ABSTRACT
BACKGROUND: To date, there have been no published studies evaluating the cost-effectiveness of robot-assisted gait training (RAGT) in adolescent and adult patients with cerebral palsy (CP). The study´s aim was to analyse the cost-effectiveness of RAGT versus conventional kinesiotherapy (CON) from the health care provider's perspective. METHODS: We expressed the cost-effectiveness of RAGT in the Lokomat® system after analysing the costs and effects of RAGT and conventional therapy through the Incremental Cost-Effectiveness Ratio (ICER) based on a bicentric randomized controlled study, in which we demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP. RESULTS: According to the calculated ICER ratio for Lokomat®, an additional improvement per unit of effect (1% in GMFM), compared to conventional therapy, results in an average cost increase of EUR70.38 per patient in a therapeutic block consisting of 20 TUs (Therapeutic Units). CONCLUSION: However, from the comprehensive analysis of the results and evaluation of the long-term effects, it follows that RAGT applied in adolescent and adult patients with bilateral spastic CP is not only more effective in terms of evaluation of monitored clinical parameters, but in the long term it is also more cost-effective compared to conventional therapy.
ABSTRACT
BACKGROUND/AIMS: Dementia and psychiatric disorders are common in assisted living facilities (ALFs) and have suboptimal rates of recognition and treatment. Therefore, we aimed to obtain a direct estimate of the prevalence of cognitive impairment and especially dementia among residents of ALFs in western Slovakia and their rates of primary recognition and adequate treatment. METHODS: We conducted two cross-sectional studies. Ten ALFs within the city of Bratislava were chosen for the study in 2004, and again in 2011. A total of 866 residents in ALFs were examined in 2004, and 821 residents in ALFs were examined in 2011. The rate and characterization of dementia, its primary recognition and adequate treatment were investigated in both cross-sectional studies. RESULTS: In 2004, 57% of the participants had dementia. Only 7.2% of the participants with probable Alzheimer disease were treated with acetylcholinesterase inhibitors. In 2011, we observed a significant improvement in primary diagnostics and therapy. 66.9% of the cases of dementia were adequately evaluated, and 52.1% were adequately treated. CONCLUSION: Cognitive deficit and dementia are significantly underdiagnosed and undertreated in assisted living settings. In the second cross-sectional study we detected significant but not complete improvement in the primary recognition and adequate therapy of dementia.
Subject(s)
Assisted Living Facilities , Dementia/epidemiology , Dementia/therapy , Aged , Aged, 80 and over , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Alzheimer Disease/psychology , Cognition Disorders/diagnosis , Cognition Disorders/epidemiology , Cognition Disorders/psychology , Cognitive Dysfunction/epidemiology , Cognitive Dysfunction/psychology , Cognitive Dysfunction/therapy , Cross-Sectional Studies , Dementia/psychology , Female , Humans , Male , Mental Disorders/complications , Mental Disorders/epidemiology , Mental Disorders/therapy , Mental Status and Dementia Tests , Middle Aged , Neuropsychological Tests , Prevalence , Slovakia/epidemiologyABSTRACT
We have focused on determining the range of oxidative stress biomarkers and their dynamic changes in patients at different time points after the acute ischemic stroke (AIS). 82 patients with AIS were involved in our study and were tested: within 24 h from the onset of the attack (group A); at 7-day follow-up (group B); and at 3-month follow-up (group C). 81 gender and age matched volunteers were used as controls. Stroke patients in group A had significantly higher concentrations of plasma lipid peroxides and urine 8-isoprostanes when compared with controls. Protein carbonyls were not significantly different in any experimental group compared to controls. Antioxidant capacity of plasma was increased only in experimental group C. Activities of superoxide dismutase and catalase were elevated in all three experimental AIS groups compared to controls. Paraoxonase activity was reduced in groups A and B and unchanged in group C when compared to controls. Glutathione peroxide activity was elevated only in group A. Our results suggest that free radical damage is the highest within 24 h after the attack. During the next 3 months oxidative damage to lipids caused by free radicals is reduced due to activated antioxidant system.
