Has increased clinical experience with methotrexate reduced the direct costs of medical management of ectopic pregnancy compared to surgery?

<p>Abstract</p> <p>Background</p> <p>There is a debate about the cost-efficiency of methotrexate for the management of ectopic pregnancy (EP), especially for patients presenting with serum human chorionic gonadotrophin levels of >1500 IU/L. We hypothesised that further experience with methotrexate, and increased use of guideline-based protocols, has reduced the direct costs of management with methotrexate.</p> <p>Methods</p> <p>We conducted a retrospective cost analysis on women treated for EP in a large UK teaching hospital to (1) investigate whether the cost of medical management is less expensive than surgical management for those patients eligible for both treatments and (2) to compare the cost of medical management for women with hCG concentrations 1500–3000 IU/L against those with similar hCG concentrations that elected for surgery. Three distinct treatment groups were identified: (1) those who had initial medical management with methotrexate, (2) those who were eligible for initial medical management but chose surgery (‘elected’ surgery) and (3) those who initially ‘required’ surgery and did not meet the eligibility criteria for methotrexate. We calculated the costs from the point of view of the National Health Service (NHS) in the UK. We summarised the cost per study group using the mean, standard deviation, median and range and, to account for the skewed nature of the data, we calculated 95% confidence intervals for differential costs using the nonparametric bootstrap method.</p> <p>Results</p> <p>Methotrexate was £1179 (CI 819–1550) per patient cheaper than surgery but there were no significant savings with methotrexate in women with hCG >1500 IU/L due to treatment failures.</p> <p>Conclusions</p> <p>Our data support an ongoing unmet economic need for better medical treatments for EP with hCG >1500 IU/L.</p

Lambda hyperon production and polarization in collisions of p(3.5 GeV) + Nb

Results on $\Lambda$ hyperon production are reported for collisions of p(3.5 GeV) + Nb, studied with the High Acceptance Di-Electron Spectrometer (HADES) at SIS18 at GSI Helmholtzzentrum for Heavy-Ion Research, Darmstadt. The transverse mass distributions in rapidity bins are well described by Boltzmann shapes with a maximum inverse slope parameter of about $90\,$MeV at a rapidity of $y=1.0$, i.e. slightly below the center-of-mass rapidity for nucleon-nucleon collisions, $y_{cm}=1.12$. The rapidity density decreases monotonically with increasing rapidity within a rapidity window ranging from 0.3 to 1.3. The $\Lambda$ phase-space distribution is compared with results of other experiments and with predictions of two transport approaches which are available publicly. None of the present versions of the employed models is able to fully reproduce the experimental distributions, i.e. in absolute yield and in shape. Presumably, this finding results from an insufficient modelling in the transport models of the elementary processes being relevant for $\Lambda$ production, rescattering and absorption. The present high-statistics data allow for a genuine two-dimensional investigation as a function of phase space of the self-analyzing $\Lambda$ polarization in the weak decay $\Lambda\rightarrow p \pi^-$. Finite negative values of the polarization in the order of $5-20\,\%$ are observed over the entire phase space studied. The absolute value of the polarization increases almost linearly with increasing transverse momentum for $p_t>300\,$MeV/c and increases with decreasing rapidity for $y < 0.8$.Comment: accepted by Eur. Phys. J.

Subthreshold Xi- Production in Collisions of p(3.5 GeV)+Nb

Results on the production of the double-strange cascade hyperon $\mathrm{\Xi^-}$ are reported for collisions of p\,(3.5~GeV)\,+\,Nb, studied with the High Acceptance Di-Electron Spectrometer (HADES) at SIS18 at GSI Helmholtzzentrum for Heavy-Ion Research, Darmstadt. For the first time, subthreshold $\mathrm{\Xi^-}$ production is observed in proton-nucleus interactions. Assuming a $\mathrm{\Xi^-}$ phase-space distribution similar to that of $\mathrm{\Lambda}$ hyperons, the production probability amounts to $P_{\mathrm{\Xi^-}}=(2.0\,\pm0.4\,\mathrm{(stat)}\,\pm 0.3\,\mathrm{(norm)}\,\pm 0.6\,\mathrm{(syst)})\times10^{-4}$ resulting in a $\mathrm{\Xi^-/(\Lambda+\Sigma^0)}$ ratio of $P_{\mathrm{\Xi^-}}/\ P_{\mathrm{\Lambda+\Sigma^0}}=(1.2\pm 0.3\,\mathrm{(stat)}\pm0.4\,\mathrm{(syst)})\times10^{-2}$. Available model predictions are significantly lower than the estimated$\mathrm{\Xi^-}$ yield.Comment: 6 pages, 3 figure

Women's experiences of early pregnancy assessment unit services: a qualitative investigation

Objective: To explore the experiences of women who had used an Early Pregnancy Assessment Unit (EPAU) service in the UK and make recommendations for their improvement. Design: Qualitative interview study. Setting: Early Pregnancy Assessment Units in the UK. Sample: A maximum variation sample of women who had consented to be interviewed having attended one of 26 EPAUs involved in the VESPA study in 2018. Methods: In-depth telephone interviews with 38 women. A thematic framework analysis was conducted, with a focus on how experiences varied according to EPAU service configuration and clinical pathway. Main outcome measures: Women's experiences of EPAU services. Results: We found that EPAUs are highly valued, and women's experiences were generally positive. However, women reported a range of issues that negatively affected their experience. These included difficulties accessing the service, insensitive management of the investigation and treatment options of pregnancy loss, poor communication, insufficient information and a lack of support for their psychological health. These issues were not strongly associated with EPAU configuration or clinical pathway. Conclusions: Recommendations to improve women's experiences include the separation of EPAUs from general maternity services, and we make suggestions on how to remove barriers to access by reviewing opening hours, how to provide sensitive patient management, such as automatically cancelling appointments and scans following pregnancy loss, and how to improve communication, both with women and their partners as well as with other parts of the health service. Tweetable abstract: Early Pregnancy Assessment Units are highly valued by women but aspects of their care experiences, particularly around sensitive management of pregnancy loss, could be improved

Deep sub-threshold Ξ−\Xi^- production in Ar+KCl reactions at 1.76A GeV

We report first results on a deep sub-threshold production of the doubly strange hyperon $\Xi^-$ in a heavy-ion reaction. At a beam energy of 1.76A GeV the reaction Ar+KCl was studied with the High Acceptance Di-Electron Spectrometer (HADES) at SIS18/GSI. A high-statistics and high-purity $\Lambda$ sample was collected, allowing for the investigation of the decay channel $\Xi^- \to \Lambda \pi^-$. The deduced $\Xi^-/(\Lambda+\Sigma^0)$ production ratio of $(5.6 \pm 1.2 ^{+1.8}_{-1.7})\cdot 10^{-3}$ is significantly larger than available model predictions.Comment: 4 pages, including 4 figure

Searching a Dark Photon with HADES

We present a search for the e+e- decay of a hypothetical dark photon, also names U vector boson, in inclusive dielectron spectra measured by HADES in the p (3.5 GeV) + p, Nb reactions, as well as the Ar (1.756 GeV/u) + KCl reaction. An upper limit on the kinetic mixing parameter squared epsilon^{2} at 90% CL has been obtained for the mass range M(U) = 0.02 - 0.55 GeV/c2 and is compared with the present world data set. For masses 0.03 - 0.1 GeV/c^2, the limit has been lowered with respect to previous results, allowing now to exclude a large part of the parameter region favoured by the muon g-2 anomaly. Furthermore, an improved upper limit on the branching ratio of 2.3 * 10^{-6} has been set on the helicity-suppressed direct decay of the eta meson, eta-> e+e-, at 90% CL

Study of the quasi-free np→npπ+π−np \to np \pi^+\pi^- reaction with a deuterium beam at 1.25 GeV/nucleon

The tagged quasi-free $np \to np\pi^+\pi^-$ reaction has been studied experimentally with the High Acceptance Di-Electron Spectrometer (HADES) at GSI at a deuteron incident beam energy of 1.25 GeV/nucleon ($\sqrt s \sim$ 2.42 GeV/c for the quasi-free collision). For the first time, differential distributions for $\pi^{+}\pi^{-}$ production in $np$ collisions have been collected in the region corresponding to the large transverse momenta of the secondary particles. The invariant mass and angular distributions for the $np\rightarrow np\pi^{+}\pi^{-}$ reaction are compared with different models. This comparison confirms the dominance of the $t$-channel with $\Delta\Delta$ contribution. It also validates the changes previously introduced in the Valencia model to describe two-pion production data in other isospin channels, although some deviations are observed, especially for the $\pi^{+}\pi^{-}$ invariant mass spectrum. The extracted total cross section is also in much better agreement with this model. Our new measurement puts useful constraints for the existence of the conjectured dibaryon resonance at mass M$\sim$ 2.38 GeV and with width $\Gamma\sim$ 70 MeV

Partial Wave Analysis of the Reaction p(3.5GeV)+p→pK+Λp(3.5 GeV)+p \to pK^+\Lambda to Search for the "ppK−ppK^-" Bound State

Employing the Bonn-Gatchina partial wave analysis framework (PWA), we have analyzed HADES data of the reaction $p(3.5GeV)+p\to pK^{+}\Lambda$. This reaction might contain information about the kaonic cluster "$ppK^-$" via its decay into $p\Lambda$. Due to interference effects in our coherent description of the data, a hypothetical $\overline{K}NN$ (or, specifically "$ppK^-$") cluster signal must not necessarily show up as a pronounced feature (e.g. a peak) in an invariant mass spectra like $p\Lambda$. Our PWA analysis includes a variety of resonant and non-resonant intermediate states and delivers a good description of our data (various angular distributions and two-hadron invariant mass spectra) without a contribution of a $\overline{K}NN$ cluster. At a confidence level of CL$_{s}$=95\% such a cluster can not contribute more than 2-12\% to the total cross section with a $pK^{+}\Lambda$ final state, which translates into a production cross-section between 0.7 $\mu b$ and 4.2 $\mu b$, respectively. The range of the upper limit depends on the assumed cluster mass, width and production process.Comment: 7 Pages, 5 Figure