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International Journal of Food Sciences... Nov 2010Bread baking technology has an important effect on starch digestibility measured as its predicted glycemic index tested in vitro. The aim of this work was to evaluate... (Comparative Study)
Comparative Study
Bread baking technology has an important effect on starch digestibility measured as its predicted glycemic index tested in vitro. The aim of this work was to evaluate the changes in predicted glycemic index of pound cake baked in a two-cycle microwave toaster and a conventional oven. The glycemic index was calculated from hydrolysis index values by the Granfeldt method. Non-significant differences (P > 0.05) were found in hydrolysis index (60.67 ± 3.96 for the product baked in microwave oven and 65.94 ± 4.09 for the product baked in conventional oven) and predicted glycemic index content (60.5 for product baked in microwave oven and 65 for the product baked in conventional oven) in freshly-baked samples. Results clearly demonstrate that the baking pound cake conventional process could be replicated using a two-cycle multifunction microwave oven, reducing the traditional baking time. Further research is required in order to achieve pound cake crumb uniformity.
Topics: Bread; Cooking; Digestion; Glycemic Index; Hot Temperature; Humans; Microwaves; Starch
PubMed: 20367217
DOI: 10.3109/09637481003716395 -
Otolaryngology--head and Neck Surgery :... Jun 2015To analyze and determine the incidence and severity of weight loss in adult tonsillectomies.
OBJECTIVE
To analyze and determine the incidence and severity of weight loss in adult tonsillectomies.
STUDY DESIGN
Case series with chart review.
SETTING
Adult tonsillectomy is performed for a variety of indications. Anecdotally, patients report a 10- to 15-pound weight loss in the postoperative period; however, no supporting research has been documented. The pediatric population has a well-documented weight gain postoperatively.
SUBJECTS
In total, 138 adults (aged 18-40 years) receiving tonsillectomy at Naval Medical Center Portsmouth (NMCP) between 2008 and 2013.
METHODS
A retrospective study was performed using an S3 surgery scheduling system search of all adult tonsillectomies at NMCP between 2008 and 2013. A subsequent electronic medical record search (AHLTA) of preoperative and postoperative weights and demographics was performed.
RESULTS
Data analysis revealed a significant difference found between preoperative and postoperative weight across all age groups (4.77 pounds, P < .005). Analysis of variance was performed to determine if there is a significant difference between these age and body mass index (BMI) groups. The highest amount of weight loss was observed in the oldest population group (5.72 pounds in subjects aged >40 years, 4.95 pounds in 31- to 40-year-olds, and 5.44 pounds in 20- to 30-year-olds, P = .03). Age comparisons were statistically significant. There was no statistically significant association between BMI and postoperative weight loss.
CONCLUSIONS
These results indicate that there is evidence of a roughly 5-pound weight loss in the postoperative period following tonsillectomy in adults with subsequent return to baseline weight after roughly 5 months. These findings are significant since this could lead to further research into changes in obesity-associated disease.
Topics: Adolescent; Adult; Age Factors; Body Mass Index; Body Weight; Cohort Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Retrospective Studies; Sex Factors; Tonsillectomy; Weight Loss; Young Adult
PubMed: 25847146
DOI: 10.1177/0194599815578110 -
BJU International May 2004To assess the costs of flexible ureterorenoscopy.
OBJECTIVE
To assess the costs of flexible ureterorenoscopy.
MATERIALS AND METHODS
Data were collected prospectively for 100 cases using a new flexible ureteroscope (DUR8, Circon ACMI, Stamford, USA), including the indications for flexible ureterorenoscopy, use of laser probes, disposable instrumentation, and the cost and timing of ureteroscope repair.
RESULTS
Of the 100 procedures 68 were for stone disease, 21 for known or suspected transitional cell carcinoma (TCC), six were diagnostic only and five were for pelvi-ureteric junction obstruction. The ureteroscope was repaired after the 29th and 88th cases. The ability of the ureteroscope to deflect was maintained throughout. At the time of purchase the ureteroscope was listed at pound 15 000 and each repair/exchange currently costs pound 4200, thus the total expenditure on the ureteroscope was pound 23 400. Total expenditure on ancillary equipment was pound 28 727, of which pound 22 927 was on disposables and pound 5800 on 10 laser probes.
CONCLUSION
In this series the costs of the ancillary equipment exceeded the purchase and maintenance of the ureteroscope, and we expect this trend to continue in the long term. The advent of more durable ureteroscopes may ultimately reduce the frequency of costly repairs. The cost of disposables should be considered in planning the budget.
Topics: Carcinoma, Transitional Cell; Cost-Benefit Analysis; Disposable Equipment; Humans; Kidney Neoplasms; Prospective Studies; Ureteral Calculi; Ureteral Neoplasms; Ureteroscopy
PubMed: 15142156
DOI: 10.1111/j.1464-410X.2003.04774.x -
BJOG : An International Journal of... Feb 2001To carry out a systematic review of the literature relating to economic aspects of alternative modes of delivery. (Review)
Review
OBJECTIVE
To carry out a systematic review of the literature relating to economic aspects of alternative modes of delivery.
METHODS
A comprehensive literature search of the years 1990-1999 was conducted of electronic and non-electronic sources using a tested search strategy. Papers considered to contain useful cost or resource use data were read in full and classified according to their relevance to the review and their methodological quality. Relevant cost and resource use data were converted to pound sterling and inflated to 1998-1999 price levels.
RESULTS
The literature search resulted in 975 papers, 49 of which met criteria for the review. Thirty-two papers were from the USA where the organisation, structure and costs of health care are significantly different from that of other industrialised countries. The aggregate costs of different modes of delivery reported in these American studies were between four and five times higher than costs reported in other studies. The majority of included studies were of poor quality. Data from the better quality studies demonstrated that caesarean section costs a health service substantially more than other modes of delivery. The range of costs of an uncomplicated vaginal delivery were 629 pound sterling - 1,298 pound sterling compared with1,238 pound sterling - 3,551 pound sterling for a caesarean section. However, papers have so far only considered short term health service costs.
CONCLUSIONS
Research is required to estimate the cost and resource use attributable to alternative modes of delivery. Future research should investigate the long term health service costs and the costs that arise outside the health service which are likely to vary according to mode of delivery.
Topics: Cesarean Section; Delivery, Obstetric; Female; Health Care Costs; Humans; Length of Stay; Obstetric Labor Complications; Pregnancy
PubMed: 11236114
DOI: 10.1111/j.1471-0528.2001.00044.x -
Case Reports in Transplantation 2014Graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation and consists of a reaction of donor derived immune cells directed against host...
Graft-versus-host disease (GVHD) is a rare complication after solid organ transplantation and consists of a reaction of donor derived immune cells directed against host tissues. The vast majority of cases reported in the literature involve liver, small intestine and pancreas transplantation. We report a case of GVHD in a 48-year-old man after living-unrelated kidney transplantation at another center. Six months postoperatively he developed a skin rash, anorexia, and diarrhea that resulted in malnutrition and a 90 pound weight loss. At this point he was transferred to our center with a BMI of 16 and severe cachexia. Intravenous hyperalimentation was initiated and an extensive work-up for an infectious etiology was performed and was negative. An esophagogastroduodenoscopy was performed and revealed nodularity of the gastric mucosa, atrophy, and edema in the first and second portion of his duodenum. Biopsy findings were consistent with GVHD. Aggressive immunosuppressive therapy was instituted with a good response. The anorexia and diarrhea resolved, and he was discharged on hospital day 20. Three months later, there had been no recurrence of the diarrhea, the patient had gained an additional 40 pounds, BMI of 25, and a repeat upper endoscopy revealed complete resolution of the initial endoscopic abnormalities.
PubMed: 24812587
DOI: 10.1155/2014/971426 -
PharmacoEconomics Jul 2000Multiple sclerosis (MS) is a devastating disease that can occur in early life, progressing to rapid disability and loss of physical, psychosocial and economic... (Review)
Review
Multiple sclerosis (MS) is a devastating disease that can occur in early life, progressing to rapid disability and loss of physical, psychosocial and economic functioning, significantly affecting quality of life. The traditional treatment for MS has been symptomatic, treating acute relapses without affecting the underlying disease. The introduction of interferon-beta (IFN beta) has offered significant clinical benefits by reducing the frequency of relapses and slowing disease progression. Although the costs of this treatment are high, the costs to society of caring for a patient disabled by MS are greater, and if IFN beta can delay disease progression in the longer term, the economic impact would be substantial. Previous pharmacoeconomic studies of IFN beta have suggested that benefits can only be achieved at extremely high cost, with reported cost-effectiveness measures of up to 1 million pounds sterling (Pound) per quality-adjusted life year (QALY) [1995 values]. However, these studies have considered only the short term benefits of IFN beta treatment: over 2 to 3 years, the impact of treatment on patients' quality of life is relatively small, and cost-utility analyses that do not consider longer term benefits nor include societal costs may be misleading. The model reported here is based on the hypothesis that the delay in disease progression seen in short term clinical trials is likely to continue if treatment is continued. The model also assumes that the delay in disease progression, which represents a reduction in brain atrophy, will result in lasting clinical benefits even if treatment is stopped. These assumptions are strongly supported by clinical trial data and the treatment hypothesis itself. A delay in disease progression will result in a significant improvement in functioning and quality of life, and if the costs associated with increased disability can be postponed, even long term treatment of MS with IFN beta can be shown to be cost effective. Using resource utilisation costs derived from an economic evaluation of MS in the UK, it was possible to calculate the impact of delaying disease progression in terms of both health service and societal costs. An estimate of mean disease progression in patients with MS treated with IFN beta-1a compared with patients who did not receive disease-modifying agents suggested that significant cost savings would be realised after about 12 years' treatment with IFN beta-1a. The application of utility scores to the disease progression curves also facilitated estimates of cost effectiveness, with cost per QALY values ranging from 27,036 Pounds after 2 years' treatment with IFN beta-1a to 37,845 Pounds after 20 years' treatment (1995 values).
Topics: Cost-Benefit Analysis; Disease Progression; Humans; Interferon-beta; Multiple Sclerosis; Recombinant Proteins
PubMed: 11010603
DOI: 10.2165/00019053-200018010-00005 -
Health Technology Assessment... Jun 2005To establish the clinical effectiveness and cost-effectiveness of selective oestrogen receptor modulators, bisphosphonates and parathyroid hormone (subject to licensing)... (Meta-Analysis)
Meta-Analysis Review
A systematic review and economic evaluation of alendronate, etidronate, risedronate, raloxifene and teriparatide for the prevention and treatment of postmenopausal osteoporosis.
OBJECTIVES
To establish the clinical effectiveness and cost-effectiveness of selective oestrogen receptor modulators, bisphosphonates and parathyroid hormone (subject to licensing) for the prevention and treatment of osteoporosis and the prevention of osteoporotic fractures in postmenopausal women.
DATA SOURCES
Electronic databases.
REVIEW METHODS
Studies that met the review's entry criteria were eligible for inclusion in the meta-analyses provided that they reported fracture incidence in terms of the number of patients suffering fractures. Meta-analysis was carried out using the random-effects model. A model was constructed to estimate the cost-effectiveness of osteoporosis interventions. The model calculated the number of fractures that occurred and provided the costs associated with osteoporotic fractures, and the quality-adjusted life-years (QALYs). In addition, the conditions of breast cancer and coronary heart disease (CHD) were modelled, as some interventions have been shown to affect the risk of these conditions.
RESULTS
Ninety randomised controlled trials (RCTs) met the inclusion criteria. They related to the five interventions (alendronate, etidronate, risedronate, raloxifene and teriparatide) and to five comparators (calcium, calcium plus vitamin D, calcitriol, hormone replacement therapy and exercise), as well as placebo or no treatment. All five interventions have been shown to reduce the risk of vertebral fracture in women with severe osteoporosis with adequate calcium intakes. However, none of these drugs has been demonstrated, by direct comparison, to be significantly more effective than either each other or the other active interventions reviewed in this report. The intervention costs of treating all osteoporotic women, for a period of 5 years, were in the region of pound 900-1500 million for alendronate, etidronate, risedronate and raloxifene. The cost per QALY ratios fell dramatically with age. Assuming the risks of a woman with severe osteoporosis at the threshold of osteoporosis, no treatment had a cost per QALY below pound 35,000 at 50 years of age. At 60 years of age, the cost per QALY of raloxifene was pound 26,000 assuming no impact on hip fractures, and pound 31,000 assuming an adverse effect. However, these results are driven by the effect on breast cancer and the assumptions made regarding this disease state. No other intervention had a cost per QALY below pound 35,000. When analyses were conducted assuming that the fracture risk is doubled at each site, alendronate and risedronate had cost per QALY ratios below pound 30,000 at all ages. For women at the threshold of osteoporosis, without a prior fracture and aged 70 years, the cost per QALY of the three bisphosphonates ranged from pound 34,000 to pound 41,000. Raloxifene had a cost per QALY of pound 23,000, assuming no effect on hip fracture, given assumptions regarding breast cancer. At 80 years of age, the cost per QALY of alendronate and risedronate was below pound 20,000. This was true for etidronate when incorporating observational data, but the value rose to pound 69,000 when only RCT data were used. No other intervention had a cost per QALY below pound 35,000. It was assumed that doubling the risk of fracture for women without a prior fracture would give results similar to patients at the threshold of osteoporosis with a prior fracture.
CONCLUSIONS
Of the five interventions, only raloxifene appeared to reduce the risk of vertebral fracture in postmenopausal women unselected for low bone mineral density (BMD). However, as the full data have not been made public, there is some uncertainty regarding this result. None of the five interventions has been shown to reduce the risk of non-vertebral fracture in women unselected for low BMD. All of the proposed interventions provided gains in QALYs compared with no treatment in women with sufficient calcium and vitamin D intakes. The size of the QALY gain for each intervention was strongly related to the age of the patient. The estimated costs varied widely for the interventions. These net costs were markedly different by age, with some interventions becoming cost-saving at higher age ranges in patients with a prior fracture. Areas for future research include: the evidence base for the efficacy of fracture prevention in the very elderly, reanalysis of raloxifene using a dedicated breast cancer and CHD model, and more trials considering the cost-effectiveness of teriparatide.
Topics: Age Factors; Aged; Alendronate; Bone Density; Bone Density Conservation Agents; Cost-Benefit Analysis; Etidronic Acid; Evidence-Based Medicine; Female; Fractures, Bone; Humans; Middle Aged; Osteoporosis, Postmenopausal; Quality-Adjusted Life Years; Raloxifene Hydrochloride; Randomized Controlled Trials as Topic; Risedronic Acid; Teriparatide
PubMed: 15929857
DOI: 10.3310/hta9220 -
The Consultant Pharmacist : the Journal... Jul 2016Patients who have transitioned to end-of-life (EOL) care are at an increased risk for polypharmacy as they face new symptoms requiring palliative-care medications.
INTRODUCTION
Patients who have transitioned to end-of-life (EOL) care are at an increased risk for polypharmacy as they face new symptoms requiring palliative-care medications.
CASE
The patient was a 96-year-old, 6' 2", 125-pound male patient who was brought into the outpatient geriatric practice by his daughter, with whom he had been living all his life. The patient had no pain, but severe dysphagia. Both daughter and patient were fully aware that death was imminent, as the patient had lost 60 pounds in the past three to four months because of gastrointestinal cancer. The daughter asked if she could stop any of his medications, which she had been struggling to provide because of his dysphagia; Her bed-bound father was anorectic; at that point the geriatrician called for a pharmacy consult, specifically to address the issue of unnecessary medications.
DISCUSSION
There is little evidence or guidance in reducing or discontinuing medications for chronic illnesses during EOL care. While it is understandable that the number of symptom-relief medications will increase, patient comfort can be helped by reducing maintenance medications that have little to no short-term benefit.
CONCLUSION
As EOL approaches, a patient's last wishes must be respected, including timely changes to his or her medication regimen. Pharmacists are an essential asset to the geriatric interdisciplinary team, as they can provide extensive medication counseling.
Topics: Aged, 80 and over; Antineoplastic Agents; Deglutition Disorders; Drug-Related Side Effects and Adverse Reactions; Gastrointestinal Neoplasms; Geriatric Assessment; Humans; Male; Medical Futility; Medication Adherence; Palliative Care; Patient Care Team; Patient Preference; Pharmacists; Polypharmacy; Professional Role; Quality of Life; Risk Factors; Terminal Care; Unnecessary Procedures
PubMed: 27412313
DOI: 10.4140/TCP.n.2016.375 -
Journal - Southern California Dental... Sep 1970
Topics: Dentistry; Denture Design; Denture, Complete, Immediate; Denture, Partial, Immediate
PubMed: 4916398
DOI: No ID Found -
American Literature: a Journal of... 1981
Topics: History, Modern 1601-; Literature; Mental Disorders; United States
PubMed: 11616528
DOI: No ID Found