81 research outputs found
Comparing new treatments for idiopathic pulmonary fibrosis - a network meta-analysis
No full textBACKGROUND: The treatment landscape for idiopathic pulmonary fibrosis, a devastating lung disease, is changing. To investigate the effectiveness of treatments for idiopathic pulmonary fibrosis we undertook a systematic review, network meta-analysis and indirect comparison.METHODS: We searched MEDLINE, EMBASE and The Cochrane library for relevant studies. Randomised controlled trials of pirfenidone, nintedanib or N-acetylcysteine were eligible. Predefined processes for selecting references, extracting data and assessing study quality were applied. Our network meta-analysis of published data used a fixed effect model. For forced vital capacity measures a standardised mean difference approach was used and converted to odds ratios for interpretation.RESULTS: Of 1076 references, 67 were retrieved and 11 studies included. Studies were of reasonable size, populations were similar, and the overall quality was good. Only two treatments, pirfenidone (odds ratio 0.62, 95% credible interval 0.52, 0.74) and nintedanib (0.41, 95% credible interval 0.34, 0.51) produced a statistically significant slowing in the rate of forced vital capacity decline compared with placebo. In an indirect comparison, results indicate that nintedanib is statistically significantly better than pirfenidone in slowing forced vital capacity decline (odds ratio 0.67, 95% credible interval 0.51, 0.88). Results were stable in scenario analysis and random effects models. Indirect comparisons of mortality were not statistically significant between nintedanib and pirfenidone.CONCLUSIONS: Two treatments show beneficial effects and when compared indirectly nintedanib appears to have superior benefit on forced vital capacity. Limitations to indirect comparisons should be considered when interpreting these results, however, our findings can be useful to inform treatment decisions.</p
The clinical effectiveness and cost-effectiveness of treatments for idiopathic pulmonary fibrosis: a systematic review and economic evaluation
No full textBackground: idiopathic pulmonary fibrosis (IPF) is a life-limiting lung disease that generally affects people over 60 years old. The main symptoms are shortness of breath and cough, and as the disease progresses there is a considerable impact on day-to-day life. Few treatments are currently available.Objectives: to conduct a systematic review of clinical effectiveness and an analysis of cost-effectiveness of treatments for IPF based on an economic model informed by systematic reviews of cost-effectiveness and quality of life.Data sources: eleven electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, and The Cochrane Library and the Centre for Reviews and Dissemination databases, were searched from database inception to July 2013. Reference lists of relevant publications were also checked and experts consulted.Methods: two reviewers independently screened references for the systematic reviews, extracted and checked data from the included studies and appraised their risk of bias. An advisory group was consulted about the choice of interventions until consensus was reached about eligibility. A narrative review with meta-analysis was undertaken, and a network meta-analysis (NMA) was performed. A decision-analytic Markov model was developed to estimate cost-effectiveness of pharmacological treatments for IPF. Parameter values were obtained from NMA and systematic reviews. Univariate and probabilistic sensitivity analyses were undertaken. The model perspective is NHS and Personal Social Services, and discount rate is 3.5% for costs and health benefits.Results: fourteen studies were included in the review of clinical effectiveness, of which one evaluated azathioprine, three N-acetylcysteine (NAC) (alone or in combination), four pirfenidone, one BIBF 1120, one sildenafil, one thalidomide, two pulmonary rehabilitation, and one a disease management programme. Study quality was generally good, with a low risk of bias. The current evidence suggests that some treatments appear to be clinically effective. The model base-case results show increased survival for five pharmacological treatments, compared with best supportive care, at increased cost. General recommendations cannot be made of their cost-effectiveness owing to limitations in the evidence base.Limitations: few direct comparisons of treatments were identified. An indirect comparison through a NMA was performed; however, caution is recommended in the interpretation of these results. In relation to the economic model, there is an assumption that pharmacological treatments have a constant effect on the relative rate of per cent predicted forced vital capacity decline.Conclusions: few interventions have any statistically significant effect on IPF and a lack of studies on palliative care approaches was identified. Research is required into the effects of symptom control interventions, in particular pulmonary rehabilitation and thalidomide. Other research priorities include a well-conducted randomised controlled trial on inhaled NAC therapy and an updated evidence synthesis once the results of ongoing studies are reported.Study registration: this study is registered as PROSPERO CRD42012002116.Funding: the National Institute for Health Research Health Technology Assessment programme.<br/
The effectiveness and cost-effectiveness of treatments for idiopathic pulmonary fibrosis: systematic review, network meta-analysis and health economic evaluation
No full textBackground: Idiopathic pulmonary fibrosis (IPF) is a life-limiting lung disease with considerable impact on patients and carers as the disease progresses. Currently few treatments are available. We aimed to evaluate the clinical and cost-effectiveness of available treatments for IPF. Methods: Systematic reviews of clinical effectiveness, quality of life and cost effectiveness were undertaken. Eleven bibliographic databases were searched from inception to July 2013 and studies were assessed for eligibility against a set of pre-defined criteria. Two reviewers screened references, extracted data from included studies and appraised their quality. An advisory group was consulted about the choice of interventions. A narrative review was undertaken and where feasible fixed effect and random effects meta-analysis were undertaken including a network meta-analysis (NMA). A decision-analytic Markov model was developed to estimate cost-effectiveness of pharmacological treatments for IPF. Following best practice recommendations, the model perspective was of the national health service and personal social services, a discount rate of 3.5% for costs and health benefits was applied and outcomes were expressed as cost per quality adjusted life-year gained. Parameter values were obtained from the NMA and systematic reviews. Sensitivity analyses were undertaken. Results: Fourteen studies were included in the review of clinical effectiveness, of which one evaluated azathioprine, three N-acetylcysteine [NAC] (alone or in combination), four pirfenidone, one nintedanib, one sildenafil, one thalidomide, two pulmonary rehabilitation, and one a disease management programme. Study quality was generally good. Evidence suggests that some effective treatments are available. In NMA only nintedanib and pirfenidone show statistically significant improvements. The model results show increased survival for five pharmacological treatments (NAC triple therapy, inhaled NAC, nintedanib, pirfenidone, and sildenafil) compared with best supportive care, at increased cost. Only inhaled NAC was cost-effective at current willingness to pay thresholds but it may not be clinically effective. Conclusions: Few interventions have any statistically significant effect and the cost-effectiveness of treatments is uncertain. A lack of studies on palliative care approaches was identified and there is a need for further research into pulmonary rehabilitation and thalidomide in particular. A well conducted RCT on inhaled NAC therapy should also be considered
Influenza aerosols in UK hospitals during the H1N1 (2009) pandemic - the risk of aerosol generation during medical procedures
No full textWith our small sample size we found that AGPs do not significantly increase the probability of sampling an H1N1 (2009) positive aerosol (OR (95% CI)?=?4.31 (0.83-22.5). Although the probability of detecting positive H1N1 (2009) positive aerosols when performing various AGPs on intensive care patients above the baseline rate (i.e. in the absence of AGPs) did not reach significance, there was a trend towards hierarchy of AGPs, placing bronchoscopy and respiratory and airway suctioning above baseline (background) values. Further, larger studies are required but these preliminary findings may be of benefit to infection control teams
Influenza aerosols in UK hospitals during the influenza H1N1 (2009–10) pandemic: air sampling in the vicinity of patients undergoing WHO-defined aerosol generating procedures
No full textA critical examination of selected abuses in the minority business enterprise program: a case study of federal highway contracts in Georgia, 1986
No full textThe primary intent of this paper is to critically examine and dis�cuss selected abuses in the Minority Business Enterprise Program of the Federal Highway Contracts in Georgia. An attempt has been made to describe the certification process associated with fulfilling the eligibility requirements of the Minority Business Enterprise Program in order for minority contractors to obtain federal highway contracts. In addition, the study also examined the merits and demerits of the propos�al by the U. S. Commission on Civil Rights under the leadership of Clarence Pendelton to dismantle the minority set-aside program. This program is significant for several reasons: (1) it provides opportunities to minority contractors to participate in an area (i.e. federal highway contracts) which they have historically been denied access, (2) the program also offers minority contractors the opportun�ity to gain a much needed practical experience in a major sector of federal transportation activities, and (3) it sets aside a pool of money (specifically 10 percent of all federal highway contracts) targeted for only female and minority contractors. The study revealed that, in spite of the eligibility requirements, some unscrupulous majority contractors have been able to obtain federal highway contracts by forming nonbonafide partnerships with minorities and through falsification of documents. The main sources of information were from interviews and newspa�pers, especially the Atlanta Journal and Constitution, the Mall Street Journal, as well as the U. S. Department of Transportation's publica�tions. Also, a wide variety of secondary information, including books, periodicals and unpublished materials was used. Limitation of Study The writer was unable to gain the cooperation of the majority and minority contractors to respond to questions about the abuses in spite of the fact that they were promised anonymity
Twentieth Century Nicaraguan Protest Poetry: The Struggle for Cultural Hegemony
No full textThe University of Kansas has long historical connections with Central America and the many Central Americans who have earned graduate degrees at KU. This work is part of the Central American Theses and Dissertations collection in KU ScholarWorks and is being made freely available with permission of the author through the efforts of Professor Emeritus Charles Stansifer of the History department and the staff of the Scholarly Communications program at the University of Kansas Libraries’ Center for Digital Scholarship
A non-US non-UK perspective on OA (Open Access)
No full textOpen access is being talked about, and implemented, around the globe, by everyone from the U.N. to individual authors, editors, and publishers, and collaborative groups. As of October 2004, requests for a government mandate for OA had gone forward not only in the U.S. and the U.K., but also Croatia. The Scielo (Scientific Electronic Online) collections of Latin America are very substantial, fully open access journal collections. In the developing world, OA is seen not only as the best means to access the research results of others, but as an opportunity to contribute their own scholarly research findings. Outside the U.S. and the U.K., profits from scientific publishing are not common, and subsidies are not unusual. The author predicts that the present slow but steady growth in institutional repositories will be replaced in the near future by dramatic growth
Bibliographics for the 983 eprints in the live archives of E-LIS : trends and status report up to 7th July 2004, based on author-self-archiving metadata
No full textThe priority for ideas and philosophy related to "Network Theory" have been traced back and documented by Braun(2004),and credit goes to Karinthy(1929).The IT has empowered to realise it, as the most practical phenomena and it is no more a humour. The OAI (Open Archives Initiatives)and ACIS (Academic Contributor Information System)are progressive in the direction ,which may lead to realise the "Collective Genius" at global level. Focus of present study is on Author-Self-Archiving (A-S-A)Metadata of the 983 Eprints in the Live Archives of the E-LIS (EPrints of Library and Information Science),which were approved till 7th July 2004.The A-S-A Metadata was used for librametric analysis. Self-explanatory bibliographics are illustrated.The highlights include: Conference papers (34%); highest approval, June 2004 (28%); published archives (76%);not refereed (52%); not in public domain (60%); highest self-archiving-author (De Robbio, Antonella).The Nos. of EPrints having single JITA domain specifications were: Theoretical and general aspects of libraries and information(27); Information use and sociology of information(80);Users,literacy and reading(13);Libraries as physical collections(30);Publishing and legal issues(57);Management(13);Industry, profession and education(36);Information sources, supports, channels(113) ; Information treatment for information services, Information functions and techniques (101); Technical services libraries, archives and museums(25); Housing technologies(1); Information technology and library technology(92); and Inter-domainery (395) i.e. having specifications of two or more than two JITA classes
Estimating the variation in need for community-based social care by body mass index in England and associated cost: population-based cross-sectional study.
No full textBACKGROUND: Adult obesity is linked to a greater need for social care because of its association with the development of long term conditions and because obese adults can have physical and social difficulties which inhibit daily living. Obesity thus has considerable social care cost implications but the magnitude of these costs is currently unknown. This paper outlines an approach to estimating obesity-related social care costs in adults aged over 65 in England. METHODS: We used univariable and multivariable logistic regression models to investigate the relation between the self-reported need for social care and potential determinants, including body mass index (BMI), using data from Health Survey for England. We combined these modelled estimates of need for social care with the mean hours of help received, conditional on receiving any help, to calculate the expected hours of social care received per adult by BMI. RESULTS: BMI is positively associated with self-reported need for social care. A one unit (ie 1 kg/m2) increase in BMI is on average associated with a 5% increase in the odds of need for help with social care (odds ratio 1.05, 95% CI 1.04 to 1.07) in an unadjusted model. Adjusting for long term illness and sociodemographic characteristics we estimate the annual cost of local authority funded care for those who receive it is £599 at a BMI of 23 but £1086 at a BMI of 40. CONCLUSION: BMI is positively associated with self-reported need for social care after adjustment for sociodemographic factors and limiting long term illness. The increase in need for care with BMI gives rise to additional costs in social care provision which should be borne in mind when calculating the cost-effectiveness of interventions aimed at reducing obesity
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