ABSTRACT
Cost-effectiveness analysis has long been practiced; registries date back to the United States of America War Department in 1886. In addition, everyone does intuitive cost-effectiveness analyses in their daily lives. In routine medical care, health economic assessment becomes increasingly important due to progressively limited resources, rising demands, population increases, and continuous therapeutic innovations. The health economic assessment must analyze the outcomes and costs of actions and technologies as objectively as possible to guarantee efficient assessment of novel interventions for Public Health Policy. In other words, it is necessary to determine how much society or patients are willing to or able to pay for novel interventions compared with existing alternatives, given the available resources. In addition, increased cost may displace other health care services already provided in case of fixed budget health care systems. To conduct such analyses, researchers must use standard methodologies and interpretations in light of regional characteristics according to social and economic determinants as well as clinical practice. Such an approach may be essential for transforming the current healthcare system to a value-based model. In this narrative review, concepts of the importance of and some approaches to health economic evaluation in clinical practice will be discussed.
Subject(s)
Cost-Effectiveness Analysis , Public Policy , Humans , United States , Cost-Benefit Analysis , Patient Care , Health Care CostsABSTRACT
MicroRNAs (miRNAs) são um (constituyen un) grupo de pequenos RNAs, com aproximadamente 19-25 nucleotídeos, que não-codificam (no codifican) proteínas e que estão (y se encuentran) presentesem grande parte dos organismos eucariontes, incluindo o homem. Desde a sua descoberta (1993) osmiRNAs vêm ganhando um (vienen ganando un) enorme destaque na (papel destacado en la) comunidade científica, representando hoje uma das (en la actualidad una de las) áreas mais estimulantes da ciência médica moderna. Estas moléculas têm a singular (poseen la singular) habilidade de modular em uma (para modular una) enorme e complexa rede (compleja red) regulatória da expressão dos genes estimada em cerca de 70% do genoma humano. Os miRNAs exercem sua (ejercen su) função por meioda (a través de la) inibição da tradução de mRNAs específicos (controle pós-transcricional), ou seja, impedem a (es decir, impiden la) síntese de determinadas proteínas durante um certo intervalo de tempo.Desta forma, os miRNAs desempenham um papel crucial não só nos (no sólo en los) processos celulares normais, como desenvolvimento e (desarrollo y) diferenciação, mas também na (en la) patogênese de diversas doenças (enfermedades). Estudos recentes mostram que os perfis (los perfiles) de miRNAs se alteram de acordo com a etiologia, intensidade e estágio da (y etapa de la) doença, podendo ser utilizados como potenciais ferramentas de diagnóstico e prognóstico. Aliado a isto, a (Asociado con esto, la) possibilidade do uso dos miRNAs para silenciar ou ativar (o activar) genes específicos é uma (constituye una) atual e promissora ferramenta que permite o desenvolvimento de novas estratégias terapêuticas individualizadas, ou seja (es decir), baseadas na (con base en la) condição específica de cada paciente.Nesta revisão serão abordados aspectos sobre a biologia dos miRNAs e como eles podem nos ajudar no (y como ellos pueden ayudar en el) combate às (de las) enfermidades humanas...
Subject(s)
Humans , RNA , Genome, Human , NeoplasmsABSTRACT
OBJECTIVES: We performed a prospective, randomized, double-blind, placebo-controlled study of carvedilol effects in children with severe, chronic heart failure (HF), despite the use of conventional therapy. BACKGROUND: Little is known about the effects of carvedilol in youngsters with chronic HF and severe left ventricular (LV) dysfunction. METHODS: We conducted a double-blind, placebo-controlled study of 22 consecutive children with severe LV dysfunction. The children had chronic HF and left ventricular ejection fraction (LVEF) <30%. Patients were randomly assigned to receive either placebo (8 patients) or the beta-blocker carvedilol (14 patients) at 0.01 mg/kg/day titrated up to 0.2 mg/kg/day, followed-up for six months. RESULTS: During the follow-up and the up-titration period in the carvedilol group, four patients died and one underwent heart transplantation. In patients receiving carvedilol evaluated after six months, a significant increase occurred in LVEF, from 17.8% (95% confidence interval [CI], 14.1 to 21.4%) to 34.6% (95% CI, 25.2 to 44.0%); p = 0.001. Modified New York Heart Association (NYHA) functional class improved in nine patients taken off the transplant waiting list. All nine patients were alive at follow-up. In the placebo group, during the six-month follow-up, two patients died, and two underwent heart transplantation. Four patients persisted with HF symptoms (NYHA functional class IV). No significant change occurred in LVEF or fractional shortening. CONCLUSIONS: Carvedilol added to standard therapy may reduce HF progression and improve cardiac function, allowing some youngsters to be removed from the heart transplantation waiting list.
Subject(s)
Adrenergic beta-Antagonists/therapeutic use , Antioxidants/therapeutic use , Carbazoles/therapeutic use , Heart Failure/therapy , Heart Transplantation , Propanolamines/therapeutic use , Waiting Lists , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Blood Pressure/drug effects , Brazil , Carvedilol , Child , Child Welfare , Child, Preschool , Chronic Disease , Diastole/drug effects , Dose-Response Relationship, Drug , Double-Blind Method , Echocardiography , Female , Follow-Up Studies , Heart Failure/complications , Heart Failure/diagnosis , Humans , Infant , Infant Welfare , Male , Prospective Studies , Radionuclide Ventriculography , Severity of Illness Index , Stroke Volume/drug effects , Systole/drug effects , Treatment Outcome , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/therapyABSTRACT
PURPOSE: To analyse prevalence, clinical features and organ involvement in viral infections occuring after heart transplantation. METHODS: One hundred consecutive heart transplantation patients were studied. The follow-up was three to 90 (mean 23.32 +/- 25.97) months. Viral infections were diagnosed using the Center for Disease Control criteria. RESULTS: Viral infections were responsible for 51 infections, 19.6 of all infections in this patient population. Herpesvirus infection was the most common etiology: 32 (59.25) of all viral infections were caused by reactivation of or reinfection by cytomegalovirus. Of those infections 27 (84.37) occurred in the first three weeks following surgery. Only 4 (12.50) of those showed clinical signs of cytomegalovirus disease. Other herpesvirus causing infections were herpes simplex and varicella-zoster virus. CONCLUSION: Infections are common after heart transplantation and viral infections of herpesviridae family are important causes of those infections; usually as reactivation in an immune suppressed patient. The most important viral infections were caused by reactivation of or reinfection by cytomegalovirus.
Purpose - To analyse prevalence, clinical features and organ involvement in viral infections occuring after heart transplantation. Methods - One hundred consecutive heart transplatation patients were studied. The follow-up was three to 90 (mean 23.32 ± 25.97) months. Viral infections were diagnosed using the Center for Disease Control criteria. Results - Viral infections were responsible for 51 infections, 19.6% of all infections in this patient population. Herpesvirus infections was the most common etiology: 32 (59.25%) of all viral infections were caused by reactivation of or reinfection by cytomegalovirus. Of those infections 27 (84.37%) occurred in the first three weeks following surgery. Only 4 (12.50%) of those showed clinical signs of cytomegalovirus disease. Other herpesvirus causing infections were herpes simplex and varicella-zoster virus. Conclusion - Infections are common after heart transplantation and viral infections of herpesviridae family are important causes of those infections; usually as reactivation in an immune suppressed patient. The most important viral infections were caused by reactivation of or reinfection by cytomegalovirus
