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Biomedical subjects

M G Smith

Publications and source records attributed to M G Smith.

112 records · Page 7Linked to original sources
PubMedDate not supplied

Clinical and economic benefits of ramipril: an Australian analysis of the HOPE study.

BACKGROUND: The Heart Outcomes Prevention Evaluation (HOPE) study has demonstrated that ramipril 10 mg/day for 5 years in an at-risk population results in clinically and statistically significant reductions in the occurrence of cardiovascular death, myocardial infarction (MI), stroke and revascularization procedures. The likely impact of the intervention in Australia, in terms of the number of potential events avoided and the cost per life-year saved, has previously not been determined. AIMS: To assess the clinical and economic impacts of the use of daily ramipril in the Australian at-risk population from the perspective of the public health-care budget. METHODS: The clinical benefits were calculated from endpoints used in the trial, which were converted to the 'number needed to treat'. These were then applied to the at-risk population, which was determined nationally from the relevant Australian statistics. The result of this calculation is the potential number of events avoided in Australia. The economic benefits were established by undertaking an incremental cost-effectiveness analysis. The economic model considered the clinical benefits and the costs (and cost offsets) arising from ramipril 10 mg/day therapy for 5 years. Life-years saved was determined by calculating the difference in total years survived between the ramipril and control arms of the study. Net costs divided by life-years saved is the cost per life-year saved, and this is reported in Australian dollars as the incremental cost effectiveness. RESULTS: The clinical benefits over a 5-year period were expressed as the number of potential events avoided and comprised approximately: 9188 strokes; 14 658 MI; 14 317 revascularization procedures; and 12,534 cardiovascular-related deaths, nationally. The incremental cost-effectiveness analysis showed the estimated cost per life-year saved to be 17,214 Australia dollars. CONCLUSION: The use of ramipril 10 mg/day over a 5-year period in the at-risk Australian population could prevent many thousands of cardiovascular events, including 12,534 cardiovascular-related deaths. The cost per life-year saved compares favourably to other health care interventions.

Angiotensin-Converting Enzyme Inhibitors↗
PubMedDate not supplied

Hepatitis B virus transmission in an elementary school setting.

CONTEXT: The risk of transmission of hepatitis B virus (HBV) in day care centers and schools is low. OBJECTIVE: To investigate the source of HBV transmission for an elementary school teacher with acute hepatitis B. DESIGN: Serologic survey for HBV infection among elementary school students, school staff, and household members of an HBV-infected teacher and student. SETTING: General community and elementary school. PATIENTS: Elementary school students and staff members and household members of an HBV-infected teacher. MAIN OUTCOME MEASURES: Elementary school students, school staff, and household members of an HBV-infected teacher were tested for markers of HBV infection. Samples positive for hepatitis B surface antigen (HBsAg) were tested for HBsAg subtype using monoclonal antibodies and examined for HBV DNA homology by polymerase chain reaction techniques. RESULTS: An HBV-infected student and the teacher were found to have the same HBV subtype (ayw1-2) and to have identical HBV DNA sequences. The teacher reported none of the usual risk factors for acquiring HBV infection, and none of her family members had been infected prior to her illness. The specific means of HBV transmission from student to teacher was not identified. Of 108 total children in the same grade as the HBV-infected student, 102 (94%) were tested for serologic markers of HBV infection, and none was positive. CONCLUSIONS: This investigation documented transmission from an HBV-infected student to a teacher in an elementary school setting without a reported overt percutaneous or permucosal exposure to blood or infectious body fluids. Transmission of HBV to other students or staff members in the school was not observed.

Acute Disease↗