An economic analysis of selective laser trabeculoplasty versus topical prostaglandin analogues as initial therapy for primary open-angle glaucoma in a tertiary government hospital in the Philippines

Objective@# This study compared the economic viability of initial medical therapy with topical prostaglandin analogues (PGAs) versus selective laser trabeculoplasty (SLT) in the treatment of primary open-angle glaucoma (POAG).@*Method@#This was an economic analysis using actual, current treatment costs of PGA therapy versus SLT applied to theoretical, literature-derived clinical efficacy data projected for a period of 19 years. A socioeconomic and demographic survey conducted among POAG patients at the Department of Health Eye Center of the East Avenue Medical Center from March-April 2022 provided the economic context and setting for the analysis. The treatment regimens were compared in terms of total cost, clinical efficacy, cost-effectiveness and cost-utility in the setting of a tertiary government hospital.@*Results@#Thirty-one (31) patients were included in the study. The total annual cost of topical PGAs was Philippine Pesos (Php) 13,532 versus Php 6,195 for SLT. Cost-effectiveness was Php 1,933 for PGAs/mmHg reduction in intraocular pressure (IOP) versus Php 983 for SLT. Cost-utility was Php 59,793/Quality Adjusted Life Years (QALY) gained for PGAs versus Php 27,373/QALY gained for SLT projected for 19 years. With government insurance coverage, cost-utility ratio was Php 47,831/QALY gained for topical PGAs versus 16,327/QALY gained for SLT.@*Conclusion@#In POAG patients, SLT was more cost-effective versus PGAs with a lower cost per mmHg IOP reduction, and lower cost-utility ratio for every QALY gained. SLT can be recommended as initial therapy for POAG especially for patients being treated at tertiary government hospitals.

Clinical effectiveness and safety evaluation of a respiratory training device / 中华全科医师杂志

Objective:To evaluate the clinical effectiveness and safety of a respiratory training device (patent No.201320672057.6), which was developed and produced in China.Methods:Sixty patients with chronic respiratory diseases admitted in China-Japan Friendship Hospital from May 2019 to July 2019 were enrolled in the study. Patients were randomly divided into trial group ( n=30) and control group ( n=30), in the trial group, respiratory training device was used on the basis of conventional treatment, while in the control group, patients received conventional treatment only. Baseline data were collected at the time of enrollment, patients were followed up every 4 weeks, and the final data were collected at the 16th week. The primary outcomes were mMRC score, LCQ score and expectoration. The secondary outcomes were pulmonary function, respiratory muscle strength, SpO 2, FeNO, SGRQ score, times of acute exacerbation and adverse events. Results:There was no significant difference in proportion of decreased mMRC score between trial group and control group [36.0% (9/25) vs. 23.1% (6/26), Z=-1.044, P=0.301). On expectoration, the decrease rate of no-sputum patients in the trial group was significantly higher than that in the control group [28.0%(7/25) vs. 7.7%(2/26), Z=2.050, P=0.041]. In addition, 56%(14/25) patients in the trial group had a decrease in sputum volume compared to 19.2%(5/26)in the control group ( Z=-2.574, P=0.010). There was no statistical difference between the two groups before and after the follow-up in LCQ score( F=0.668, P=0.418). The PEF of pulmonary function in the trial group was significantly improved compared to the baseline( F=4.532, P=0.039); and R 35 was also significantly improved in the trial group( F=4.125, P=0.048). In terms of quality of life, the study found no statistical differences in SGRQ scores between baseline and follow-up. However, the SGRQ symptom score decreased significantly in trial group( F=7.481, P=0.009). There was no statistical difference in acute exacerbation between the two groups ( Z=0.297, P=0.766). No adverse events occurred during the follow-up period. Conclusions:This study evaluated the clinical effectiveness and safety of a respiratory training device developed in China. In terms of the clinical effectiveness, the device can reduce sputum, increase PEF, reduce R 35, indicating that there is a certain therapeutic effect. It is not clear that the device can reduce the severity of dyspnea and pulmonary function, improve quality of life, reduce the times of acute exacerbation. In terms of safety, the device did not show adverse effects during follow-up in this study.

Efetividade de um treinamento na aprendizagem de familiares de pacientes cardiopatas sobre ressuscitação cardiopulmonar / The effectiveness of training in the teaching of relatives of patients with heart disease on cardiopulmonary resuscitation

Introdução: Considerando que as doenças cardiovasculares são responsáveis por elevadas taxas de mortalidade no mundo e que esse cenário não é diferente no Brasil, a Sociedade Brasileira de Cardiologia alerta que os cardiopatas podem ser acometidos a qualquer momento por uma parada cardiorrespiratória (PCR), muitas vezes presenciada por familiares leigos. A correta realização da ressuscitação cardiopulmonar (RCP) tem favorecido positivamente a sobrevida das vítimas dessa emergência, reforçando a importância da capacitação de familiares de pacientes cardiopatas no atendimento à pessoa em PCR. Objetivo: Avaliar a efetividade de um treinamento na aprendizagem de familiares de pacientes cardiopatas sobre RCP. Métodos: Estudo quase experimental, realizado em São Paulo, cuja amostra foi composta por familiares que atenderam aos seguintes critérios de inclusão: ter idade 18 anos; possuir algum membro da família cardiopata, internado na unidade de clínica médica do Hospital Universitário da Universidade de São Paulo e com programação de alta; residir com o paciente; apresentar condições físicas que permitissem realizar o treinamento prático; e ser morador(a) da Grande São Paulo. A coleta de dados, realizada entre 5 de março e 30 de agosto de 2018, foi desenvolvida em duas fases. Na primeira, foram avaliados o conhecimento teórico e as habilidades dos participantes sobre a RCP antes e imediatamente após o treinamento, oferecido por enfermeiro, que incluiu explicação teórica e capacitação prática sobre atendimento a uma pessoa em PCR por meio de simulações em manequim e uso do desfibrilador externo automático (DEA), tendo como base o suporte básico de vida (SBV) em cardiologia. A segunda fase aconteceu um mês após o treinamento com a aplicação das mesmas avaliações realizadas na primeira. Os testes McNemar e Stuart-Maxwell e um modelo de efeitos mistos foram utilizados para as análises dos dados, com nível de significância de 5%. Resultados: Dos 60 familiares de pacientes cardiopatas que compuseram a casuística (71,67% do sexo feminino; média de idade de 36,22 anos; 73,34% com ensino médio completo), observou-se que houve aumento significativo (p<0,050) do conhecimento teórico dos participantes antes e após o treinamento e elevada retenção desse conhecimento após 30 dias da capacitação. A frequência das compressões torácicas foi a única questão teórica que apresentou perda significativa de acertos (p=0,003) dos participantes entre os períodos pós-treinamento e 30 dias depois. Em relação ao desempenho prático, os familiares apresentaram, após a capacitação, melhora significativa (p<0,001) das habilidades nas 15 ações analisadas durante a atividade de simulação. Após um mês do treinamento, os participantes mantiveram as habilidades práticas assimiladas sobre RCP na grande maioria dos passos do atendimento, com exceção da frequência das compressões torácicas (p=0,002) e do tempo entre ligar o DEA e aplicar o choque (p=0,039), ações que apresentaram queda significativa de acertos em comparação aos resultados mensurados imediatamente após a capacitação. Conclusão: O treinamento de SBV, realizado por enfermeiro, foi efetivo na retenção do conhecimento teórico e nas habilidades assimiladas pelos familiares de pacientes cardiopatas sobre RCP.

Introduction: Considering that cardiovascular diseases are responsible for high mortality rates in the world and that this scenario is not different in Brazil, the Brazilian Society of Cardiology warns that cardiac patients can be affected by Cardiac Arrest (CA), often witnessed by untrained relatives. The correct performance of cardiopulmonary resuscitation (CPR) has positively favored the survival of victims of this emergency, reinforcing the importance of qualification of family members of patients with heart disease during CA. Objective: To evaluate the effectiveness of training relatives of patients with cardiac disease on CPR. Methods: A quasi-experimental study was carried out in São Paulo, whose sample consisted of relatives who met the following inclusion criteria: age 18 years; who possessed a family member who was cardiopathic, admitted to the Medical Clinic Unit of the University Hospital of São Paulo University and with discharge plans; reside with the patient; contain physical conditions that allow practical training; and be a resident of The great São Paulo. Data collection, conducted between March 5 and August 30, 2018, was developed in two phases. In the first phase, we evaluated the theoretical knowledge and the ability of the participants to perform CPR before and immediately after the training, offered by nurse, which included a theoretical explanation and practical training on the care of a person in CA through dummy simulations and use of the automatic external defibrillator (AED), based on the Basic Life Support (BLS) in cardiology. The second phase took place one month after the training with the application of the same assessments performed during the first phase. McNemar and Stuart-Maxwell's tests and a mixed effects model were used for data analysis, with a significance level of 5%. Results: Of the 60 relatives of patients with heart disease who composed the casuistic (71.67% female; mean age of 36.22 years; 73.34% with complete high school), it was observed that there was a significant increase (p<0.05) of the theoretical knowledge of articipants before and after training and high retention of this knowledge after 30 days of training. The frequency of toracic compressions was the only theoretical question that presented significant loss of correct answers (p=0.003) of the participants between the post-training period and 30 days later. Regarding the practical performance, the relatives presented, after the training, significant improvement (p<0.001) in the 15 actions analyzed during the simulated activity. After one month of training, the participants maintained the practical ability assimilated on CPR in the vast majority of the steps of care, with the exception of the frequency of thoracic compressions (p=0.002) and the time between connecting the AED and applying the shock (p=0.039), actions that showed a significant decrease in correct answers compared to the results measured immediately after training. Conclusion: BLS training, performed by nurse, was effective in the retention of theoretical knowledge on CPR and the abilities assimilated by relatives of patients with heart disease.

Liderazgo transformacional y la facilitación de la aceptación al cambio organizacional / Transformational leadership and the facilitation of acceptance to organizational change

Objetivo. El objetivo de esta investigación fue evaluar la relación entre el estilo de liderazgo transformacional y la aceptación al cambio organizacional en trabajadores de dos empresas de Bogotá, pertenecientes al sector económico terciario. Método. Es una investigación no experimental con un diseño correlacional. Se aplicó el instrumento de medición al cambio organizacional (IMC) a 9 jefes o líderes de cargos medios y el cuestionario liderazgo multifactor (MLQ) a 62 operarios. Resultados. En los resultados se evidencian asociaciones significativas y positivas entre efectividad y comunicación en un 0,685. Conclusión. Se concluye que la comunicación y la actitud al cambio son elementos importantes en un proceso de cambio organizacional. Para efectos de futuras investigaciones se podría ampliar la muestra y adaptar el cuestionario de liderazgo transformacional a la población colombiana.

Objective. The objective of this research was to evaluate the relationship between transformational leadership styles and the acceptance of organizational change in workers of two companies in Bogotá, belonging to the terciary economic sector. Method: This was non-experimental research with a correlational design. The instrument for measuring organizational change (IMC) was applied to 9 middle management (IMC) bosses or leaders, and the multifactor leadership questionnaire (MLQ) to 62 other workers. Results. The results showed significant and positive relationships between effectiveness and communication at 0.685. Conclusion. It was concluded that communication and attitude to change are important elements in a process or organizational change. In future research the sample could be increased, and the questionnaire could be adapted to transformational leadership with the Colombian population.

O escopo de esta pesquisa foi avaliar a relação entre a forma de liderança transformacional e a aceitação à mudança organizacional em trabalhadores de duas empresas de Bogotá pertencentes ao setor econômico terciário. Metodologia. É uma pesquisa não experimental com um desenho cor relacional. Foi aplicado o instrumento de medição à mudança organizacional (IMC) em 9 chefes ou líderes de cargos médios e o questionário liderança multi-fator. (MLQ) em 62 operários. Resultados. Nos resultados foram evidenciadas associações significativas e positivas entre a efetividade e comunicação em um 0,685. Conclusão. Concluiu-se que a comunicação e a atitude são elementos importantes em um processo de mudança organizacional. Para efeito de futuras pesquisas pode-se ampliar a amostra e adaptar o questionário de liderança transformacional à população colombiana.

The relationship between bisphosphonate use and demographic characteristics of male osteoporosis patients

INTRODUCTION: This study aimed to investigate a number of demographic characteristics in males with osteoporosis (OP) treated with bisphosphonate and determine whether any of these measures could act as an effective indicator of medication persistence and compliance. MATERIAL AND METHOD: Among the patients with OP who applied to our clinic and were prescribed weekly oral bisphosphonate treatment, 89 patients over 50 years of age were included in this study. The demographic characteristics of these patients were evaluated. The number of medications used by the patients over the past 1 and 3 years were counted, and the persistence and compliance with bisphosphonate treatment was estimated. The patients were divided into two groups: fully compliant and noncompliant subjects. The two groups of patients were compared separately for 1 and 3 years while considering their demographic characteristics. RESULTS: The mean age of the 89 patients included in the study was 62.43 + 9.41 years. Comparisons among the studied demographic characteristics during the 1-year period of medication use indicated that the educational status of the fully compliant patients was higher. During the 3-year period of medication use, educational status was the only demographic characteristic that was determined to be significantly lower in the noncompliant patients than in the fully compliant group. CONCLUSION: Although deficiencies in medication persistence and compliance during osteoporosis treatment can lead to serious health and social problems in both genders, the causes of these deficiencies have not been thoroughly clarified. We suggest that the educational status of the patient may contribute to these deficiencies.

The Effectiveness of Na Education Program in Elementary School: Six Month Follow-up Study / 대한지역사회영양학회지

Nutrition education in elementary school is confronted with the present problem, as a legal basis about obligation of nutrition education in school was clarified. Moreover, it's also important for providing evidence based scientific resources to make a study of evaluating the education effectiveness. Most studies of the nutrition education effectiveness have evaluated the changing dietary attitude and nutritional knowledge score before and after the nutrition education, and suggested the effectiveness of intervention as changing between pre- and post-treatment. Nutrition education, however, purposing long-term changes, follow-up evaluation process about the learned attitude and knowledge of nutrition education were requested. For these reasons, this study attempted to fulfilled standardized nutrition education program which use "Na Story and Food World" and "Na Story for Me", a textbook for the 1st-3rd grade and 4th-6th grade designed by KFDA, and analyzed the changes about the effectiveness of nutrition education happened over a period of time. In this study, each student was assessed their dietary attitude and nutritional knowledge by four periods, before the education, right after the education, after 3 months, and after 6 months. As a result, an average score of nutritional knowledge before the education, 70.08 +/- 17.91, were changed significantly higher right after the education to 85.69 +/- 15.05 (p < 0.001), but it lowered to 84 +/- 15.56 after 3 month. After the nutrition education, students in all grades had positive dietary attitude to Na reduction (p < 0.001). However, the healthy eating attitude about Na reduction had been unable to maintain after 3 and 6 months. Therefore, the systematic reeducated program in elementary school was positively necessary to reinforce children's learning and cognitive skills to maintain healthy eating knowledge and attitude toward Na reduction.