Analysis of Financial Losses due to Poor Adherence of Patients with Chronic Diseases and Their Impact on Health Economics

Pharmaceutical drugs—prescription drugs, not over-the-counter drugs—have prices that are negotiated between pharmaceutical companies and National Ministry of Health or national agency for medicines or national health insurers in every country. Prescription drug expenditures have increased every country’s healthcare costs. Medication adherence (defined as not obtained refills of prescriptions or suboptimal dosing of prescribed drugs) is a growing concern to physicians and healthcare systems because of the multiple evidence of noncompliance among patients and correlated adverse outcomes. A patient is considered adherent if he/she takes 80% of his/her prescribed medicine(s). Different studies showed that patients do not take their prescribed medicines about half the time. Financial losses due to poor adherence are the result of unnecessary time-consuming work and costs for potential harm to patients. Hospitalization rates are reduced at higher levels of medication adherence. There are two types of financial losses due to poor treatment adherence: medical costs (measured by hospitalization risk) and drugs costs (without patient copayments). This financial loss analysis underlines the promotion of medication adherence by the patients

Personal Autonomy as Quality of Life Predictor for Multiple Sclerosis Patients

Multiple sclerosis (MS) is a chronic, severe disease, characterized by a progressive alteration in neuronal transmission, which decreases personal independence and quality of life (QoL). This study aimed to investigate the relationship between QoL and personal autonomy in patients with MS, as well as its correlation with age, educational level, and diseases severity. Twenty-six MS patients were followed-up for six months. All patients completed the 15D questionnaire two times: at T0, when they started a new treatment, and at T1 after six months of treatment. At the end point, all patients completed the Personal Autonomy Questionnaire. The average patient age was 43 years (SD = 10), and 89% of them were female. The mean severity and duration of MS were 3.5 (SD = 1.75) and 9.5 (SD = 5.1), respectively. The average QoL of MS patients at T0 was 0.66 (SD = 0.18), and that at T1 was 0.71 (SD = 0.16). The scores of patients with different types of MS, i.e., relapsing–remitting MS (RRMS) or secondary progressive MS (SPMS), were compared. SPMS patients were older than RRMS patients (mean age 47.5 vs. 39.7 years; p = 0.032), and more RRMS patients were working (0.014). SPMS patients described the same QoL and personal autonomy as RRMS patients. Results from bivariate correlation analyses showed a significant relationship between QoL and age, education, and severity of MS. Also, the analysis showed no significant correlation between QoL and personal autonomy

Personal Autonomy as Quality of Life Predictor for Multiple Sclerosis Patients

Multiple sclerosis (MS) is a chronic, severe disease, characterized by a progressive alteration in neuronal transmission, which decreases personal independence and quality of life (QoL). This study aimed to investigate the relationship between QoL and personal autonomy in patients with MS, as well as its correlation with age, educational level, and diseases severity. Twenty-six MS patients were followed-up for six months. All patients completed the 15D questionnaire two times: at T0, when they started a new treatment, and at T1 after six months of treatment. At the end point, all patients completed the Personal Autonomy Questionnaire. The average patient age was 43 years (SD = 10), and 89% of them were female. The mean severity and duration of MS were 3.5 (SD = 1.75) and 9.5 (SD = 5.1), respectively. The average QoL of MS patients at T0 was 0.66 (SD = 0.18), and that at T1 was 0.71 (SD = 0.16). The scores of patients with different types of MS, i.e., relapsing–remitting MS (RRMS) or secondary progressive MS (SPMS), were compared. SPMS patients were older than RRMS patients (mean age 47.5 vs. 39.7 years; p = 0.032), and more RRMS patients were working (0.014). SPMS patients described the same QoL and personal autonomy as RRMS patients. Results from bivariate correlation analyses showed a significant relationship between QoL and age, education, and severity of MS. Also, the analysis showed no significant correlation between QoL and personal autonomy

Ectopic adrenal adenoma causing gross hematuria: Steroidogenic enzyme profiling and literature review

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149375/1/iju512068.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149375/2/iju512068_am.pd

The Clinical Impact of [68Ga]‐DOTATATE PET/CT for the Diagnosis and Management of Ectopic Adrenocorticotropic Hormone – Secreting Tumours

ObjectivesLocalization of ectopic ACTH‐secreting tumours causing Cushing syndrome (ECS) is essential for clinical management, yet often difficult. [68Ga]‐DOTATATE PET/CT ([68Ga]‐DOTA‐(Tyr3)‐octreotate)] is an FDA‐approved high‐resolution diagnostic tool for imaging neuroendocrine tumours. Data on the clinical utility of [68Ga]‐DOTATATE in patients with ECS, however, are scarce. The objectives of this study were to determine the efficacy for ECS localization and the clinical benefit of [68Ga]‐DOTATATE imaging.MethodWe conducted a retrospective review of all cases with ECS evaluated with [68Ga]‐DOTATATE from November 2016 through October 2018 at three referral centres. The clinical benefit of [68Ga]‐DOTATATE was based on detection of new tumours and resultant changes in management.ResultsOver the study period, 28 patients with ECS underwent [68Ga]‐DOTATATE: 17 for identification of the primary tumour and 11 during follow‐up. [68Ga]‐DOTATATE identified the suspected primary ECS in 11/17 patients (65%). Of these, nine patients underwent surgery: eight with confirmed ECS (5 bronchial, 1 thymic, 1 pancreatic and 1 metastatic neuroendocrine tumour of unknown primary origin) and one patient with a false‐positive scan (adrenal gland). Of the 11 patients with ECS who underwent [68Ga]‐DOTATATE evaluation during follow‐up, the study led to changes in clinical management in 7/11 (64%) patients.Conclusions[68Ga]‐DOTATATE is sensitive in detecting primary and metastatic ECS, often identifies occult tumours after conventional imaging, and impacts clinical care in the majority of patients.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150507/1/cen14008.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150507/2/cen14008_am.pd

The effect of glucosamine, chondroitin and harpagophytum procumbens on femoral hyaline cartilage thickness in patients with knee osteoarthritis– An MRI versus ultrasonography study

Background: the evaluation of cartilage thickness has become possible with new techniques such as musculoskeletal ultrasonography (US) and magnetic resonance imagining (MRI), making the evaluation of the treatment response and the progression of the disease more accurate. Objective: to evaluate the efficacy of a Symptomatic Slow Acting Drug for Osteoarthritis using both US and MRI for measuring cartilage thickness at baseline and after 1 year. Methods: The study included the clinical evaluation of 20 patients at baseline, at 6 and 12 months as well as imaging exams (US and MRI) at baseline and after 1 year. Measurements were performed in both knees, in lateral and medial condyles, and in the intercondylar area. After the baseline visit, patients underwent a SYSADOA treatment which included Harpagophytum procumbens (HPc) administered on a daily basis, in a specific regimen. Results and discussions: The US examination permitted the detailed evaluation of the femoral hyaline cartilage thickness, with statistically significant differences before and after treatment at the level of the medial compartment, both in the dominant (1.59±0.49 vs. 1.68±0.49, p=0.0013) and non-dominant knee (1.73±0.53 vs. 1.79±0.52, p=0.0106). The US and the MRI correlated well (r=0.63) and showed no radiographic progression in knee osteoarthritis after one year of treatment with specific SYSADOA. Moreover, the US showed improvement in the cartilage thickness of the medial compartment. Conclusions: The combination with HPc could increase the delay in the radiographic progression of the knee osteoarthritis, with improvement of femoral hyaline cartilage thickness in the medial and lateral compartment. The US might be an important tool in OA evaluation and monitoring

Discordance between imaging and immunohistochemistry in unilateral primary aldosteronism

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139975/1/cen13442.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139975/2/cen13442_am.pd

How to Sample the Unreachable: Transbronchial Biopsy

Transbronchial biopsy (TBBx) or bronchoscopic lung biopsy (BLBx) should be a diagnosis tool for focal peripheral lesions and for diffuse lung disease in every bronchoscopic suite around the world. The main advantage of this procedure is that it avoids open lung surgery for peripheral lung biopsy. The procedure is usually safe and can be done in an outpatient setting with moderate sedation, but life-threatening complications can occur, so a proper evaluation of the risk benefits ratio should be carefully analyzed before the intervention. There is no need for guidance in diffuse peripheral lesions, but for localized peripheral lesions, the diagnostic yield of TBBx is significantly higher with fluoroscopic guidance. In this chapter, we assess the utility, indications, and contraindication of this technique, as well as its clinical applications and complications

Hydroxyapatite-ciprofloxacin delivery system: Synthesis, characterisation and antibacterial activity

The main objective of this study was to synthesize hydroxyapatite-ciprofloxacin composites using a chemical precipitation method and to evaluate the properties and in vitro release profile of the drug from the hydroxyapatite-ciprofloxacin composites. Composite characterization was achieved by FT-IR, XRD and DLS. Ciprofloxacin determination was accomplished by HPLC, resulting in good incorporation efficiency of the drug (18.13 %). The in vitro release study (Higuchi model C = K t1/2 and Ritger-Peppas model, C = K t0.6) showed a diffusion-controlled mechanism. The antibacterial activity showed that the bacterial growth inhibition zones were approximately equal for the synthesis composites and for the mechanical mixture on the Staphylococcus aureus germ. The use of hydroxyapatite, which is a biocompatible, bioactive and osteoconductive material, with ciprofloxacin, which has good antibacterial activity in this composite, makes it suitable for the development of bone grafts. Furthermore, the synthesis process allows a slow local release of the drug