Rehab Centers: Incorporating Considerations of Cost-Effectiveness, Affordability, and Resource Implications in Guideline Development: Article 6 in Integrating and Coordinating Efforts in COPD Guideline Development. an Official ATS/ERS Workshop Report.

Incorporating Considerations of Cost-Effectiveness, Affordability, and Resource Implications in Guideline Development: Article 6 in Integrating and Coordinating Efforts in COPD Guideline Development. An Official ATS/ERS Workshop Report.

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Proc Am Thorac Soc. 2012 Dec; 9(5): 251-255
Hill SR, Olson LG, Falck-Ytter Y, Cruz AA, Atkins D, Baumann M, Jaeschke R, Woitalla T, Schünemann HJ,

Introduction: Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are based on the best available research evidence. This is the sixth of a series of 14 articles prepared to advise guideline developers for respiratory and other diseases on how to achieve this goal. In this article, we focused on integrating cost and resource information in guideline development and formulating recommendations focusing on four key questions. Methods: We addressed the following specific questions. (1) When is it important to incorporate costs, and/or resource implications, and/or cost-effectiveness, and/or affordability considerations in guidelines? (2) Which costs and which resource use should be considered in guidelines? (3)What sources of evidence should be used to estimate costs, resource use, and cost-effectiveness? (4) How can cost-effectiveness, resource implications, and affordability be taken into account explicitly? Our work was based on a prior review on this topic and our conclusions are based on available evidence, consideration of what guideline developers are doing, and workshop discussions. Results and Discussion: Many authorities suggest that there is a need to include explicit consideration of costs, resource use, and affordability during guideline development. Where drug use is at issue, “explicit consideration” may need to involve only noting whether the price (easily determined and usually the main component of “acquisition cost”) of a drug is high or low. Complex interventions such as rehabilitation services are to a greater degree setting- and system-dependent. Resources used, and the costs of those resources, will vary among systems, and formal identification by a guideline group of the resource requirements of a complex intervention is essential. A clinical guideline usually contains multiple recommendations, and in some cases there are hundreds. Defining costs and resource use for all of them-especially for multiple settings-is unlikely to be feasible. At present, disaggregated resource utilization accompanied by some cost information seems to be the most promising approach. The method for assigning values to costs, including external or indirect cost (such as time off work), can have a significant impact on the outcome of any economic evaluation. The perspective that the guideline assumes should be made explicit. Standards for evidence for clinical data are usually good-quality trials reporting a relevant endpoint that should be summarized in a systematic review. Like others, we are therefore proposing that the ideal sources of evidence for cost and resource utilization data for guideline development are systematic reviews of randomized controlled trials that report resource utilization, with direct comparisons between the interventions of interest.
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Locally-Prepared Ready-to-Use Therapeutic Food for Children with Severe Acute Malnutrition: A Controlled Trial.

Filed under: Rehab Centers

Indian Pediatr. 2012 Oct 5;
Thakur G, Singh HP, Patel C

OBJECTIVE: To compare the efficacy of locally-prepared ready-to-use therapeutic food (LRUTF) and locally-prepared F100 diet in promoting weight-gain in children with severe acute malnutrition during rehabilitation phase in hospital. STUDY DESIGN: Non-Randomized Controlled trial. SETTING: Pediatric ward of tertiary care public hospital in Central India. STUDY PERIOD: October, 2009 30th May, 2010. SUBJECTS: Children aged 6 to 60 months, diagnosed as severe acute malnutrition and hospitalized during study period. INTERVENTION: Random group allocation followed for selection of intervention and control cohorts. The control cohort enrolled during Oct 1, 2009 to Jan 31, 2010 received F100 while the intervention cohort enrolled during 1 Feb to 15 May 2010 received LRUTF. Subjects receiving either of the two therapeutic foods were temporally separated to minimize the spillover effect. The study subjects and the technician delegated for measuring weight was blinded for type of intervention. Primary outcome variable: Rate of weight gain/kg/day. RESULTS: There were 49 subjects in each group. Both groups were comparable. Rate of weight-gain was found to be (9.59±3.39 g/kg/d) in LRUTF group and (5.41±1.05 gm/kg/d) in locally prepared F100 group. Significant difference in rate of weight gain was observed in LRUTF group (P7lt0.0001; 95% CI 3.17-5.19). No serious adverse effect was observed with use of LRUTF. CONCLUSION: LRUTF promotes more rapid weight-gain when compared with F100 in patients with severe acute malnutrition during rehabilitation phase.
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Functional diffusion map as an imaging predictor of functional outcome in patients with primary intracerebral haemorrhage.

Filed under: Rehab Centers

Br J Radiol. 2013 Jan; 86(1021): 20110644
Tsai YH, Hsu LM, Weng HH, Lee MH, Yang JT, Lin CP

Objective Predicting outcome in patients with primary intracerebral haemorrhage (ICH) in the acute stage can provide information to determine the best therapeutic and rehabilitation strategies. We prospectively investigated the predictive value of the functional diffusion map (fDM) in the acute stage of ICH. Methods 47 patients with ICH were enrolled for clinical evaluation and MRI within 24 h of symptom onset and 5 days after ICH. Functional diffusion mapping prospectively monitored the apparent diffusion coefficient (ADC) maps of perihaematomal oedema. Consequently, the change in perihaematomal oedema was classified into three categories: increased, decreased, or no significant change. Clinical outcomes were evaluated 6 months after ICH according to the modified Rankin Scale. Correlation between clinical outcome and the fDMs was performed. Results Among the clinical variables, thalamic haematoma, serum glucose level and National Institutes of Health Stroke Scale scores were significantly different between the good- and poor-outcome groups. The percentage of oedematous tissue undergoing significant change between baseline and Day 5 was also significantly different between the groups. Conclusion fDMs allow for spatial voxel-by-voxel tracking of changes in ADC values. It may be feasible to use fDMs to predict the functional outcome of patients with ICH during the acute stage. Advances in knowledge The use of fDMs for stroke study is demonstrated. fDMs may be more suitable to reflect the pathophysiological heterogeneity within oedemas and may facilitate another thinking process for imaging study of stroke and other neurological diseases.
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