Клинико-экономическая оценка терапии острого повреждения почек при сепсисе продолжительными комбинированными методами заместительной почечной терапии

Objective: complex assessment of clinical and economic effectiveness as well as saving of the state budget assets within the therapy of patients with sepsis/septic shock based on different technologies of blood purification.Methods. Evaluation of direct and indirect costs of the eight blood purifcation methods. The target population includes adult patients 18+ with septic acute kidney injury. The study was conducted in compliance with acting Standards on Clinical Economic Studies used in the Russian Federation.The study methods included evaluation of existing randomized clinical studies and trials with data from network meta-analyses and systematic reviews of the target technologies. The direct medical and indirect non-medical costs were calculated and analyzed in respect of cost-effectiveness  and budget impact analyses.Results. Direct and indirect costs were calculated for the sorption devices oXiris (Baxter International Inc.), Toraymyxin (Toray Medical Co.), Alteco LPS Adsorber (Alteco Medical AB), Toxipak (POKARD NPF), Desepta.LPS (BIOTECH M NPP), CytoSorb (CytoSorbents Inc.), HA330 (Jafron Biomedical Co.), Desepta (BIOTECH M NPP) for two time-horizons: 1-year period and 5-years period with discounting. For both periods, the use of oXiris hemoflter results in the least economic burden for the state budget.Conclusion. The use of blood purifcation in septic patients therapy is associated with considerable direct and indirect fnancial expenses, the amount of which and consequential budget saving depend on the technology of blood purifcation applied. The actual tariff compensation policy evidently demands revising.Цель исследования: комплексная оценка клинико-экономической эффективности и экономии бюджетных средств при использовании разных технологий экстракорпоральной гемокоррекции (ЭГК) при лечении больных с сепсисом / септическим шоком.Методика. Предмет исследования – фармако-экономические показатели прямых медицинских и непрямых затрат при использовании восьми технологий ЭГ. Целевая популяция – пациенты старше 18 лет с сепсис-ассоциированным острым повреждением почек. Исследование осуществлено в соответствии с действующим отраслевым стандартом «Клинико-экономические исследования», применяемым в России.Методология предполагала оценку имеющихся рандомизированных клинических исследований, а также исследований, включающих данные сетевых метаанализов и систематических обзоров применения изучаемых технологий. Произведен расчет прямых медицинских и непрямых немедицинских затрат с анализом по критериям «затраты ‒ эффективность», «влияние на бюджет».Результаты. Определена величина прямых и косвенных затрат при использовании сорбционных устройств oXiris (Baxter International Inc.), Toraymyxin (Toray Medical Co.), Alteco LPS Adsorber (Alteco Medical AB), Toxipak (НПФ ПОКАРД), Desepta.LPS (НПП Биотех М), CytoSorb (CytoSorbents Inc.), HA330 (Jafron Biomedical Co.), Desepta (НПП Биотех М) в расчете на применение технологий в течение 1 года и на временной 5-летний горизонт. Показано, что среди всех технологий в оба этих периода наименьшую нагрузку на бюджет оказывает использование гемофильтра oXiris.Выводы. Использование экстракорпоральной гемокоррекции при лечении больных с сепсисом сопровождается большими прямыми и косвенными финансовыми затратами, величина которых и экономия бюджетных средств зависят от применяемой технологии. Порядок компенсации затрат на экстракорпоральную гемокоррекцию при сепсисе, реализуемый в настоящее время в рамках модели, основанной на клинико-статистических группах, требует пересмотра

Networked teleoperation applied in mobile teaching: Study

In the last few decades, an increasing number of people are beginning to realize that bilateral teleoperation plays an important role in the extension of human manipulation in fields such as space, underwater exploration, medical surgery, and hazardous environments. There is also enormous and untapped potential in applying bilateral teleoperation in mobile teaching especially networked scenarios. Nowadays, education not only focuses on the passing on of knowledge but also the interaction between teacher and student. Meanwhile, increasing numbers of people are beneficial from mobile/distance education. While due to the limitations of practicing, students are limited to art subjects. Thus, with the better than better smartphones emerging, bilateral teleoperation-based mobile teaching will become a revelation to the existing education structure. When it comes to the teleoperation system, the greatest consideration is the time delay over the transmission which influences the performance of the system. With the development of the Internet, in recent years, an increasing number of teleoperation applications are applied over this global network. There is no denying the fact that dealing with the time delay issue on the Internet has been considered as the primary challenge as it can deteriorate system performance and even destabilize it. Many studies in the literature address the problem of the transmission delay of teleoperation across the Internet. Those among them that consider the controller design and experimental simulations are mostly focused on two kinds of time delays: constant time delay and time-varying delay. As time-varying and asymmetric delays often occur in network-based bilateral teleoperation systems, designing an appropriate control system to maintain their stability has proved to be critical. This chapter focuses on the control of bilateral teleoperation systems across the Internet which can be potentially applied in numerical mobile teaching applications. We design a controller that takes the time-varying and asymmetric delays into account. Its key features include adaptability to time-varying asymmetric delays and stability with good transparency performance. We use new controller synthesis methods to develop the system by defining appropriate Lyapunov-Krasovskii functional. This method is developed by applying tighter bounding technology in a cross terms and weighting matrix approach. Furthermore, the controller synthesis conditions are expressed as matrix inequalities, which are solvable by existing methods. We then apply the designed controller to a linear system model with increasing forward and backward delays. Finally, an experimental validation of the developed theoretical methods is used to demonstrate the effectiveness of the proposed method, and the results show that the proposed criteria improve the force tracking with less response time and less overshoot as well as with an acceptable position error