Estimating the Cost-Effectiveness of Quality-Improving Interventions in Oral Anticoagulation Management within General Practice

AbstractObjectivesA clinical trial, “Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT),” significantly improved the quality after implementing four different quality-improving interventions in four randomly divided groups of general practitioners (GPs). The quality-improving interventions consisted of multifaceted education with or without feedback reports on their performance, international normalized ratio (INR) testing by the GP with a CoaguChek device or computer-assisted advice for adapting oral anticoagulation therapy. The quality improvement in INR control versus baseline was similar in the four groups. The aim of the current study was to calculate the cost-effectiveness and influencing factors of the four quality-improving interventions compared with usual care.MethodsActivity-based costing techniques with questionnaires were used to determine the global costs per patient per month in the different intervention groups. Effectiveness data were obtained from the BISOAT study. Cost-effectiveness was expressed as cost per additional day within a 0.5 range from INR target.ResultsThe one-time cost of multifaceted education was €49,997 for the whole study. Monthly continuous costs per intervention ranged between €37 and €54 per patient. Using the CoaguChek in combination with the multifaceted education was associated with net savings and quality improvement, hence dominated usual care. Sensitivity analyses showed improved cost-effectiveness with extended duration and with increased program size.ConclusionImplementation of the combination multifaceted education with the use of the CoaguChek is a cost-effective new organizational model of oral anticoagulation management in general practice

The effect of domperidone on pyloric activity in dog and in man

In a study in dogs using ultrasonic transducers to measure degree of pyloric dilatation, it was found that i.v. domperidone (0.35 and 0.7 mg/kg) significantly increased the diameter of the pyloric lumen without affecting the frequency of pyloric relaxations. A subsequent study involving 59 patients referred for upper digestive tract endoscopy, confirmed this increase in diameter of the pylorus which indicates a potential use of domperidone (either i.v. or oral) in the treatment of some forms of dyspepsia characterized by delayed gastric emptying.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

The Belgian Improvement Study on Oral Anticoagulation Therapy: a randomized clinical trial

L’effort systématique pour former des chercheurs capables de produire des connaissances dans le domaine de l’histoire médiévale au Brésil est très récent. Il date des années 1980. Historiquement, son développement accompagne de près celui de la modernisation récente du système universitaire brésilien. Un bilan très large de la trajectoire suivie par les études sur l’histoire médiévale au Brésil conduit à observer essentiellement deux domaines complémentaires. En premier lieu, celui de l’appui..

Estimating the cost-effectiveness of quality-improving interventions in oral anticoagulation management within general practice

Objectives: A clinical trial, "Belgian Improvement Study on Oral Anticoagulation Therapy (BISOAT)," significantly improved the quality after implementing four different quality-improving interventions in four randomly divided groups of general practitioners (GPs). The quality-improving interventions consisted of multifaceted education with or without feedback reports on their performance, international normalized ratio (INR) testing by the GP with a CoaguChek device or computer-assisted advice for adapting oral anticoagulation therapy. The quality improvement in INR control versus baseline was similar in the four groups. The aim of the current study was to calculate the cost-effectiveness and influencing factors of the four quality-improving interventions compared with usual care. Methods: Activity-based costing techniques with questionnaires were used to determine the global costs per patient per month in the different intervention groups. Effectiveness data were obtained from the BISOAT study. Cost-effectiveness was expressed as cost per additional day within a 0.5 range from INR target. Results: The one-time cost of multifaceted education was 49,997 for the whole study. Monthly continuous costs per intervention ranged between 37 and 54 per patient. Using the CoaguChek in combination with the multifaceted education was associated with net savings and quality improvement, hence dominated usual care. Sensitivity analyses showed improved cost-effectiveness with extended duration and with increased program size. Conclusions: Implementation of the combination multifaceted education with the use of the CoaguChek is a cost-effective new organizational model of oral anticoagulation management in general practice

Fourth Catalogue of Stars Measured in the Long-Term Photometry of Variables Project (1992 - 1994).

info:eu-repo/semantics/publishe

Pharmacological Inhibition of poly(ADP-ribose) polymerases improves fitness and mitochondrial function in skeletal muscle

We previously demonstrated that the deletion of the poly(ADP-ribose)polymerase (Parp)-1 gene in mice enhances oxidative metabolism, thereby protecting against diet-induced obesity. However, the therapeutic use of PARP inhibitors to enhance mitochondrial function remains to be explored. Here, we show tight negative correlation between Parp-1 expression and energy expenditure in heterogeneous mouse populations, indicating that variations in PARP-1 activity have an impact on metabolic homeostasis. Notably, these genetic correlations can be translated into pharmacological applications. Long-term treatment with PARP inhibitors enhances fitness in mice by increasing the abundance of mitochondrial respiratory complexes and boosting mitochondrial respiratory capacity. Furthermore, PARP inhibitors reverse mitochondrial defects in primary myotubes of obese humans and attenuate genetic defects of mitochondrial metabolism in human fibroblasts and C. elegans. Overall, our work validates in worm, mouse, and human models that PARP inhibition may be used to treat both genetic and acquired muscle dysfunction linked to defective mitochondrial function