Short-Term cost impact of compliance with clinical practice guidelines for initial sarcoma treatment

Background: The impact of compliance to clinical practice guidelines (CPG) on outcomes and/or costs of care has not been completely clarified.Objective: To estimate relationships between medical expenditures and compliance to CPG for initial sarcoma treatment.Research design: Selected cohorts of patients diagnosed with sarcoma in 2005 and 2006, and treated at the University hospital and/or the cancer centre of the Rhône-Alpes region, France (n=90). Main outcome measurements were: patient characteristics, compliance with CPG, health outcomes, and costs. Data were mainly extracted from patient records. The logarithm of treatment costs was modelled using linear and Tobit regressions.Results: Rates of compliance with CPG were 86%, 66%, 88%, 89%, and 95% for initial diagnosis, primary surgical excision, wide surgical excision, chemotherapy, and radiotherapy, respectively. Total average costs reached €24,439, with €1,784, €11,225, €10,360, and €1,016 for diagnosis, surgery (primary and wide surgical excisions), chemotherapy, and radiotherapy, respectively. Compliance of diagnosis with CPG decreased the cost of diagnosis, whereas compliance of primary surgical excision increased the cost of chemotherapy. Compliance of chemotherapy with CPG decreased the cost of radiotherapy.Conclusion: Since chemotherapy is one of the major cost drivers, these results support that compliance with guidelines increases medical care expenditures in short term.Oncology; Sarcoma; Cost; Clinical guidelines; Efficacy; Medical Practices; Government Policy; Regulation; Public Health

La réponse proposée par des citoyens engagés dans la réflexion et la pratique de l'économie sociale

Dans le cadre d'un cycle de conférences d'ATTAC, j'ai présenté les contours de l'économie sociale ainsi qu'une série d'enjeux auxquels elle est confrontée. A la suite de ma présentation, B. Morelle présentait l'expérience de "Quelque chose à faire"

Tenofovir-related acute kidney injury and proximal tubule dysfunction precipitated by diclofenac : a case of drug-drug interaction

We describe an HIV1-positive patient under long-term tenofovir treatment who developed a severe, biopsy-proven, acute tubular necrosis with proximal tubule (PT) dysfunction, precipitated by the very recent start of diclofenac, a nonsteroidal antiinflammatory drug (NSAID). Recent studies show that NSAIDs not only alter glomerular filtration but also multidrug resistance protein (MRP) 4-mediated PT secretion of several substrates. Since the patient tolerated tenofovir well for several years prior to diclofenac use, our observation suggests that diclofenac interfered with tenofovir clearance, thereby favoring its nephrotoxicity. NSAIDs should be avoided in patients under tenofovir

The impact of CD34+ cell dose on the cost of HDT with PBSC transplantation in lymphomia

National audienc

Synthesis of New Ionic Liquid-Grafted Metal-Oxo Nanoclusters – Design of Nanostructured Hybrid Organic-Inorganic Polymer Networks

International audienceDesigning innovative multi-functional thermoset polymers represents a major challenge in materials science. In this work, two novel polyhedral imidazolium ionic liquid supported on oligomeric silsesquioxane nanocages having chloride (Cl-) and bistrifluoromethanesulfonimidate (NTf2-) counter anions have been synthesized. These ionic nano-objects were used to nanostructure a model epoxy network. Hence, networks displaying a homogeneous nanoscale morphology were obtained by introducing 5wt % of such organic-inorganic (O/I) silicon-oxo clusters functionalized with ionic liquids. The obtained ionic hybrid O/I epoxy-amine networks display an excellent thermal stability (> 400 °C) compared to their neat counterparts, as well as a pronounced hydrophobic character (23 mJ m-2) and good mechanical performances. Moreover, these O/I nanostructured networks demonstrate an improved fire resistance according to pyrolysis-combustion flow calorimetry (PCFC) and cone calorimetry analyses. In fact, the use of low amounts of imidazolium ionic liquid-modified polyhedral oligomeric silsesquioxanes induce a significant decrease of heat release rate (about 55 %), as well as a retardation of the ignition time (close to 29 %) compared to the neat epoxy-amine network

New reptile records from Lekedi Park and Haut-Ogooue Province, southeastern Gabon

Presented is a compilation of new locality records with natural history data for 49 reptile species in Haut-Ogooue Province, southeastern Gabon, Equatorial Africa. One new snake species record is added to Gabon (Colubridae: Philothamnus hughesi), 14 new reptile species records to Haut-Ogooue Province, three new reptile records for Leconi Park, and 28 new reptile records for Lekedi Park. A predation case is reported of Naja melanoleuca preying on Dasypeltis fasciata and of Boaedon perisilvestris on a micromammal

Vers une nécessaire harmonisation des évaluations de coûts en santé. L'exemple des intensifications thérapeutiques avec autogreffes de cellules souches du sang périphérique en France

National audienc

Vers une nécessaire harmonisation des évaluations de coûts en santé. L'exemple des intensifications thérapeutiques avec autogreffes de cellules souches du sang périphérique en France

National audienc

Clinical and mutational spectrum of hypoparathyroidism, deafness and renal dysplasia syndrome.

Hypoparathyroidism, deafness and renal dysplasia (HDR) syndrome is a rare autosomal dominant disorder, secondary to mutations in the GATA-3 gene. Due to its wide range of penetrance and expressivity, the disease may not always be recognized. We herein describe clinical and genetic features of patients with HDR syndrome, highlighting diagnostic clues