Search

Introduction: We aimed to assess complications and stone-free rate of flexible ureteroscopy (FU) reusing disposable scopes (RDS) after repeated sterilization. Methods: Data from adults from 11 centers were retrospectively reviewed (January 2020-December 2022). Inclusion criteria were proximal ureteral/renal stone(s). All cases were performed using an RDS to save costs for patients who come from economically challenged environments. Residual fragments (RFs) were defined as single fragment ≥4 mm or multiple fragments of any size within 3 months. Continuous variables are presented as median and interquartile range. Results: Two thousand one hundred and eighty-three patients were included, of whom 67.0 were male. Median age was 48.0 (36-59) years. The median stone diameter was 10.2 (9-14) mm. Flash sterilization was used in 90.2 (plasma in 60.5). Approximately, 88 had FU with an RDS used ≤2 times (12: 3-5 times). RDS needed to be changed intraoperatively in 3.9 of cases due to its malfunction. Commonly, defects in RDS function were reported in upward (1.6) and downward deflection (6.5) and image quality on white balancing (4.7). Fever >38C was seen in 13.7 of cases, and sepsis in 0.5. RFs were found in 31.4 of cases. Lower pole (odds ratio [OR] 5.63) or pelvis stone (OR 4.67), faulty scopes (OR 12.8), and total operation time (OR 1.05) were factors associated with higher odds of RFs. Stone size (OR 1.09), positive urine culture (OR 1.67), interpolar stone (OR 1.68), and prestenting (OR 1.37) were factors associated with higher odds of fever/sepsis. Conclusions: RDS was used as a cost-conscious approach with a low rate of serious infections but with a high rate of RFs., Author(s): Vineet Gauhar [1]; Olivier Traxer [2]; Ravindra B Sabnis [3]; Khi Yung Fong [4]; Parimalsinh Gharia [5]; Rishi Grover [5]; Deepak Ragoori [6]; Ee Jean Lim [7]; Yiloren Tanidir [...]

Unlike pharmaceuticals (pills and injectables), medical devices come in all different shapes, sizes, forms, and price points--from bandages to robotics and software as a medical device (SaMD). The breathtaking innovation [...]

Background Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence. Method and findings We conducted a randomised controlled trial to test the effectiveness of a formal shock coping strategy to prevent HIV among women at high risk of HIV (registration number: ISRCTN 22516548). Between June and August 2021, we recruited 1,508 adolescent girls and women over age 15 years who were involved in transactional sex (n = 753) or commercial sex (n = 755), using snowball sampling. Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579; commercial sex n = 289, transactional sex n = 290) from November 2021 or at the end of the study 12 months later (control; n = 568; commercial sex n = 290, transactional sex n = 278). We collected data on socioeconomic characteristics of participants. Primary outcomes included incidence of HIV and STIs and were measured at baseline, 6 months after randomisation, and 12 months after randomisation. We found that study participants who engaged in transactional sex and were assigned to the intervention group were less likely to become infected with HIV post-intervention (combined result of 6 months post-intervention or 12 months post-intervention, depending on the follow-up data available; odds ratio (OR) = 0.109 (95% confidence interval (CI) [0.014, 0.870]); p = 0.036). There was no evidence of a reduction in HIV incidence among women and girls involved in commercial sex. There was also no effect on STI acquisition among both strata of high-risk sexual activity. The main limitations of this study were the challenges of collecting reliable STI incidence data and the low incidence of HIV in women and girls involved in commercial sex, which might have prevented detection of study effects. Conclusion The study provides to our knowledge the first evidence of the effectiveness of a formal shock coping strategy for HIV prevention among women who engage in transactional sex in Africa, reinforcing the importance of structural interventions to prevent HIV. Trial registration The trial was registered with the ISRCTN Registry: ISRCTN 22516548. Registered on 31 July 2021., Author(s): Aurélia Lépine 1,*, Sandie Szawlowski 1, Emile Nitcheu 2, Henry Cust 1, Eric Defo Tamgno 2, Julienne Noo 2, Fanny Procureur 1, Illiasou Mfochive 2, Serge Billong 3, Ubald [...]

Background While the effectiveness of patient-reported outcome measures (PROMs) as an intervention to impact patient pathways has been established for cancer care, it is unknown for other indications. We assessed the cost-effectiveness of a PROM-based monitoring and alert intervention for early detection of critical recovery paths following hip and knee replacement. Methods and findings The cost-effectiveness analysis (CEA) is based on a multicentre randomised controlled trial encompassing 3,697 patients with hip replacement and 3,110 patients with knee replacement enrolled from 2019 to 2020 in 9 German hospitals. The analysis was conducted with a subset of 546 hip and 492 knee replacement cases with longitudinal cost data from 24 statutory health insurances. Patients were randomised 1:1 to a PROM-based remote monitoring and alert intervention or to a standard care group. All patients were assessed at 12-months post-surgery via digitally collected PROMs. Patients within the intervention group were additionally assessed at 1-, 3-, and 6-months post-surgery to be contacted in case of critical recovery paths. For the effect evaluation, a PROM-based composite measure (PRO-CM) was developed, combining changes across various PROMs in a single index ranging from 0 to 100. The PRO-CM included 6 PROMs focused on quality of life and various aspects of physical and mental health. The primary outcome was the incremental cost-effectiveness ratio (ICER). The intervention group showed incremental outcomes of 2.54 units PRO-CM (95% confidence interval (CI) [0.93, 4.14]; p = 0.002) for patients with hip and 0.87 (95% CI [-0.94, 2.67]; p = 0.347) for patients with knee replacement. Within the 12-months post-surgery period the intervention group had less costs of 376.43[euro] (95% CI [-639.74, -113.12]; p = 0.005) in patients with hip, and 375.50[euro] (95% CI [-767.40, 16.39]; p = 0.060) in patients with knee replacement, revealing a dominant ICER for both procedures. However, it remains unclear which step of the multistage intervention contributes most to the positive effect. Conclusions The intervention significantly improved patient outcomes at lower costs in patients with hip replacements when compared with standard care. Further it showed a nonsignificant cost reduction in knee replacement patients. This reinforces the notion that PROMs can be utilised as a cost-effective instrument for remote monitoring in standard care settings. Trial registration Registration: German Register for Clinical Studies (DRKS) under DRKS00019916., Author(s): Lukas Schöner 1,*, David Kuklinski 2,*, Laura Wittich 1, Viktoria Steinbeck 1, Benedikt Langenberger 1, Thorben Breitkreuz 3, Felix Compes 4, Mathias Kretzler 5, Ursula Marschall 6, Wolfgang Klauser [...]

: BACKGROUND: Although pulmonary rehabilitation (PR) is recommended in patients with chronic obstructive pulmonary disease (COPD), there is a scarcity of data demonstrating the cost-effectiveness and effectiveness of PR in reducing exacerbations. METHODS: A quasi-experimental study in 200 patients with COPD was conducted to determine the number of exacerbations 1 year before and after their participation in a PR program. Quality of life was measured using the COPD assessment test and EuroQol-5D. The costs of the program and exacerbations were assessed the year before and after participation in the PR program. The incremental cost-effectiveness ratio (ICER) was estimated in terms of quality-adjusted life years (QALYs). RESULTS: The number of admissions, length of hospital stay, and admissions to the emergency department decreased after participation in the PR program by 48.2, 46.6, and 42.5, respectively (P < 0.001 for all). Results on quality of life tests improved significantly (P < 0.001 for the two tests). The cost of PR per patient and the cost of pre-PR and post-PR exacerbations were €1867.7 and €7895.2 and €4201.9, respectively. The PR resulted in a cost saving of €1826 (total, €365,200) per patient/year, and the gain in QALYs was+0.107. ICER was -€17,056. The total cost was CONCLUSIONS: PR contributes to reducing the number of exacerbations in patients with COPD, thereby slowing clinical deterioration. In addition, it is cost-effective in terms of QALYs. Keywords: Chronic obstructive pulmonary disease, cost-effectiveness study, exacerbations, pulmonary rehabilitation, Author(s): Maria Elena Toubes-Navarro [1]; Francisco Gude-Sampedro [2]; José Manuel Álvarez-Dobaño [3,4]; Francisco Reyes-Santias [5]; Carlos Rábade-Castedo [1]; Carlota Rodríguez-García [1]; Óscar Lado-Baleato [6,7]; Raquel Lago-Fidalgo [2,8]; Noelia Sánchez-Martínez [2,8]; [...]

Byline: Mukul. Sehrawat, Santhosh. Madhusudhan, Shubha. Bakkappa, Srinivas. Devendrappa Background: Real-world data on the efficacy and cost-effectiveness of multiple sclerosis (MS) disease-modifying drugs (DMTs) is lacking in the Indian setting. [...]