Cost-effectiveness of indwelling pleural catheter compared with talc in malignant pleural effusion

BACKGROUND AND OBJECTIVE: Malignant pleural effusion is associated with morbidity and mortality. A randomized controlled trial previously compared clinical outcomes and resource use with indwelling pleural catheter (IPC) and talc pleurodesis in this population. Using unpublished quality of life data, we estimate the cost-effectiveness of IPC compared with talc pleurodesis. METHODS: Healthcare utilization and costs were captured during the trial. Utility weights produced by the EuroQol Group five-dimensional three-level questionnaire and survival were used to determine quality-adjusted life-years (QALYs) gained. The incremental cost-effectiveness ratio (ICER) was calculated over the 1-year trial period. Sensitivity analysis used patient survival data and modelled additional nursing time required per week for catheter drainage. RESULTS: Utility scores, cost and QALYs gained did not differ significantly between groups. The ICER for IPC compared with talc was favorable at $US10 870 per QALY gained. IPC was less costly with a probability exceeding 95% of being cost-effective when survival was <14 weeks, and was more costly when 2-h nursing time per week was assumed for catheter drainage. CONCLUSION: IPC is cost-effective when compared with talc, although substantial uncertainty exists around this estimate. IPC appears most cost-effective in patients with limited survival. If significant nursing time is required for catheter drainage, IPC becomes less likely to be cost-effective. Either therapy may be considered as a first-line option in treating malignant pleural effusion in patients without history of prior pleurodesis, with consideration for patient survival, support and preferences

A Multi-Specialty Delphi Consensus on Assessing and Managing Cardiopulmonary Risk in Patients with COPD

Mohit Bhutani,1 Jean Bourbeau,2 Shaun G Goodman,3 Nathaniel Mark Hawkins,4 Alan G Kaplan,5 Peter James Lin,6 Erika Dianne Penz,7 Subodh Verma,8 Shelley Zieroth9 1Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada; 2Department of Medicine, Division of Pulmonary Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; 3Department of Medicine, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada; 4Department of Medicine, Division of Cardiology, University of British Columbia, Vancouver, British Columbia; 5Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; 6The Canadian Heart Research Centre, Primary Care Initiatives, Toronto, Ontario, Canada; 7College of Medicine, Division of Respirology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 8Department of Surgery, Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada; 9College of Medicine, Section of Cardiology, University of Manitoba, Winnipeg, Manitoba, CanadaCorrespondence: Mohit Bhutani, Department of Medicine, Division of Pulmonary Medicine, University of Alberta, 3-133 Clinical Sciences Building, 11304-83 Avenue NW, Edmonton, Alberta, T6G 2G3, Canada, Tel +1-780-492-3739, Email [email protected]: In Canada, COPD represents a significant burden to the patient and health system, as it is often under or misdiagnosed and sub-optimally treated. Cardiovascular disease (CVD) is a common co-morbidity in COPD and there is significant interplay between these two chronic conditions. Across all stages of COPD disease severity, deaths can be attributed not only to respiratory causes but also to cardiovascular-related factors. The established links between COPD and CVD suggest the need for a greater degree of collaboration between respirologists and cardiologists. This modified Delphi consensus was initiated to consider how optimal COPD care can be delivered within Canada, with specific consideration of reducing cardiopulmonary risk and outcomes in COPD patients.Methods: A steering group with interest in the management of COPD and CVD from primary care, cardiology, and respirology identified 40 statements formed from four key themes. A 4-point Likert scale questionnaire was sent to healthcare professionals working in COPD across Canada by an independent third party to assess agreement (consensus) with these statements. Consensus was defined as high if ≥ 75% and very high if ≥ 90% of respondents agreed with a statement.Results: A total of 100 responses were received from respirologists (n=30), cardiologists (n=30), and primary care physicians (n=40). Consensus was very strong (≥ 90%) in 28 (70%) statements, strong (≥ 75 and < 90%) in 7 (17.5%) statements and was not achieved (< 75%) in 5 (12.5%) of statements.Conclusion: Based on the consensus scores, 9 key recommendations were proposed by the steering group. These focus on the need to comprehensively risk stratify and manage COPD patients to help prevent exacerbations. Consensus within this study provides a call to action for the expeditious implementation of the latest COPD guidelines from the Canadian Thoracic Society.Keywords: chronic obstructive pulmonary disease, consensus development, consultation and referral, primary care, health care, Canad

Efeito da forma física da ração sobre a porosidade, espessura da casca, perda de água e eclodibilidade em ovos de perdiz (Rhynchotus rufescens) Effect of the physical form of diet on the eggshell porosity and thickness, water loss and hatchability of partridge (Rhynchotus rufescens) eggs

O objetivo do presente estudo foi avaliar se a forma física da ração (farelada e peletizada) afeta a porosidade e espessura da casca, e porcentagem de perda de água e eclodibilidade de ovos de perdiz. Os ovos foram coletados logo após a postura e separados em diferentes intervalos de peso (35-45g, 46-50g, 51-55g, 56-60g e 61-70g), sendo 10 ovos/classe/ração. O número de poros das cascas foi avaliado nas regiões apical, equatorial e basal dos ovos. Utilizou-se um micrômetro digital para a mensuração da espessura das três regiões da casca dos ovos, a partir dos quais obteve-se a espessura média por ovo. Os ovos para avaliação da eclodibilidade e porcentagem de perda de água do ovo até a transferência para o nascedouro (16º dia) foram pesados, desinfectados, incubados (T=35,5&ordm;C e UR= 70%) e transferidos no 16&ordm; dia de incubação para o nascedouro, onde foram mantidos até a eclosão. As análises estatísticas empregadas foram: Análise de Variância e de Correlação, e teste de Tukey 5%. Os dados mostraram que, em perdizes, o número de poros na casca pode variar com a região da casca, peso do ovo e a forma física da ração, e que a ingestão de ração peletizada promove um aumento na espessura da casca dos ovos sem alterar a eclodibilidade e a porcentagem de perda de água dos mesmos durante a incubação.<br>The aim of this study was to determine the effect of the ingestion of meal and pelleted diets on eggshell porosity and thickness, water loss and hatchability percentages of partridge (Rhynchotus rufescens) eggs. The eggs (n=100) were divided into five different weight classes (1: 35-45 g, 2: 46-50 g, 3: 51-55 g, 4: 56-60 g, 5: 61-70 g). Parts from different regions (air space, equator and small end) of each eggshell were analized in order to count pore numbers. Eggshell thickness measurements were carried out after removal of the egg membranes. The eggs used in the analyses of the water loss and hatchability percentages were weighed, desinfected, and then incubated (T=35.5&ordm;C and RH=70%). On the 16th day of incubation, these eggs were transferred to a hatchery maintained at temperature and RH similar to those used in the incubator, where they were kept until hatching. The results showed that the mean number of eggshell pores changed among the three regions of the eggshell and egg weight classes, and also between the physical form of diets. Ingestion of pelleted diet increased eggshell thickness; however, hatchability and water loss percentages remained unchanged