Cost-effectiveness of red blood cell transfusion vs. non-intervention in women with acute anaemia after postpartum haemorrhage

BackgroundRed blood cell (RBC) transfusion is frequently used to treat women with acute anaemia after postpartum haemorrhage. We aimed to assess the economic consequences of red blood cell transfusion compared to non-intervention in these women. MethodsA trial-based cost-effectiveness analysis was performed alongside the Well-Being of Obstetric patients on Minimal Blood transfusions (WOMB) trial. Women with acute anaemia [Hb 48-79g/dl (30-49mm)] after postpartum haemorrhage, without severe anaemic symptoms, were randomly allocated to RBC transfusion or non-intervention. Primary outcome of the trial was physical fatigue (Multidimensional Fatigue Inventory, scale 4-20; 20 represents maximal fatigue). Total costs per arm were calculated using a hospital perspective with a 6weeks time horizon. ResultsPer woman, mean costs in the RBC transfusion arm (n=258) were Euro1957 compared to Euro1708 in the non-intervention arm (n=261; P=0024). The 13% difference in costs between study arms predominantly originated from costs of RBC units, as costs of RBC units were six times higher in the RBC transfusion arm. RBC transfusion led to a small improvement in physical fatigue of 058 points per day; thus, the costs to improve the physical fatigue score with one point would be Euro431. ConclusionIn women with acute anaemia after postpartum haemorrhage (PPH), RBC transfusion is on average Euro249 more expensive per woman than non-intervention, with only a small gain in HRQoL after RBC transfusion. Taking both clinical and economic consequences into account, implementation of a non-intervention policy seems justified

Simulation of Microgravity by Magnetic Levitation and Random Positioning: Effect on Human A431 Cell Morphology

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Review Update on Topical Therapy for Psoriasis

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. Purpose of Review: Studies show frequent usage but low adherence rates and poor satisfaction from topical therapy for psoriasis. These were attributed to low efficacy, inconvenience of application, and poor cosmetic quality for different body parts. Recent Findings: Multicenter surveys on patients suggest a two-way holistic approach, where patients convey what bothers them most and doctors explain how products address specific concerns. New rapid response targeted topical agents, in cosmetically acceptable preparations, applied less often, are undergoing efficacy and safety studies, ideally on large populations up to 1 year or more. Until available, this review addresses gaps in knowledge on how to maximize effects of emollients, used alone, with physiologic lipids, or as base for active topical therapy. Summary: Updates—on how psoriasis skin becomes itchy, red, dry, thick, and scaly from inflammation and barrier defects—explain clinical responses to the physical, chemical, and functional properties of psoriasis topical therapies

Pick Up and Oocyte Management

Pregnancy-related cardiovascular complications are rare clinical conditions that can lead to significant maternal morbidity and mortality. With the implementation of infertility treatment, a new selected population of woman can experience pregnancy. Women with multiple medical problems and women near or beyond menopause are now able to conceive. Despite many unanswered questions, clinicians should be prepared for the challenges and potential cardiovascular complications related to patients who are epidemiologically different than those seen in the past