The PATH study: Preparing for the Adoption of innovative hearing THerapies

BACKGROUND: Innovative drug, gene and cell therapies are being developed to address the unmet clinical need of people with hearing loss. With approval for clinical use on the horizon in the next 5 years, it is essential to start preparing for the implementation of these therapies in hearing healthcare services. AIM: To provide stakeholders who develop, will use and pay for innovative hearing therapies, with a detailed understanding of the elements that influence their adoption and implementation and with practical strategies to facilitate their uptake in the UK healthcare system. METHOD: 1) To inform product development and decisions on value for money, I constructed an early health economic model with input data from literature searches and 26 interviews. 2) To characterise and understand the elements that influence the adoption and implementation of innovative hearing therapies in the UK healthcare system, I conducted 37 semi-structured interviews drawing upon insights from the early health economic model. 3) To add to this understanding, I performed a hermeneutic review of elements that influence the adoption and implementation of innovative therapies in general. 4) To integrate the findings from my thesis, I constructed a framework that maps the elements that influence innovative hearing therapy adoption and implementation, and that summarises practical strategies to facilitate uptake. RESULTS: I found that alliances between clinicians, scientists, patients, biotechnology and hearing technology companies can facilitate adoption of innovative hearing therapies, benefitting from pooled resources, diffusion networks and established market access. Timely clinician education can break down engrained clinical practices and gain clinician buy-in. Early engagement with patients can help ensure these therapies meet patient needs and generate patient and public interest, which can influence clinician uptake and policy decisions. Precision diagnostics are critical to the development and uptake of innovative hearing therapies; co-development strategies and novel regulatory pathways can accelerate their development. Accelerator organisations can help navigate healthcare systems, assist with manufacturing and distribution strategies, support clinical trialing, help develop business cases, and lobby decision makers. Additional insights revealed that novel payment strategies and robust business cases can help make procurement affordable and avoid delays in adoption. Real world data can increase confidence to take-up innovative hearing therapies, support payment strategies, early access programs and help fulfil regulatory requirements. CONCLUSION: My research has resulted in a framework that can accelerate the uptake of innovative hearing therapies across healthcare systems. Stakeholders can use my framework to gain detailed information on the processes that need to take place for adoption and implementation of these therapies as well as strategies to facilitate these processes

Atlantoaxial TB with paralysis: posterior-only cervical approach with good results

Early posterior cervical approach is an effective strategy for patients with cervical tuberculosis in the appropriate circumstances

What health policy makers need to know about mismatches between public perceptions of disease risk, prevalence and severity: a national survey

Objectives: The aim of this study was to assess people’s perceptions of their personal risk, population prevalence and perceived severity in relation to three key health conditions (cancer, heart disease and hearing loss), gauge the size of any misperceptions, and identify correlates of such misperceptions. / Design: This study was a cross-sectional survey. / Study sample: A total of 10,401 adults representative of the UK population were participated in the study. / Results: Clear majorities of people incorrectly believe that they are at greater personal risk of cancer (>75%), that cancer is more prevalent in the population (>50%) and that cancer is more disabling (>65%), than either heart disease or hearing loss. In turn, people consistently regard their personal risk of hearing loss, the population prevalence of hearing loss and the severity of hearing loss as lower than either cancer or heart disease. Multiple regression analyses showed inconsistent patterns of relationships between people’s beliefs, sociodemographic characteristics and their health behaviours. / Conclusions: Accuracy in beliefs about cancer, heart disease and hearing loss is low, and the relationships between these beliefs, their potential antecedents and consequences are complex. Policy makers should ensure close adherence to evidence or risk-making decisions that are costly both in financial terms and in terms of suboptimal population subjective well-being

Effectiveness of UK provider financial incentives on quality of care: a systematic review

Background: Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency. / Aim: To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care. / Design and setting: Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. / Method: MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist. / Results: Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points. / Conclusion: The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK

Evaluation of anti-inflammatory, analgesic, and antipyretic effects of ethanolic extract of Pedalium murex linn. fruits

This study investigated the possible anti-inflammatory, analgesic, and antipyretic effects of ethanolic extract of Pedalium murex Linn. fruits in selected experimental animal models. Anti-inflammatory activity of  Pedalium murex Linn., with doses of 200 mg/kg and 400 mg/kg, p.o., was evaluated by Lambda-carrageenan induced paw oedema in Wistar albinorats; analgesic activity with doses of 280 mg/kg and 560 mg/kg, p.o., was evaluated by hot plate method and acetic acid induced writhing method in Swiss albino mice; and antipyretic activity with doses of 110 mg/kg and 220 mg/kg, p.o., was evaluated in New Zealand white rabbits by injecting gram –ve lipopolysaccharide obtained from E. coli. Results were analysed by one way ANOVA followed by Dunnet’s multiple comparison test.  Pedalium murex Linn. showed significant anti-inflammatory activity from 15 min to 180 min as compared to vehicle treated animals. It was comparable to diclofenac sodium at 180 min. The extract did not prolong the reaction time on hot plate method but significantly reduced the number of writhing after acetic acid administration. Also the extract did not show any antipyretic activity on lipopolysaccharide induced pyrexia. It is therefore concluded that the ethanolic extract of Pedalium murex Linn. fruits has an anti-inflammatory and peripheral analgesic effects.Keywords: Anti-inflammatory, Analgesic, Antipyretic, Pedalium murex Linn., Carrageena

Beyond Beck's triad: A case report of cardiac tamponade in a “super-super� obese patient

Cardiac tamponade is a medical emergency with various etiologies. Prompt recognition of the signs and symptoms of cardiac tamponade is critical but potentially full of challenge in clinical practice [1]. Here we report a case that required approaches more than classical Beck's triad due to extreme body habitus

Modeling Mechanisms of Human Immunodeficiency Virus and Sexually Transmitted Infections Contraction Among Serodiscordant Couples

This dissertation seeks to incrementally explain the impact of individual, interpersonal, and environmental levels of risk upon HIV/STI incidents among heterosexual African American serodiscordant couples residing in four metropolitan cities. Using archival data from a cluster-RCT (Project EBAN) and governmental surveillance reports, analytic methods that can model heterogeneous pathways within and across each level of risk were used. Findings from this dissertation revealed unique patterns and pathways via which African American females in serodiscordant relationships contracted HIV/STI

EXPLORING VISCERAL ADIPOSITY INDEX AS A PREDICTOR OF VISCERAL ADIPOSITY DYSFUNCTION AND EVALUATING ITS PERFORMANCE IN PREDICTING HEPATIC INSULIN RESISTANCE IN INDIAN TYPE 2 DIABETICS

Objective: Visceral adiposity index (VAI) is a simple clinical algorithm developed as a surrogate marker for characterizing visceral adiposity dysfunction (VAD). This study aimed to explore an optimal VAI cut off value for predicting VAD as reflected quantitatively by magnetic resonance imaging (MRI) and to evaluate its merit in predicting the severity of the cardiometabolic risk (CMR) in type 2 diabetic patients of India.Methods: Data was collected from 81 diabetics and 48 healthy participants, who underwent metabolic assessments. VAI derived using BMI, waist circumference (WC), triglycerides (TG) and HDLc, was studied against visceral fat area measuring ≥130 cm2 by MRI as it is associated with higher CMR through raised VAD. Optimal VAI cutoff was determined using the area under the receiver operator characteristic curve (AUROC). Diabetic participants were divided into VAD absent, and VAD present groups based on derived VAI cut off to study associated difference in their metabolic profile. Results: Diabetic group had significantly deranged metabolic profile compared to the healthy control group. Most of the diabetic group participants had a visceral fat area between 101 and 200 cm2. From the ROC curve analysis (AUROC = 0.761), VAI cut-off of 2.0 predicted VAD with sensitivity and specificity of 73.21% and 71.23% respectively. Diabetic participants with VAI values more than 2, had significantly (p<0.05) higher WC, visceral fat, fasting insulin, HOMA-IR (Homeostatic model assessment for insulin resistance), TG (p<0.01), non-HDLc and apolipoprotein B/A1 ratio values. Age adjusted partial correlation analysis showed a significant (p<0.01) positive correlation between VAI and HOMA-IR.Conclusion: VAI was useful in predicting VAD and identifying the severity of CMR within type 2 diabetics. VAI can replace imaging procedures with the advantages of reduced economic burden and can be used as screening tool for surveillance of CMR in Indian population.Â