Cost-utility analysis of a telehealth programme for patients with severe chronic obstructive pulmonary disease treated with long-term oxygen therapy.

We conducted a cost-utility analysis of a telehealth programme for patients with severe chronic obstructive pulmonary disease (COPD) compared with usual care. A randomized controlled trial was carried out over four months with 45 patients treated with long-term oxygen therapy, 24 in the telehealth group (TG) and 21 in the control group (CG). The analysis took into account whether the severity of comorbidity (defined as the presence of additional chronic diseases co-occurring with COPD) was associated with differences in costs and/or quality-adjusted life years (QALYs). Results of cost-utility analysis were expressed in terms of the incremental cost-effectiveness ratio (ICER). The average total cost was €2300 for the TG and €1103 for the CG, and the average QALY gain was 0.0059 for the TG and 0.0006 for the CG (resulting an ICER of 223,726 €/QALY). For patients without comorbidity, the average total cost was €855 for the TG and €1354 for the CG, and the average QALY gain was 0.0288 for the TG and 0.0082 for the CG (resulting in the telehealth programme being the dominant strategy). For patients with comorbidity, the average total cost was €2782 for the TG and €949 for the CG, and the average QALY gain was -0.0017 for the TG and -0.0041 for the CG (resulting an ICER of 754,592 €/QALY). The telehealth programme may not have been cost-effective compared to usual care, although it could be considered cost-effective for patients without comorbidity.

Implementation of a telehealth programme for patients with severe chronic obstructive pulmonary disease treated with long-term oxygen therapy.

We conducted a pilot study of the effectiveness of home telehealth for patients with advanced chronic obstructive pulmonary disease treated with long-term oxygen therapy. Patients were randomized into a telehealth group (n = 24) and a control group (n = 21) who received usual care. Patients in the telehealth group measured their vital signs on weekdays and performed spirometry on two days per week. The data were transmitted automatically to a clinical call centre. After four months of monitoring the mean number of accident and emergency department visits in the telehealth group was slightly lower than in the control group (0.29 versus 0.43, P = 0.25). The mean number of hospital admissions was 0.38 in the telehealth group and 0.14 in the control group (P = 0.47). During the study a total of 40 alerts were detected. The clinical triage process detected eight clinical exacerbations which were escalated by the case manager for a specialist consultation. There were clinically important differences in health-related quality of life in both groups. The mean score on the SGRQ was 10.9 versus 4.5 in the control group (P = 0.53). The EuroQol-5D score improved by 0.036 in the telehealth group and by 0.003 in the control group (P = 0.68). Both patients and healthcare professionals showed a high level of satisfaction with the telehealth programme.

Real-time direct measurement of human liver allograft temperature from recovery to transplantation.

Temperature is a key parameter in organ preservation that has been consistently linked to primary nonfunction (PNF). In this communication, and for the first time anywhere, continued and direct measurements of human liver intraparenchymal temperatures are reported in six clinical cases of orthotopic liver transplantations (OLT). These measurements cover the entire transplantation procedure and include the full transport phase. In contrast with long-held beliefs, these data demonstrate that liver allograft temperatures reach and stabilize at near 0 degrees C, instead of 4 degrees C, during transport using standard protocols. Furthermore, these low temperatures do not appear to contribute to graft failure when negative factors such as long preservation, the presence of hepatic steatosis, or advanced donor age are present. The clinical and experimental implications of these findings, together with other relevant elements derived from the direct and continuous monitoring of human liver allograft intraparenchymal temperatures, are discussed.

Influence of extracellular polymeric substances on deposition and redeposition of Pseudomonas aeruginosa to surfaces.

In this study, the role of extracellular polymeric substances (EPS) in the initial adhesion of EPS-producing Pseudomonas aeruginosa SG81 and SG81R1, a non-EPS-producing strain, to substrata with different hydrophobicity was investigated. The release of EPS by SG81 was concurrent with a decrease in surface tension of a bacterial suspension from 70 to 45 mJ m(-2) that was absent for SG81R1. Both strains adhered faster and in higher numbers to a hydrophilic than to a hydrophobic substratum, but the initial deposition rates and numbers of adhering bacteria in a stationary-end point were highest for the non-EPS-producing strain SG81R1, regardless of substratum hydrophobicity. Both strains adhered less to substrata pre-coated with isolated EPS of strain SG81. Furthermore, it was investigated whether bacteria, detached by passing air-bubbles, had left behind 'footprints' with an influence on adhesion of newly redepositing bacteria. Redeposition on glass was highest for non-EPS-producing SG81R1 and decreased linearly with the number of times these cycles of detachment and deposition were repeated to become similar to the redeposition of SG81 after six cycles. This indicates that P. aeruginosa SG81 leaves the substratum surface nearly completely covered with EPS after detachment, while SG81R1 releases only minor amounts of surface active EPS, completely covering the substratum after repeated cycles of detachment and adhesion. Atomic force microscopy showed a thick and irregular EPS layer (up to 32 nm) after the first detachment cycle of EPS-producing strain SG81, whereas the putatively non-EPS-producing strain SG81R1 left a 9 nm thin layer after one cycle. X-ray photoelectron spectroscopy indicated that the bacterial footprints consisted of uronic acids, the prevalence of which increased with the number of detachment and deposition cycles.

Hydrophobicity of peritoneal tissues in the rat.

In this study, an inventory of the hydrophobicity of peritoneal tissues in the living rat was made. Peritoneal tissues were divided into mesentery (i.e., omentum) and parietal and visceral peritoneum and their hydrophobicity was determined by the sessile drop method. All peritoneal tissues were hydrophilic with water contact angles varying from 0 degrees to 61 degrees. Mesentery and visceral peritoneum covering the intestines were significantly more hydrophilic than parietal and other visceral peritoneal tissues. In general, visceral peritoneum was the most hydrophobic tissue, and visceral peritoneum covering the kidneys (61 degrees) and the stomach (54 degrees) was less hydrophilic than that covering the rest of the organs, i.e., spleen (49 degrees), liver (45 degrees), and bladder (41 degrees). In summary, peritoneal tissues involved in adsorptive and exchange functions and requiring lubrication are more hydrophilic than tissues with more important and protective functions.