BACKGROUND & AIMS: BACKGROUND:in men, the concomitant use of two or more benzodiazepines or two or more antipsychotics is associated with an increased risk of fracture(s). Potential associations between the concomitant use of drugs with central nervous system effects and fracture risk have not been studied. OBJECTIVE:the purpose was to describe the gender-specific risk of fractures in a population aged 65 years or over associated with the use of an opioid, antiepileptic or anticholinergic drug individually; or, their concomitant use with each other; or the concomitant use of one of these with a psychotropic drug. METHODS:this study was part of a prospective, population-based study performed in Lieto, Finland. Information about fractures in 1,177 subjects (482 men and 695 women) was confirmed with radiology reports. RESULTS:at 3 years of follow-up, the concomitant use of an opioid with an antipsychotic was associated with an increased risk of fractures in men. During the 6-year follow-up, the concomitant use of an opioid with a benzodiazepine was also related to the risk of fractures for males. No significant associations were found for females. CONCLUSION:the concomitant use of an opioid with an antipsychotic, or with a benzodiazepine may increase the risk of fractures in men aged 65 years and older.

背景与目标： 背景：在男性中，同时使用两种或多种苯二氮杂类或两种或多种抗精神病药会增加骨折的风险。尚未研究同时使用药物与中枢神经系统作用与骨折风险之间的潜在关联。
目的：目的是描述在65岁或65岁以上人群中因单独使用阿片类药物，抗癫痫药或抗胆碱能药物引起的骨折的性别特异性风险；或同时使用；或或将其中一种与精神药物同时使用。
方法：本研究是在芬兰利托进行的一项基于人群的前瞻性研究的一部分。放射学报告证实了有关1,177名受试者（482名男性和695名女性）骨折的信息。
结果：在随访的3年中，同时使用阿片类药物和抗精神病药会增加男性骨折的风险。在6年的随访期间，阿片类药物与苯二氮卓类药物同时使用也与男性骨折风险有关。没有发现与女性的显着关联。
结论：阿片类药物与抗精神病药或苯二氮卓类药物同时使用可能会增加65岁以上男性骨折的风险。

BACKGROUND & AIMS: :Twenty-four antimicrobial drugs were examined for rapidity of onset and magnitude of bactericidal activity against selected strains of Clostridium perfringens. Ceftriaxone, imipenem, metronidazole, mezlocillin, penicillin G, piperacillin, and teicoplanin reduced colony counts by at least 3 log10 units within 2-4 h after exposure. Clindamycin, fluoroquinolones, josamycin, and tetracycline caused delayed kill (greater than or equal to 99.9% reduction of viable counts at 4-22 h after exposure). Chloramphenicol and rifampin lacked bactericidal activity against 2 of 4 strains, whereas erythromycin, fusidic acid, and fosfomycin (with added glucose-6-phosphate) were merely inhibitory for all 4 strains. Imipenem and penicillin G were combined with 9 and 12 antimicrobial drugs, respectively. Essentially all drug combinations yielded indifferent effects; only penicillin G plus doxycycline resulted in an antagonistic effect against C. perfringens.

背景与目标： ：检查了二十四种抗微生物药物对产气荚膜梭状芽孢杆菌某些菌株的起效速度和杀菌活性的大小。头孢曲松，亚胺培南，甲硝唑，美洛西林，青霉素G，哌拉西林和替考拉宁在暴露后2-4小时内可将菌落数减少至少3 log10个单位。克林霉素，氟喹诺酮，乔沙霉素和四环素引起延迟杀灭（暴露后4-22 h内存活计数减少等于或大于99.9％）。氯霉素和利福平对4个菌株中的2个缺乏杀菌活性，而红霉素，夫西地酸和磷霉素（添加了6-磷酸葡萄糖）仅对全部4个菌株具有抑制作用。亚胺培南和青霉素G分别与9种和12种抗菌药物合用。基本上所有药物组合均产生无关紧要的作用。仅青霉素G加强力霉素可导致对产气荚膜梭菌的拮抗作用。

BACKGROUND & AIMS: :Novel treatment strategies for tuberculosis are urgently needed. Many different preclinical models assessing anti-tuberculosis drug activity are available, but it is yet unclear which combination of models is most predictive of clinical treatment efficacy. The aim of this study was to determine the role of our in vitro time kill-kinetics assay as an asset to a predictive preclinical modeling framework assessing anti-tuberculosis drug activity. The concentration- and time-dependent mycobacterial killing capacities of six anti-tuberculosis drugs were determined during exposure as single drugs or in dual, triple and quadruple combinations towards a Mycobacterium tuberculosis Beijing genotype strain and drug resistance was assessed. Streptomycin, rifampicin and isoniazid were most active against fast-growing M. tuberculosis. Isoniazid with rifampicin or high dose ethambutol were the only synergistic drug combinations. The addition of rifampicin or streptomycin to isoniazid prevented isoniazid resistance. In vitro ranking showed agreement with early bactericidal activity in tuberculosis patients for some but not all anti-tuberculosis drugs. The time-kill kinetics assay provides important information on the mycobacterial killing dynamics of anti-tuberculosis drugs during the early phase of drug exposure. As such, this assay is a valuable component of the preclinical modeling framework.

背景与目标： ：迫切需要新的结核病治疗策略。目前已有许多评估抗结核药物活性的临床前模型，但尚不清楚哪种模型组合最能预测临床治疗效果。这项研究的目的是确定我们在体外时间杀伤动力学测定中作为评估抗结核药物活性的预测性临床前建模框架的一项资产的作用。在暴露于结核分枝杆菌北京基因型菌株的单药或双重，三重和四重组合暴露期间，确定了六种抗结核药物的浓度和时间依赖性分枝杆菌杀伤能力，并评估了耐药性。链霉素，利福平和异烟肼对快速增长的结核分枝杆菌最为活跃。异烟肼与利福平或大剂量乙胺丁醇是唯一的协同药物组合。在异烟肼中添加利福平或链霉素可防止异烟肼耐药。在体外排名显示，对于某些但不是全部抗结核药物，结核病患者的早期杀菌活性与之一致。时间杀灭动力学测定法提供了有关药物暴露初期抗结核药物分枝杆菌杀灭动力学的重要信息。因此，该测定是临床前建模框架的重要组成部分。

BACKGROUND & AIMS: :Achieving 'universal access' to antiretroviral HIV treatment (ART) in lower income and transitional settings is a global target. Yet, access to ART is shaped by local social condition and is by no means universal. Qualitative studies are ideally suited to describing how access to ART is socially situated. We explored systemic barriers to accessing ART among people who inject drugs (PWID) in a Russian city (Ekaterinburg) with a large burden of HIV treatment demand. We undertook 42 in-depth qualitative interviews with people living with HIV with current or recent experience of injecting drug use. Accounts were analysed thematically, and supplemented here with an illustrative case study. Three core themes were identified: 'labyrinthine bureaucracy' governing access to ART; a 'system Catch 22' created by an expectation that access to ART was conditional upon treated drug use in a setting of limited drug treatment opportunity; and 'system verticalization', where a lack of integration across HIV, tuberculosis (TB) and drug treatment compromised access to ART. Taken together, we find that systemic factors play a key role in shaping access to ART with the potential adverse effects of reproducing treatment initiation delay and disengagement from treatment. We argue that meso-level systemic factors affecting access to ART for PWID interact with wider macro-level structural forces, including those related to drug treatment policy and the social marginalization of PWID. We note the urgent need for systemic and structural changes to improve access to ART for PWID in this setting, including to simplify bureaucratic procedures, foster integrated HIV, TB and drug treatment services, and advocate for drug treatment policy reform.

背景与目标： ：在较低的收入和过渡环境中实现对抗逆转录病毒HIV治疗（ART）的“普遍获得”是全球目标。然而，获得抗逆转录病毒药物的途径取决于当地的社会状况，绝不是普遍的。定性研究非常适合描述获得抗逆转录病毒疗法在社会上的位置。我们探索了在俄罗斯城市（叶卡捷琳堡）注射艾滋病毒（HIV）需求量很大的注射毒品者（PWID）中获取ART的系统性障碍。我们对具有当前或最近注射吸毒经验的艾滋病毒感染者进行了42次深入的定性访谈。对帐目进行了主题分析，并在此处补充了说明性的案例研究。确定了三个核心主题：控制获取抗逆转录病毒药物的“迷宫式官僚主义”；期望在有限的药物治疗机会的情况下获得抗病毒药物的条件是要获得抗逆转录病毒药物而创建的“系统捕​​获22”；以及“系统垂直化”，即艾滋病毒，结核病和药物治疗之间缺乏整合，影响了抗逆转录病毒疗法的获取。综上所述，我们发现系统性因素在影响获得ART的过程中起着关键作用，并具有再生治疗起始延迟和脱离治疗的潜在不利影响。我们认为影响PWID获得抗逆转录病毒疗法的中观系统性因素与更广泛的宏观结构性因素相互作用，包括那些与毒品治疗政策和PWID的社会边缘化有关的因素。我们注意到迫切需要进行系统和结构上的改革，以改善在这种情况下PWID获得抗病毒治疗的途径，包括简化官僚程序，促进艾滋病毒，结核病和药物治疗的综合服务，以及倡导药物治疗政策的改革。

BACKGROUND & AIMS: From January 1994 through May 1995, Prudential HealthCare-North Texas prospectively studied 299 member patients diagnosed with hypercholesterolemia for whom pharmacotherapy with one of four 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, also known as statins, was prescribed. The purpose of this study was to measure the relative cost-effectiveness (CE) of these drugs in a real-world setting. This study provides information to assist decision makers in managed-care organizations (MCO) in making formulary selections. The study used a prospective, randomized, balanced cohort design, examining patients who had been prescribed initial therapy with a statin drug as monotherapy. Costs (direct medical and indirect costs) and effectiveness (percent reduction in low-density lipoprotein cholesterol levels) were based on approximately the first 6 months of initial therapy. Both the MCO and patient perspectives were considered. In the base case, mean CE ratios were significantly lower for fluvastatin compared with lovastatin, pravastatin, and simvastatin from both the managed-care perspective and the patient perspective. Sensitivity analysis did not alter the CE conclusions, even under conditions of varying cost structures. Although differences were found in the effectiveness of lovastatin, pravastatin, and simvastatin measured in this study versus efficacy measured for these drugs in controlled clinical trials, sensitivity analysis suggests that these differences alone do not determine the superior CE of fluvastatin. Finally, this study supports the idea that well-designed formularies should consider drug CE (based on safety, effectiveness, and cost) and that integration of the pharmacy benefit management with other medical management is essential. These results provide evidence that fluvastatin may represent a more cost-effective formulary choice among statin products used for initial monotherapy of hypercholesterolemia.

背景与目标： 从1994年1月到1995年5月，Prudential HealthCare-North Texas对299名被诊断患有高胆固醇血症的成员患者进行了前瞻性研究，他们开了用四种3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（也称为他汀类药物）之一进行药物治疗的处方。这项研究的目的是在现实环境中测量这些药物的相对成本效益（CE）。这项研究提供信息，以帮助管理服务组织（MCO）的决策者选择配方。该研究采用前瞻性，随机，均衡的队列设计，检查了已开始接受他汀类药物作为单一疗法的初始治疗的患者。成本（直接医疗和间接成本）和有效性（低密度脂蛋白胆固醇水平降低的百分比）基于初始治疗的前6个月。同时考虑了MCO和患者的观点。在基本病例中，从管理治疗和患者角度看，氟伐他汀的平均CE比率均比洛伐他汀，普伐他汀和辛伐他汀低。即使在成本结构变化的情况下，敏感性分析也不会改变CE的结论。尽管在这项研究中发现洛伐他汀，普伐他汀和辛伐他汀的疗效与对照临床试验中这些药物的疗效存在差异，但敏感性分析表明，仅凭这些差异并不能确定氟伐他汀的优异CE。最后，本研究支持以下观点：精心设计的配方应考虑药物CE（基于安全性，有效性和成本），并且将药房收益管理与其他医疗管理相结合是必不可少的。这些结果表明，氟伐他汀可能代表一种用于高胆固醇血症初始单一疗法的他汀类产品中更具成本效益的配方选择。

BACKGROUND & AIMS: Costs were monitored for three different types of oncology practicea telemedicine clinic and a fly-in outreach clinic, both held in rural areas, and a traditional clinic held in a city hospital. Total expenses were calculated over the year May 1995 to April 1996. The average cost per telemedicine visit was $812. The average cost per outreach clinic visit was $897. Flying in oncology support for this practice was therefore about 10% more costly than telemedicine. While the outreach cost may have been inappropriately high due to a slow start-up phase, it was still less expensive during this period to be seen via telemedicine. For comparison, the average cost per traditional oncology clinic visit was $149. However, this figure does not take into account the costs of access to a city-based service by rural patients.

背景与目标： 监视了三种不同类型的肿瘤科诊所，远程医疗诊所和飞入式外展诊所（均在农村地区，以及传统诊所在城市医院中）的成本。计算的总费用是从1995年5月至1996年4月。每次远程医疗就诊的平均费用为812美元。每次门诊就诊的平均费用为897美元。因此，为这种做法提供肿瘤支持的费用比远程医疗的费用高出约10％。尽管由于启动阶段缓慢，外展费用可能过高，但在此期间通过远程医疗可以看到费用仍然较低。相比之下，传统肿瘤诊所的平均每次访问费用为149美元。但是，该数字未考虑到农村患者获得城市服务的成本。

BACKGROUND & AIMS: Percutaneous tracheostomy was initiated as an alternative to open tracheostomy at our institution in December 1993. To assess safety, operative time, and cost, a comparative analysis of percutaneous and open tracheostomies was performed. A retrospective evaluation of all patients who underwent percutaneous tracheostomy (P) from December 1993 to March 1996 was completed. Patients were evaluated for indications for tracheostomy, length of operation, morbidity, and cost. The results were compared with patients who underwent open tracheostomy (O) during the 12 months prior to introduction of the percutaneous technique. Tracheostomy was performed percutaneously in 74 patients and by a standard open technique in 109 patients. Indications for tracheostomy includedchronic ventilator dependence (P, 49 vs O, 58); airway protection (P, 19 vs O, 42); laryngeal dysfunction (P, 2 vs O, 7); and facial trauma (P 6 vs O, 2). The length of operation was 21 +/- 6 minutes and 46 +/- 21 minutes for percutaneous and open tracheostomy, respectively (P < 0.05). Perioperative morbidity occurred in 2 patients (3%) following percutaneous tracheostomy compared to 10 patients (9%) following open tracheostomy (P > 0.05). The mean operating room costs per patient were $1093 and $1370 for percutaneous and open tracheostomy, respectively. Percutaneous tracheostomy is a safe procedure that can be performed in less time and at a lower cost than standard open tracheostomy.

背景与目标： 我们的机构于1993年12月开始采用经皮气管切开术代替开放式气管切开术。为评估安全性，手术时间和成本，对经皮和开放式气管切开术进行了比较分析。对1993年12月至1996年3月所有行经皮气管切开术（P）的患者进行了回顾性评估。对患者进行气管切开术，手术时间，发病率和费用的指征进行评估。将结果与在引入经皮技术之前的12个月内接受开放气管切开术（O）的患者进行比较。 74例患者经皮气管切开术，109例患者采用标准开放技术进行气管切开术。气管切开术的适应症包括慢性呼吸机依赖性（P，49 vs O，58）；气道保护（P，19 vs O，42）;喉功能不全（P，2 vs O，7）;和面部创伤（P 6 vs O，2）。对于经皮气管切开术和开放式气管切开术，手术时间分别为21/6分钟和46 / 2-21分钟（P <0.05）。经皮气管切开术后2例（3％）发生围手术期发病，相比之下，开放气管切开术后10例（9％）发生围手术期发病（P> 0.05）。经皮气管切开术和开放式气管切开术每名患者的平均手术室费用分别为$ 1093和$ 1370。经皮气管切开术是一种安全的方法，与标准的开放式气管切开术相比，可在更短的时间内完成，且成本更低。

BACKGROUND & AIMS: :Rheumatoid arthritis (RA) is characterized by inflammation and an increased risk for cardiovascular disease (CVD). This study investigates possible associations between CVD and the use of conventional disease-modifying antirheumatic drugs (DMARDs) in RA. Using a case control design, 613 RA patients (5,649 patient-years) were studied, 72 with CVD and 541 without CVD. Data on RA, CVD and drug treatment were evaluated from time of RA diagnosis up to the first cardiovascular event or the end of the follow-up period. The dataset was categorized according to DMARD use: sulfasalazine (SSZ), hydroxychloroquine (HCQ) or methotrexate (MTX). Odds ratios (ORs) for CVD, corrected for age, gender, smoking and RA duration, were calculated per DMARD group. Patients who never used SSZ, HCQ or MTX were used as a reference group. MTX treatment was associated with a significant CVD risk reduction, with ORs (95% CI): 'MTX only', 0.16 (0.04 to 0.66); 'MTX and SSZ ever', 0.20 (0.08 to 0.51); and 'MTX, SSZ and HCQ ever', 0.20 (0.08 to 0.54). The risk reductions remained significant after additional correction for the presence of rheumatoid factor and erosions. After correction for hypertension, diabetes and hypercholesterolemia, 'MTX or SSZ ever' and 'MTX, SSZ and HCQ ever' showed significant CVD risk reduction. Rheumatoid factor positivity and erosions both increased CVD risk, with ORs of 2.04 (1.02 to 4.07) and 2.36 (0.92 to 6.08), respectively. MTX and, to a lesser extent, SSZ were associated with significantly lower CVD risk compared to RA patients who never used SSZ, HCQ or MTX. We hypothesize that DMARD use, in particular MTX use, results in powerful suppression of inflammation, thereby reducing the development of atherosclerosis and subsequently clinically overt CVD.

背景与目标： 类风湿关节炎（RA）的特征在于炎症和心血管疾病（CVD）的风险增加。这项研究调查了CVD与RA中使用传统疾病缓解风湿药（DMARDs）之间的可能联系。使用病例对照设计，研究了613名RA患者（5,649患者-年），其中72例患有CVD，541例没有CVD。从RA诊断到首次心血管事件或随访期结束，评估了RA，CVD和药物治疗的数据。数据集根据DMARD使用进行了分类：柳氮磺胺吡啶（SSZ），羟氯喹（HCQ）或甲氨蝶呤（MTX）。每个DMARD组均计算出经年龄，性别，吸烟和RA持续时间校正后的CVD的赔率（OR）。从未使用过SSZ，HCQ或MTX的患者被用作参考组。 MTX治疗可显着降低CVD风险，OR为（95％CI）：“仅MTX”，0.16（0.04至0.66）； ``MTX和SSZ曾经''，0.20（0.08至0.51）;和“ MTX，SSZ和HCQ”，0.20（0.08至0.54）。在对类风湿因子和糜烂的存在进行了进一步校正后，风险降低仍然很显着。在校正了高血压，糖尿病和高胆固醇血症后，“曾经有过MTX或SSZ”以及“曾经有过MTX，SSZ和HCQ”显示出可显着降低CVD风险。类风湿因子阳性和糜烂均增加了CVD的风险，OR分别为2.04（1.02至4.07）和2.36（0.92至6.08）。与从未使用过SSZ，HCQ或MTX的RA患者相比，MTX和较小程度的SSZ与较低的CVD风险相关。我们假设使用DMARD，尤其是使用MTX可以有效抑制炎症，从而减少动脉粥样硬化的发展，进而减少临床上明显的CVD的发生。

BACKGROUND & AIMS: :The intricate problems associated with the delivery and various unnecessary in vivo transitions of proteins and drugs needs to be tackled soon to be able to exploit the myriad of putative therapeutics created by the biotechnology boom. Nanomedicine is one of the most promising applications of nanotechnology in the field of medicine. It has been defined as the monitoring, repair, construction and control of human biological systems at the molecular level using engineered nanodevices and nanostructures. These nanostructured medicines will eventually turn the world of drug delivery upside down. PEGylation (i.e. the attachment of polyethylene glycol to proteins and drugs) is an upcoming methodology for drug development and it has the potential to revolutionise medicine by drastically improving the pharmacokinetic and pharmacodynamic properties of the administered drug. This article provides a total strategy for improving the therapeutic efficacy of various biotechnological products in drug delivery. This article also presents an extensive analysis of most of the PEGylated proteins, peptides and drugs, together with extensive clinical data. Nanomedicines and PEGylation, the latest offshoots of nanotechnology will definitely pave a way in the field of drug delivery where targeted delivery, formulation, in vivo stability and retention are the major challenges.

背景与目标： ：与蛋白质和药物的递送以及各种不必要的体内过渡相关的复杂问题需要尽快解决，以便能够利用由生物技术繁荣发展而来的无数推定疗法。纳米医学是纳米技术在医学领域最有前途的应用之一。它已被定义为使用工程化的纳米器件和纳米结构在分子水平上监测，修复，构建和控制人类生物系统。这些纳米结构药物最终将颠覆药物输送的世界。聚乙二醇化（即聚乙二醇与蛋白质和药物的连接）是药物开发的一种新方法，它具有通过彻底改善所给药药物的药代动力学和药效学性质来革新药物的潜力。本文提供了用于提高各种生物技术产品在药物输送中的治疗功效的总体策略。本文还对大多数PEG化的蛋白质，肽和药物进行了广泛的分析，并提供了广泛的临床数据。纳米药物和聚乙二醇化是纳米技术的最新分支，无疑将在药物递送领域铺平道路，在这些领域中，靶向递送，制剂，体内稳定性和保留性是主要挑战。

BACKGROUND & AIMS: OBJECTIVES:To examine the long-term relationships between costs, utilization, and patient-centered medical home (PCMH) clinical practice systems. STUDY DESIGN:Clinical practice systems were evaluated at baseline by the Physician Practice Connections-Research Survey (PPC-RS). Annual costs and utilization of a retrospectively constructed cohort of 58,391 persons receiving primary care at 1 of 22 medical groups over a 5-year period (2005-2009) were compared. METHODS:Multivariate regressions adjusting for patient demographics, health status, and autoregressive errors compared PPC-RS scores and study outcomes for the entire cohort and 3 subcohorts defined by medical complexity (medication count 0-2 [n = 29,657], 2-6 [n = 19,505], >7 [n = 9229]). Outcomes (adjusted to 2005 dollars) were total costs, outpatient costs, inpatient costs, inpatient days, and emergency department (ED) use. RESULTS:For the entire cohort, a 10% increase in PPC-RS scores was associated with 3.9 (medication count: 0-2), 6 (3-6), and 11.6 (>7) fewer ED visits per 1000 in 2005; and 5.1, 7.6, and 13.6 fewer ED visits in 2009. That 10% increase was not associated with the 0-2 medication subcohort's total (-$22/person in 2005; $184/person in 2009), outpatient (-$11/person in 2005; $42/person in 2009), or inpatient ($26/person in 2005; $29/person in 2009) costs. However, it was associated with significantly decreased total (-$446/person in 2005; -$184/person in 2009) and outpatient (-$241/person in 2005; -$54/person in 2009) costs for the most medically complex subcohort (>7 medications). CONCLUSIONS:Association of PCMH clinical practice systems with reduced costs appears limited to the most medically complex patients.

背景与目标： 目的：研究成本，使用率和以患者为中心的医疗之家（PCMH）临床实践系统之间的长期关系。
研究设计：临床实践系统是通过医师实践连接研究调查（PPC-RS）在基线进行评估的。比较了过去5年（2005-2009年）在22个医疗组中的1个接受初级保健的58,391人的回顾性构建队列的年度成本和使用情况。
方法：针对患者人口统计学，健康状况和自回归误差进行多元回归调整后，比较了整个队列和3个亚队列的PPC-RS评分和研究结果（由药物复杂性定义（药物计数0-2 [n = 29,657]，2-6 [ n = 19,505]，> 7 [n = 9229]）。结果（调整为2005年美元）为总费用，门诊费用，住院费用，住院天数和急诊科（ED）的使用。
结果：在整个队列中，2005年PPC-RS得分增加10％与3.9（用药计数：0-2），6（3-6）和11.6（> 7）ED访视次数减少相关；在2009年，急诊就诊次数减少了5.1、7.6和13.6。这增加了10％与0-2药物亚人群的总数（2005年为-$ 22 /人； 2009年为$ 184 /人），门诊患者（-$ 11 /人）无关。 2005年； 42美元/人，2009年）或住院（2005年26美元/人； 2009年29美元/人）费用。但是，这与医学上最复杂的亚人群的总费用（2005年为-446美元/人； 2009年为-184美元/人）和门诊费用（-2005年为-241美元/人； -2009年为54美元/人）显着降低有关（> 7种药物）。
结论：降低成本的PCMH临床实践系统的关联似乎仅限于大多数医学上复杂的患者。

BACKGROUND & AIMS: OBJECTIVE:Financial cost is a barrier for many older adults in their decision to obtain hearing aids (HAs). This study aimed to examine conversations about the cost of HAs in detail within initial audiology appointments. DESIGN:Sixty-two initial audiology appointments were video-recorded. The data were analysed using conversation analysis. STUDY SAMPLE:Participants included 26 audiologists, 62 older adults and 17 companions. RESULTS:Audiologists and clients displayed interactional difficulty during conversations about cost. Clients often had emotional responses to the cost of HAs, which were not attended to by audiologists. It was typical for audiologists to present one HA cost option at a time, which led to multiple rejections from clients which made the interactions difficult. Alternatively, when audiologists offered multiple cost options at once this led to a smoother interaction. CONCLUSIONS:Audiologists and clients were observed to have difficulty talking about HA costs. Offering clients multiple HA cost options at the same time can engage clients in the decision-making process and lead to a smoother interaction between audiologist and client in the management phase of appointments.

背景与目标： 目标：财务成本是许多老年人决定购买助听器（HAs）的障碍。这项研究旨在详细检查有关初次听力学任命中有关HA成本的对话。
设计：录制了62个初始听力学约会。使用对话分析对数据进行了分析。
研究样本：参与者包括26位听力学家，62位老年人和17位同伴。
结果：听力学家和客户在有关费用的对话中表现出互动困难。客户通常会对HA的成本产生情感上的反应，而听力学家则没有参加。听力学家通常一次提出一个HA成本选项，这导致客户的多次拒绝，使交互变得困难。或者，当听力学家一次提供多种费用选择时，这将导致更顺畅的交互。
结论：观察到听力学家和客户在谈论HA费用方面存在困难。同时为客户提供多种HA成本选择，可以使客户参与决策过程，并在任命的管理阶段使听力学家和客户之间的交流更加顺畅。

BACKGROUND & AIMS: BACKGROUND:The economic burden associated with hip fractures calls for the investigation of innovative new cost-utility forms of organisation and integration of services for these patients. OBJECTIVE:To carry out a cost-utility analysis integrating epidemiological and economic aspects for hip fracture patients treated within a comprehensive orthogeriatric model (COGM) of care, as compared with standard of care model (SOCM). DESIGN:A demonstration study conducted in a major tertiary medical centre, operating both a COGM ward and standard orthopaedic and rehabilitation wards. METHODS:Data was collected on the clinical outcomes and health care costs of the two different treatment modalities, in order to calculate the absolute cost and disability-adjusted life years (DALY) ratio. RESULTS:The COGM model used 23% fewer resources per patient ($14,919 vs. $19,363) than the SOCM model and to avert 0.226 additional DALY per patient, mainly as a result of lower 1-year mortality rates among COGM patients (14.8% vs. 17.3%). CONCLUSION:A comprehensive ortho-geriatric care modality is more cost-effective, providing additional quality-adjusted life years (QALY) while using fewer resources compared with standard of care approach. The results should assist health policy-makers in optimising healthcare use and healthcare planning.

背景与目标： 背景：与髋部骨折相关的经济负担要求研究创新的新型成本效用形式的组织和针对这些患者的服务整合。
目的：进行成本效用分析，将在综合老年医学模型（COGM）中接受治疗的髋部骨折患者的流行病学和经济因素与标准治疗模型（SOCM）进行比较。
设计：在一家主要的三级医疗中心进行的一项示范研究，既经营COGM病房，又经营标准的骨科和康复病房。
方法：收集有关两种不同治疗方式的临床结局和医疗保健费用的数据，以计算绝对费用和残疾调整生命年（DALY）比率。
结果：COGM模型比SOCM模型使用的每位患者资源减少了23％（$ 14,919比$ 19,363），并且避免了每位患者增加0.226 DALY，这主要是由于COGM患者的1年死亡率降低了（14.8％vs. 17.3％）。
结论：与标准的护理方法相比，综合的老年病护理方式更具成本效益，可提供额外的质量调整生命年（QALY），同时使用更少的资源。结果应有助于卫生政策制定者优化医疗保健使用和医疗保健计划。

BACKGROUND & AIMS: BACKGROUND:Emergent surgery has been shown to be a risk factor for perioperative complications. Studies suggest that patient morbidity is greater with an unplanned hip arthroplasty, although it is controversial whether unplanned procedures also result in higher patient mortality. The financial impact of these procedures is not fully understood, as the costs of unplanned primary hip arthroplasties have not been studied previously. QUESTIONS/PURPOSES:We asked: (1) What are the institutional costs associated with unplanned hip arthroplasties (primary THA, hemiarthroplasty, revision arthroplasty, including treatment of periprosthetic fractures, dislocations, and infections)? (2) Does timing of surgery (urgent/unplanned versus elective) influence perioperative outcomes such as mortality, length of stay, or need for advanced care? (3) What diagnoses are associated with unplanned surgery and are treated urgently most often? (4) Do demographics and insurance status differ between admission types (unplanned versus elective hip arthroplasty)? METHODS:We prospectively followed all 419 patients who were admitted to our Level I trauma center in 2011 for procedures including primary THA, hemiarthroplasty, and revision arthroplasty, including the treatment of periprosthetic fractures, dislocations, and infections. Fifty-seven patients who were treated urgently on an unplanned basis were compared with 362 patients who were treated electively. Demographics, admission diagnoses, complications, and costs were recorded and analyzed statistically. RESULTS:Median total costs were 24% greater for patients admitted for unplanned hip arthroplasties (USD 18,206 [USD 15,261-27,491] versus USD 14,644 [USD 13,511-16,309]; p < 0.0001) for patients admitted for elective arthroplasties. Patients with unplanned admissions had a 67% longer median hospital stay (5 days [range, 4-9 days] versus 3 days [range, 3-4 days]; p < 0.0001) for patients with elective admissions. Mortality rates were equivalent between groups (p = 1.0). Femoral fracture (p < 0.0001), periprosthetic fracture (p = 0.01), prosthetic infection (p = 0.005), and prosthetic dislocation (p < 0.0001) were observed at higher rates in the patients with unplanned admissions. These patients were older (p = 0.04), less likely to have commercial insurance (p < 0.0001), more likely to be transferred from another institution (p < 0.0001), and more likely to undergo a revision procedure (p < 0.0001). CONCLUSIONS:Unplanned arthroplasty and urgent surgery are associated with increased financial and clinical burdens, which must be accounted for when considering bundled quality and reimbursement measures for these procedures.

背景与目标： 背景：紧急手术已被证明是围手术期并发症的危险因素。研究表明，计划外的髋关节置换术患者的发病率更高，尽管计划外的手术是否还会导致更高的患者死亡率仍存在争议。由于先前尚未研究计划外的原发性髋关节置换术的成本，因此尚未完全了解这些程序的财务影响。
问题/目的：我们问：（1）与计划外的髋关节置换术（原发性THA，半髋置换术，翻修置换术，包括假体周围骨折，脱位和感染的治疗）相关的机构成本是多少？ （2）手术时间（紧急/计划外与选择性）是否会影响围手术期的结果，例如死亡率，住院时间或需要高级护理？ （3）哪些诊断与计划外手术有关，并且最需要紧急治疗？ （4）入院类型（计划外髋关节置换术与选择性髋关节置换术）的人口统计学和保险状况是否不同？
方法：我们前瞻性地追踪了2011年入院I级创伤中心的所有419例患者，包括原发性THA，半髋置换和翻修置换，包括假体周围骨折，脱位和感染的治疗。比较了57例计划外紧急治疗的患者和362例选择性治疗的患者。记录人口统计学，入院诊断，并发症和费用，并进行统计分析。
结果：接受非计划性髋关节置换术的患者中位总成本高出24％（18,206美元[15,261-27,491美元]，而选择性膝关节置换术的患者为14,644 [USD 13,511-16,309]； p <0.0001）。计划性入院患者的计划外入院患者中位住院时间（5天[范围，4-9天]与3天[范围，3-4天]； p <0.0001）相比，住院时间延长了67％。两组之间的死亡率相等（p = 1.0）。在计划外入院的患者中，股骨骨折（p <0.0001），假体周围骨折（p = 0.01），假体感染（p = 0.005）和假体脱位（p <0.0001）的发生率更高。这些患者年龄较大（p = 0.04），不太可能拥有商业保险（p <0.0001），更有可能从另一家机构转诊（p <0.0001），并且更有可能接受修订程序（p <0.0001）。
结论：计划外的关节置换术和紧急手术会增加财务和临床负担，在考虑捆绑质量和这些措施的报销措施时必须考虑这些因素。

BACKGROUND & AIMS: BACKGROUND:Long-term use of ursodeoxycholic acid (UDCA) is the recommended therapy in primary biliary cirrhosis (PBC). The lifetime effectiveness and cost-effectiveness of UDCA in PBC have, however, not been assessed. AIM:To estimate the health outcomes and lifetime costs of a Norwegian cohort of PBC patients on UDCA. METHODS:Norwegian PBC patients (n = 182) (90% females; mean age 56.3 ± 8.9 years; Mayo risk score 4.38) who were included in a 5-year open-label study of UDCA therapy were subsequently followed up for up to 11.5 years. The lifetime survival was estimated using a Weibull survival model. The survival benefit from UDCA was based on a randomised clinical trial from Canada, comparing the effect of non-UDCA and UDCA. Survival and costs of standard care vs. standard care plus UDCA were simulated in a Markov model with death and liver transplantation as major events, invoking transition of a patient's state in the model. RESULTS:The gain in life expectancy for a PBC patient on UDCA compared with standard care was 2.24 years (1.19 years discounted). The lifetime treatment costs were EUR 151,403 and EUR 157,741 (EUR 102,912 and EUR 115,031 discounted) for patients with and without UDCA respectively. A probabilistic sensitivity analysis indicated an 82% probability that UDCA entails both greater life expectancy and lower costs than standard care. CONCLUSIONS:The results of this study indicate that UDCA therapy is a dominant strategy as it confers reduced morbidity and mortality, as well as cost savings, compared with standard therapy.

背景与目标： 背景：长期使用熊去氧胆酸（UDCA）是原发性胆汁性肝硬化（PBC）的推荐治疗方法。但是，尚未评估UDCA在中国人民银行的终生效力和成本效益。
目的：评估挪威人群中UDCA的PBC患者的健康结局和终生成本。
方法：对5年期开放标签UDCA治疗研究的挪威PBC患者（n = 182）（90％的女性；平均年龄56.3±8.9岁； Mayo风险评分4.38）进行了随访，随访率高达11.5。年。使用Weibull生存模型估算生存期。 UDCA的生存获益基于加拿大的一项随机临床试验，比较了非UDCA和UDCA的效果。在以死亡和肝移植为主要事件的马尔可夫模型中，模拟了标准护理与标准护理加UDCA的存活率和费用，并在模型中调用了患者的状态转换。
结果：与标准护理相比，UDCA的PBC患者的预期寿命增加了2.24岁（折扣了1.19岁）。有和没有UDCA的患者的终生治疗费用分别为151,403欧元和157,741欧元（折扣102,912欧元和115,031欧元）。概率敏感性分析表明，与标准护理相比，UDCA的预期寿命更长，成本更低，可能性为82％。
结论：本研究结果表明，与标准疗法相比，UDCA疗法是一种主要策略，因为它可以降低发病率和死亡率，并节省成本。

BACKGROUND & AIMS: :The purpose of the present research is to establish a novel nanosizing technique starting from wet nano-milling, named "dry nanosuspension" technique for poorly water-soluble drugs. The spray freeze-drying (SFD) method was applied instead of the spray-drying one previously developed. Drug particles were milled in the aqueous solution of dispersing agents using an oscillating beads-milling apparatus. The milled nanosuspension was sprayed to the surface of liquid nitrogen, and the resultant iced droplets were freeze-dried to obtain the powdery product. The loading ratio of a dispersing agent was investigated to enhance its redispersing property. Dry nanosuspension, which could be spontaneously dispersed into original nanosuspension in water, was obtained by SFD process. It was assumed that self dispersion property would be attributed to its structure with porous network, in which the primary milled drug crystals were embedded. Such unique structure contributed greatly to immediate release behaviors of the drug in gastrointestinal buffered media. These pharmaceutical properties were enhanced by increasing the ratio of the dispersing agent to the drug and the solid content in suspension to be sprayed. The present technique via wet milling and spray freeze-drying processes would be a novel dissolution-enhanced technology for poorly water-soluble drugs.

背景与目标： ：本研究的目的是建立一种从湿法纳米研磨开始的新型纳米技术，该技术被称为“干纳米悬浮”技术，用于水溶性差的药物。应用喷雾冷冻干燥（SFD）方法代替先前开发的喷雾干燥方法。使用振荡珠磨设备在分散剂的水溶液中研磨药物颗粒。将研磨后的纳米悬浮液喷雾至液氮表面，并将所得的冰滴冷冻干燥，以获得粉状产物。为了提高分散剂的再分散性，对分散剂的负载率进行了研究。通过SFD工艺获得了可以自发分散在水中的纳米悬浮液的干燥纳米悬浮液。假定自分散性归因于其具有多孔网络的结构，其中嵌入了原始研磨的药物晶体。这种独特的结构极大地促进了药物在胃肠缓冲介质中的立即释放行为。通过增加分散剂与药物的比例和待喷雾悬浮液中的固体含量，可以提高这些药物的性能。通过湿磨和喷雾冷冻干燥方法的本技术将是用于水溶性差的药物的新型溶解增强技术。