A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.

BackgroundComplex wounds present a substantial economic burden on healthcare systems, costing billions of dollars annually in North America alone. The prevalence of complex wounds is a significant patient and societal healthcare concern and cost-effective wound care management remains unclear. This article summarizes the cost-effectiveness of interventions for complex wound care through a systematic review of the evidence base.MethodsWe searched multiple databases (MEDLINE, EMBASE, Cochrane Library) for cost-effectiveness studies that examined adults treated for complex wounds. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed methodological quality using the Drummond 10-item methodological quality tool. Incremental cost-effectiveness ratios were reported, or, if not reported, calculated and converted to United States Dollars for the year 2013.ResultsOverall, 59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types.ConclusionsOur results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings. Please see related article: http://dx.doi.org/10.1186/s12916-015-0288-5

The final transformation of Étaín

Abstract Background Although serotonin (5-HT3) receptor antagonists are effective in reducing nausea and vomiting, they may be associated with increased cardiac risk. Our objective was to examine the comparative safety and effectiveness of 5-HT3 receptor antagonists (e.g., dolasetron, granisetron, ondansetron, palonosetron, tropisetron) alone or combined with steroids for patients undergoing chemotherapy. Methods We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 2015 for studies comparing 5-HT3 receptor antagonists with each other or placebo in chemotherapy patients. The search results were screened, data were abstracted, and risk of bias was appraised by pairs of reviewers, independently. Random-effects meta-analyses and network meta-analyses (NMAs) were conducted. Results After screening 9226 citations and 970 full-text articles, we included 299 studies (n = 58,412 patients). None of the included studies reported harms for active treatment versus placebo. For NMAs on the risk of arrhythmia (primary outcome; three randomized controlled trials [RCTs], 627 adults) and mortality (secondary outcome; eight RCTs, 4823 adults), no statistically significant differences were observed between agents. A NMA on the risk of QTc prolongation showed a significantly greater risk for dolasetron + dexamethasone versus ondansetron + dexamethasone (four RCTs, 3358 children and adults, odds ratio 2.94, 95% confidence interval 2.13–4.17). For NMAs on the number of patients without nausea (44 RCTs, 11,664 adults, 12 treatments), number of patients without vomiting (63 RCTs, 15,460 adults, 12 treatments), and number of patients without chemotherapy-induced nausea or vomiting (27 RCTs, 10,924 adults, nine treatments), all agents were significantly superior to placebo. For a NMA on severe vomiting (10 RCTs, 917 adults), all treatments decreased the risk, but only ondansetron and ramosetron were significantly superior to placebo. According to a rank-heat plot with the surface under the cumulative ranking curve results, palonosetron + steroid was ranked the safest and most effective agent overall. Conclusions Most 5-HT3 receptor antagonists were relatively safe when compared with each other, yet none of the studies compared active treatment with placebo for harms. However, dolasetron + dexamethasone may prolong the QTc compared to ondansetron + dexamethasone. All agents were effective for reducing risk of nausea, vomiting, and chemotherapy-induced nausea or vomiting. Trial registration This study was registered at PROSPERO: ( CRD42013003564 )

Comparison of magnetic resonance imaging and computed tomography for breast target volume delineation in prone and supine positions

Purpose To\ua0determine whether T2-weighted MRI improves seroma cavity (SC) and whole breast (WB) interobserver conformity for radiation therapy purposes, compared with the gold standard of CT, both in the prone and supine positions. Methods and Materials Eleven observers (2 radiologists and 9 radiation oncologists) delineated SC and WB clinical target volumes (CTVs) on T2-weighted MRI and CT supine and prone scans (4 scans per patient) for 33 patient datasets. Individual observer's volumes were compared using the Dice similarity coefficient, volume overlap index, center of mass shift, and Hausdorff distances. An average cavity visualization score was also determined. Results Imaging modality did not affect interobserver variation for WB CTVs. Prone WB CTVs were larger in volume and more conformal than supine CTVs (on both MRI and CT). Seroma cavity volumes were larger on CT than on MRI. Seroma cavity volumes proved to be comparable in interobserver conformity in both modalities (volume overlap index of 0.57\ua0(95% Confidence Interval (CI) 0.54-0.60) for CT supine and 0.52\ua0(95% CI 0.48-0.56) for MRI supine, 0.56\ua0(95% CI 0.53-0.59) for CT prone and 0.55\ua0(95% CI 0.51-0.59) for MRI prone); however, after registering modalities together the intermodality variation (Dice similarity coefficient of 0.41\ua0(95% CI 0.36-0.46) for supine and 0.38\ua0(0.34-0.42) for prone) was larger than the interobserver variability for SC, despite the location typically remaining constant. Conclusions Magnetic resonance imaging interobserver variation was comparable to CT for the WB CTV and SC delineation, in both prone and supine positions. Although the cavity visualization score and interobserver concordance was not significantly higher for MRI than for CT, the SCs were smaller on MRI, potentially owing to clearer SC definition, especially on T2-weighted MR images

Pattern of anti-diabetic drugs prescribed in a tertiary care hospital of Bangladesh

Background: Globally, diabetes mellitus is a common endocrine disorder. This study was conducted for collecting the demographic details of diabetic patients and determining the pattern of drugs prescribed among them in outpatient department of a tertiary healthcare center.Methods: A descriptive type of cross-sectional study was carried out at the outpatient department of Endocrinology, Dhaka Medical College Hospital, Bangladesh from 1 May to 31 July, 2015. Diabetic patients receiving the management for at least 6 months were enrolled and interviewed by the researchers after getting informed written consent. Structured case record form was used for demographic data & prescription details. Data were analysed using computer in SPSS 22 and Microsoft Excel 2010.Results: Altogether 105 patients, 40 males (38.1%) and 65 females (61.9%) were enrolled with urban predominance (69.5%) where 51 (48.6%) were in the age group 47-61 years with a mean of 53.4 (SD±10.6) years. 70 (66.7%) had diabetic history of less than 5 years and 66 (62.9%) had at least one concurrent illness. Hypertension accounted for majority (34.3%) of complications. On an average, 5.62 (SD±3.16) drugs were advised per prescription for diabetes as well as associated co-morbidities and majority (23.8%) had 4 drugs. The majority of drugs (74.3%) were from local manufacturers. Most patients (62.9%) were prescribed with oral drugs singly. Metformin alone predominated in 41% prescriptions followed by the combination of Metformin and Sitagliptin (31.4%).Conclusions: The findings can serve as a guide to choose the formulation and combination of anti-diabetic drugs in this part of the world before developing & marketing any new drug

Solar Thermal Technology for Use in Developing Countries

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Large Language Models Based Automatic Synthesis of Software Specifications

Software configurations play a crucial role in determining the behavior of software systems. In order to ensure safe and error-free operation, it is necessary to identify the correct configuration, along with their valid bounds and rules, which are commonly referred to as software specifications. As software systems grow in complexity and scale, the number of configurations and associated specifications required to ensure the correct operation can become large and prohibitively difficult to manipulate manually. Due to the fast pace of software development, it is often the case that correct software specifications are not thoroughly checked or validated within the software itself. Rather, they are frequently discussed and documented in a variety of external sources, including software manuals, code comments, and online discussion forums. Therefore, it is hard for the system administrator to know the correct specifications of configurations due to the lack of clarity, organization, and a centralized unified source to look at. To address this challenge, we propose SpecSyn a framework that leverages a state-of-the-art large language model to automatically synthesize software specifications from natural language sources. Our approach formulates software specification synthesis as a sequence-to-sequence learning problem and investigates the extraction of specifications from large contextual texts. This is the first work that uses a large language model for end-to-end specification synthesis from natural language texts. Empirical results demonstrate that our system outperforms prior the state-of-the-art specification synthesis tool by 21% in terms of F1 score and can find specifications from single as well as multiple sentences

Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study

AbstractBackground:Timely and appropriate evidence-based practices during antenatal care improve maternal andneonatal health. There is a lack of information on how pregnant women and families perceive antenatal care inBangladesh. The aim of our study was to develop targeted client communication via text messages for increasingantenatal care utilization, as part of an implementation of an electronic registry for maternal and child health.Methods:Using a phenomenological approach, we conducted this qualitative study from May to June 2017 in two sub-districts of Chandpur district, Bangladesh. We selected study participants by purposive sampling. A total of 24 in-depthinterviews were conductedwithpregnantwomen(n= 10), lactating women (n=5),husbands(n= 5), and mothers-in-law(n= 4). The Health Belief Model (HBM) was used to guide the datacollection. Thematic analysis was carried out manuallyaccording to the HBM constructs. We used behavior change techniques to inform the development of targeted clientcommunication based on the thematic results.Results:Almost no respondents mentioned antenatal care as a preventive form of care, and only perceived it as necessary ifany complications developed during pregnancy. Knowledge of the content of antenatal care (ANC) and pregnancycomplications was low. Women reported avariety of reasons for not attending ANC, including the lack of information onthe timing of ANC; lack of decision-making power; long-distance to access care; being busy with household chores, and notbeing satisfied with the treatment by health care providers. Study participants recommended phone calls as their preferredcommunication strategy when asked to choose between thephone call and text message, but saw text messages as afeasible option. Based on the findings, we developed a library of 43 automatically customizable text messages to increaseANC utilization.Conclusions:Pregnant women and family members had limited knowledge about antenatal care and pregnancycomplications. Effective health information through text messages could increase awareness of antenatal careamong the pregnant women in Bangladesh. This study presents an example of designing targeted clientcommunication to increase antenatal care utilization within formal scientific frameworks, including a taxonomy ofbehavior change techniques.publishedVersio

eRegMat – a digital registry for improved quality of antenatal care: a cluster-randomized trial in a rural area in Bangladesh

Introduction Longitudinal client tracking systems with digital health interventions are recommended for implementation in resource-limited settings but lack evidence of benefits, harms, and implementation. In the eRegMat cluster-randomized controlled trial, we aimed to assess the effectiveness of an eRegistry versus an unshared digital client record. Methods Fifty-nine primary health care facilities in Matlab, Bangladesh were randomized with a 1:1 allocation ratio to receive an eRegistry (intervention, 30 health facilities) with decision support, feedback dashboards and targeted client communication, or an unshared digital client record without digital health interventions (control, 29 health facilities). We assessed timely antenatal care attendance, quality of care, and health outcomes. Outcome data were captured in the eRegistry, or unshared digital client record used by health workers, and through a postpartum household survey. We estimated adjusted relative risks (ARRs) following the intention-to-treat principle and adjusted for cluster randomization. Results From October 2018 to June 2020, 3023 pregnant women were enrolled in the intervention and 2746 in the control groups through community and facility registrations. Intervention and control groups did not differ for the primary outcomes: timely attendance at eligible antenatal care visits (42.5% vs. 40.3%, ARR 0.96, 95% CI 0.89–1.05, p-value 0.4) and hypertension screening and management (95.1% vs. 94.7%, ARR 1.00, 95% CI 0.96–1.03, p-value 0.8). The secondary outcome of perinatal mortality and severe perinatal morbidities was lower in the intervention (14.6%) compared to the control group (15%) (ARR 0.74, 95% CI 0.58–0.96, p-value 0.02), with the change mostly attributed to morbidity outcomes. Conclusion Due to technical and implementation challenges we were unable to estimate the effect of the intervention with sufficient precision. Challenges included delays in rollout of the digital health interventions and outcome data collection, existence of parallel documentation systems on paper and digital and the COVID-19 pandemic. Given these methodological constraints, we are unable to draw definitive interpretations of trial results.publishedVersio