Increasing the information provided by probabilistic sensitivity analysis:The relative density plot

Background Results of probabilistic sensitivity analyses (PSA) are frequently visualized as a scatterplot, which is limited through overdrawing and a lack of insight in relative density. To overcome these limitations, we have developed the Relative Density plot (PSA-ReD). Methods The PSA-ReD combines a density plot and a contour plot to visualize and quantify PSA results. Relative density, depicted using a color gradient, is transformed to a cumulative probability. Contours are then plotted over regions with a specific cumulative probability. We use two real-world case studies to demonstrate the value of the PSA-ReD plot. Results The PSA-ReD method demonstrates proof-of-concept and feasibility. In the real-world case-studies, PSA-ReD provided additional visual information that could not be understood from the traditional scatterplot. High density areas were identified by color-coding and the contour plot allowed for quantification of PSA iterations within areas of the cost-effectiveness plane, diminishing overdrawing and putting infrequent iterations in perspective. Critically, the PSA-ReD plot informs modellers about non-linearities within their model. Conclusions The PSA-ReD plot is easy to implement, presents more of the information enclosed in PSA data, and prevents inappropriate interpretation of PSA results. It gives modelers additional insight in model functioning and the distribution of uncertainty around the cost-effectiveness estimate

Allopathic and traditional health practitioners’ collaboration

Background: Professional collaboration between traditional and allopathic health practitioners in South Africa is proposed in the Traditional Health Practitioners Act and could benefit and complement healthcare delivery. Objectives: To explore and describe the collaborative relationship between allopathic and traditional health practitioners regarding the legalisation of traditional healing, and these health practitioners’ views of their collaborative and professional relationship, as role-players in the healthcare delivery landscape in South Africa. Methods: A qualitative design was followed. The research population comprised 28 participants representing three groups: allopathic health practitioners (n = 10), traditionalhealers (n = 14), and traditional healers who are also allopathic health practitioners (n = 4). Purposive and snowball sampling was used. Data collection involved unstructured interviews, a focus group interview and modified participant observation. Results: Results indicate both allopathic and traditional health practitioners experienced negative attitudes towards each other. Mutual understanding (in the form of changing attitudes and communication) was considered crucial to effective collaboration between these two health systems. Participants made suggestions regarding capacity building. Conclusions: Considering realities of staff shortages and the disease burden in South Africa, facilitating collaboration between allopathic and traditional health practitioners is recommended. Recommendations could be used to develop strategies for facilitating professional collaboration between traditional and allopathic health practitioners in order to complement healthcare delivery

A new class of exact solutions of the Schrodinger equation

The aim of this paper is to find the exact solutions of the Schrodinger equation. As is known, the Schrodinger equation can be reduced to the continuum equation. In this paper, using the non-linear Legendre transform the equation of continuity is linearized. Particular solutions of such a linear equation are found in the paper and an inverse Legendre transform is considered for them with subsequent construction of solutions of the Schrodinger equation. Examples of the classical and quantum systems are considered.Comment: 26 pages, 34 figure

Improving nurses knowledge of managing endotracheal tube cuff pressure in intensive care units : a quasi-experimental study

CITATION: Mpasa, F. et al. 2020. Improving nurses’ knowledge of managing endotracheal tube cuff pressure in intensive care units: A quasi-experimental study. Health SA Gesondheid 25. doi:10.4102/hsag.v25i0.1479The original publication is available at https://hsag.co.za/index.php/hsag/pages/view/journal-informationBackground: Previous studies conducted on nurses’ knowledge regarding endotracheal tube cuff pressure revealed that there were differences in intensive care nurses’ knowledge, leading to varying practices. Aim: This study aimed to evaluate how an educational intervention based on the existing evidence-based guidelines, using both passive and active implementation strategies, could improve the knowledge of nurses regarding managing endotracheal tube cuff pressures in Malawian intensive care units. Setting: Six functional ICUs (four public and two private) in Malawi. Methods: The study followed a quasi-experimental, pre- and post-test design using an educational intervention. Intensive care nurses of six functional intensive care units in Malawi were randomly assigned to two intervention groups. Both groups received a half-day educational session, a printed version of the evidence-based guidelines, a printed and laminated summary of the guidelines and a related algorithm. Additionally, Intervention 2 group received four monitoring visits. Pre- and post-test questionnaires were conducted between February and August 2016. Descriptive and inferential data analyses (a chi-square test and t-test) were utilised. Results: An improvement in knowledge was observed on the nursing care practices for the management of endotracheal tube cuff pressure for both groups following the educational intervention, although only the results comparing Intervention 2 group participants indicate that the level of knowledge was significant (t[df = 48] = 2.08, p = 0.043, d = 0.59). Conclusion: Implementation of a formal training and mentorship programme for Malawian intensive care nurses would be of great benefit to enhance the knowledge and skills managing endotracheal tube cuff pressure. Follow-up studies would also assist in understanding how guidelines could be implemented most effectively to achieve better knowledge outcomes.Creative Commons Attribution 4.0 International (CC BY 4.0) licensePublishers versio

Malawian critical care nurses’ views on the implementation of an educational intervention to enhance sustained use of an evidence-based endotracheal tube cuff pressure management guideline: A survey study

Background. Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice. Objectives. To evaluate Malawian critical care nurses’ views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use. Methods. An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach’s alpha score of 0.85. Results. A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); t=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices). Conclusion. The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts

Targeted Therapies Compared to Dacarbazine for Treatment of BRAF V600E Metastatic Melanoma: A Cost-Effectiveness Analysis

. Purpose. Two BRAF V600E targeted therapies, dabrafenib and vemurafenib, have received US approval for treatment of metastatic melanoma in BRAF V600E patients, a mutation that affects ∼50% of patients. We evaluated the cost-effectiveness of BRAF inhibitors and traditional chemotherapy for treatment of metastatic melanoma. Methods. A Markov model was developed using a societal perspective. Transition probabilities were derived from two Phase III registration trials comparing each BRAF inhibitor against dacarbazine. Costs were obtained from literature, national databases, and Medicare fee schedules. Utilities were obtained from published literature. Deterministic and probabilistic sensitivity analyses were run to test the impact of uncertainties. Results. The incremental cost-effectiveness ratio of dabrafenib was $149,035/QALY compared to dacarbazine. Vemurafenib was dominated by dabrafenib. Probabilistic sensitivity analysis showed that, at a willingness-to-pay (WTP) threshold of ≤$100,000/QALY, dacarbazine was the optimal treatment in ∼85% of simulations. At a WTP threshold of ≥$150,000/QALY, dabrafenib was the optimal treatment. Conclusion. Compared with dacarbazine, dabrafenib and vemurafenib were not cost-effective at a willingness-to-pay threshold of$100,000/QALY. Dabrafenib is more efficient compared to vemurafenib. With few treatment options, dabrafenib is an option for qualifying patients if the overall cost of dabrafenib is reduced to $30,000-$31,000 or a WTP threshold of ≥$150,000/QALY is considered. More comparative data is needed

Clinical use of tolerogenic dendritic cells-harmonization approach in european collaborative effort

Altres ajuts: IWT/TBM/140191The number of patients with autoimmune diseases and severe allergies and recipients of transplants increases worldwide. Currently, these patients require lifelong administration of immunomodulatory drugs. Often, these drugs are expensive and show immediate or late-occurring severe side effects. Treatment would be greatly improved by targeting the cause of autoimmunity, that is, loss of tolerance to self-antigens. Accumulating knowledge on immune mechanisms has led to the development of tolerogenic dendritic cells (tolDC), with the specific objective to restrain unwanted immune reactions in the long term. The first clinical trials with tolDC have recently been conducted and more tolDC trials are underway. Although the safety trials have been encouraging, many questions relating to tolDC, for example, cell-manufacturing protocols, administration route, amount and frequency, or mechanism of action, remain to be answered. Aiming to join efforts in translating tolDC and other tolerogenic cellular products (e.g., Tregs and macrophages) to the clinic, a European COST (European Cooperation in Science and Technology) network has been initiated-A FACTT (action to focus and accelerate cell-based tolerance-inducing therapies). A FACTT aims to minimize overlap and maximize comparison of tolDC approaches through establishment of minimum information models and consensus monitoring parameters, ensuring that progress will be in an efficient, safe, and cost-effective way