vs 21.80). RF group performed less transmissions/visits per patient (1.57) than hospital group (1.96; relative reduction 31%; p=0.015). Conclusions: Remote follow-up of people with pacemakers might be considered as an equivalent option to the hospital follow-up in relation to the quality of life and it reduces the number of hospital visits

Aquacultural Homoeopathy: A Focus on Marine Species

Homoeopathy is an alternative medical system proposed by Samuel Hahnemann in the eighteenth century. It uses highly diluted and agitated substances that derived from plants, minerals or animals, which have shown to be effective in human medicine, agronomy, veterinary, and as a novelty, in marine aquaculture. Aquacultural homoeopathy has developed rapidly in recent years, partially motivated by the misuse of powerful drugs (hormones, antibiotics, disinfectants) that when solving a problem generate undesirable side effects. In the last 10 years, scientific articles have been published on its application in freshwater fish native to Brazil, obtaining beneficial effects on growth, survival, hepatosomatic index, development of muscle fibres and lipid content in muscle. At Centro de Investigaciones Biológicas del Noroeste (CIBNOR, Mexico: www.cibnor.mx), we have studied the effects of homoeopathy to improve the culture of economically important marine species of molluscs, fish and shrimp. In this chapter, we show a selection of different research with preliminary or advanced results, related to the use of homoeopathy and its impact on zootechnic, biochemical, genomic and transcriptomic parameters in marine molluscs, fish and crustaceans. The results obtained suggest that homoeopathy is an eco-friendly alternative applicable in aquaculture industry to improve various productive and health aspects

Aprendemos entre todos II

Seleccionado en la convocatoria: Ayudas a la innovación e investigación educativa en centros docentes de niveles no universitarios, Gobierno de Aragón 2009-10El CRA María Moliner de Zaragoza elabora un plan con los siguientes objetivos: alcanzar las competencias básicas de una manera más atractiva, motivadora e innovadora; potenciar el desarrollo de habilidades sociales a través de experiencias internivelares; trabajar la animación a la lectura y fomentar los procesos lecto-escritores; y utilizar las nuevas tecnológicas como recurso habitual en la dinámica del aula. La programación de los contenidos se realiza a lo largo de todo el curso escolar y realizando las siguientes actividades: taller de frutas, celebración del día de la paz, fabricación de llaveros y flores de primavera, taller de expresión corporal y aprendizaje cooperativo en el aula.Gobierno de Aragón. Departamento de Educación, Cultura y DeporteAragónDirección General de Política Educativa; Avda. Gómez Laguna, 25, planta 2; 50009 Zaragoza; Tel. +34976715416; Fax +34976715496ES

Doñana. Acta vertebrata. vol 20 (1)

Relación de sexos y edades y cronología de eclosiones de la perdíz roja (Alectoris rufa) en el sur de la provincia de AlicanteEcología térmica y uso del hábitat y patrones de actividad en la lagartija colirroja Acanthodactylus erythurus (SCHINZ,1883) en España central.Régimen alimentario del jabalí (Sus scrofa L. 1758) en el sueste IbéricoConsumo de gálbulos de sabina (Juniperus phoenicea ssp.TURBINATA GUSS, 1891) y dispersión de semillas por el conejo (Orytolagus cuniculus) en el Parque Nacional de DoñanaDiet of the stone marten (Martes foina ERXLEBEN, 1777) in the Northeastern SpainLas Posturas crípticas del alcaudón dorsirrojo Lanius collurio L. como estrategia de defensa del nidoAcarofauna parásita del murciélago troglodita, Miniopterus schreibersi (KUHL, 1819). Distribución estacional de las especies más representativasDistribución de colonias de Lagostomus maximus en relación a variables del hábitat y su impacto en el medio desértico del Monte, ArgentinaSummer food and body condition of Mallards (Anas platyrhychos L.) in river Mondego lowlandTamaño de puesta en Podarcis bocagei bocagei (Reptilia, Lacertidae)Migración del correlimos zarapitin (Calidris ferruginea) durante el otoño de 1988 por Galicia y TenerifePeer reviewe

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation