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At least 1,531 records · Page 85Linked to original sources
PubMed1981

[Life expectancy of lung cancer patients registered at the Leningrad City Oncological Dispensary in 1968].

Out of 1,240 lung cancer patients, a five-year survival was registered in 5.2% of cases (0.5% of unoperated patients, 34.3% of radically-operated among those who underwent surgery and 39.5% of patients discharged from hospital after operation). No relationship between the sex and age unoperated patients and prognosis was established. Among those radically-operated, 34.8% of young all 28% of aged patients survived for five years. Resectability should be considered the only reliable criterion of evaluation of diagnosis and treatment of lung cancer.

Adult↗
PubMed1982

[Prognosis and life expectancy in patients with hyperthyroidism].

The term "hyperthyroidism" comprises several different diseases of which two have to be distinguished particularly: 1. hyperthyroidism with Graves' disease: the immunopathogenesis of Graves' disease allows a symptomatic therapy only; therefore its prognosis is not as good as for the 2. autonomous hyperthyroidism ("toxic goiter"), which can be cured definitely by operation or radioiodine therapy. Both diseases may aggravate under iatrogenic iodine exposure (iodine-containing drugs or X-ray contrast media) to a thyroid storm; this most severe kind of hyperthyroidism still leads to death in almost 40% of the patients.

Adolescent↗
PubMed1995

[Long-term effects and life expectancy after six years intermittent self ventilation].

PATIENTS AND METHODS: 381 patients were treated by intermittent ventilation for up to 6 years, when ventilatory failure and symptoms persisted despite efficient medical treatment. Patients with chest wall disorders (COPD) were in hospital for 19 +/- 10 (21 +/- 14) days during the first and for 6 +/- 10 (14 +/- 12) days in the following years. RESULTS: Survival was found above 95% in chest wall disorders. In COPD survival ranged 75% in the 2nd and 59% in the 4th years. CONCLUSION: Intermittent mechanical ventilation, therefore, can restore hypercapnic ventilatory failure to normal. Survival is improve similar to a control group without ventilatory failure.

Follow-Up Studies↗
PubMed1975

[Life expectancy in acquired vitium cordis after operative treatment (author's transl)].

Indications and results of operative treatment of acquired heart diseases are presented with reference to our experience with over 1500 operations on the heart valves and over 800 coronary surgical operations. The risk in timely operation for prosthetic substitution of aortic and mitral defects is less than 5%. An essential condition is, however, that no irreversible changes have developed and that the defect could be completely corrected. Surgical treatment of coronary heart disease is superior to conservative therapy and carries a risk of under 2% on strict indication. Timely operation on segmental stenoses before the ischemic myocardium is fibrosed is an essential. 70% of patients operated on can count on freedom from complaint for the time being after these palliative operations.

Adolescent↗
PubMedDate not supplied

P53 auto-antibodies in non-small cell lung cancer patients can predict increased life expectancy after radiotherapy.

BACKGROUND: In this study we investigated whether the presence of p53 antibodies in sera before of during/after radiation therapy can predict increased survival in patients with non-small cell lung cancer. PATIENTS AND MATERIALS: Sera from 67 patients with a histopathologically confirmed diagnosis of nonsmall cell lung cancer have been investigated using sandwich ELISA (Dianova, Hamburg, Germany). Sera was collected before or during/after radiation therapy. RESULTS: Antibodies were detected in 18 (27%) patients. 46/67 (69%) of the sera had been taken before start of radiation therapy and the presence of p53 antibodies was a statistically significantly good prognostic factor in terms of increased survival (p = 0.025). CONCLUSION: p53 antibodies in sera, before the start of radiation therapy, can predict increased survival after radiation treatment in patients with non-small cell lung cancer.

Adenocarcinoma↗
PubMed2001

The cost effectiveness of combination antiretroviral therapy for HIV disease.

BACKGROUND: Combination antiretroviral therapy with a combination of three or more drugs has become the standard of care for patients with human immunodeficiency virus (HIV) infection in the United States. We estimated the clinical benefits and cost effectiveness of three-drug antiretroviral regimens. METHODS: We developed a mathematical simulation model of HIV disease, using the CD4 cell count and HIV RNA level as predictors of the progression of disease. Outcome measures included life expectancy, life expectancy adjusted for the quality of life, lifetime direct medical costs, and cost effectiveness in dollars per quality-adjusted year of life gained. Clinical data were derived from major clinical trials, including the AIDS Clinical Trials Group 320 Study. Data on costs were based on the national AIDS Cost and Services Utilization Survey, with drug costs obtained from the Red Book. RESULTS: For patients similar to those in the AIDS Clinical Trials Group 320 Study (mean CD4 cell count, 87 per cubic millimeter), life expectancy adjusted for the quality of life increased from 1.53 to 2.91 years, and per-person lifetime costs increased from $45,460 to $77,300 with three-drug therapy as compared with no therapy. The incremental cost per quality-adjusted year of life gained, as compared with no therapy, was $23,000. On the basis of additional data from other major studies, the cost-effectiveness ratio for three-drug therapy ranged from $13,000 to $23,000 per quality-adjusted year of life gained. The initial CD4 cell count and drug costs were the most important determinants of costs, clinical benefits, and cost effectiveness. CONCLUSIONS: Treatment of HIV infection with a combination of three antiretroviral drugs is a cost-effective use of resources.

AIDS-Related Opportunistic Infections↗
PubMed1983

Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions.

Based on estimates of activity restriction from the Canada Health Survey, institutional data on long-term care, and survival data from vital statistics, we have calculated an index of health expectancy (life expectancy in each state of health), and a summary of these indices which we have called quality-adjusted life expectancy. At birth, expected years of long-term institutionalization were 0.8 for men and 1.5 for women. Expected years of activity restriction not involving long-term institutionalization were 10.8 for men and 14.0 for women; 3.0 of the expected years of activity restriction for men and 1.3 of these years for women were in the most severe category of restriction (unable to do major activity). For both sexes together, quality-adjusted life expectancy was 1.4 years greater in Ontario and the Prairies than in the Atlantic region, 3.2 years greater in Canada's three largest cities than in rural areas and small towns, and 7.7 years greater among persons from high-income families than among persons from low-income families.

Activities of Daily Living↗
PubMed2001

Are the indications for tissue valves different in 2001 and how do we communicate these changes to our cardiology colleagues?

The indications for tissue valves in the aortic and mitral positions are becoming better defined with advances in valve design, valve preservation, and management of reoperations. Although some patients who require cardiac valve replacement clearly benefit more from one type of valve than from another, not infrequently one encounters a patient who is in the "gray zone," where the optimal choice is difficult. At present, bioprostheses for the diseased aortic valve include stented porcine and pericardial valves, stentless porcine valves, aortic homograft, and pulmonary autograft. For patients with mitral valve disease, options for tissue valve replacement are a stented porcine or pericardial prosthesis. Generally, factors to consider in choosing the appropriate valve substitute include the patient's age, expected life expectancy, coexisting medical problems, lifestyle, and socioeconomics; the etiology of the valve disease, annular size, and physician and patient preference are also relevant. Despite the known finite durability of tissue valves, which is the main limitation in their use, the long-term results have been satisfactory, particularly in older patients, patients with a limited life expectancy, and those undergoing valve replacement in the aortic position. Distillation of available information and ongoing communication between the surgeon and the cardiologist will enable us to assist the patient in choosing the best valve substitute.

Age Factors↗
PubMed2001

Cost effectiveness of human papillomavirus testing to augment cervical cancer screening in women infected with the human immunodeficiency virus.

PURPOSE: To determine the cost effectiveness of incorporating molecular testing for high-risk types of human papillomavirus into a cervical cancer screening program for women infected with the human immunodeficiency virus (HIV). SUBJECTS AND METHODS: We developed a Markov model to simulate the natural history of cervical cancer precursor lesions in HIV-infected women. Probabilities of progression and regression of cervical lesions were conditional on transient or persistent infection with human papillomavirus, as well as stage of HIV and effectiveness of antiretroviral therapy. Incorporating data from prospective cohort studies, national databases, and published literature, the model was used to calculate quality-adjusted life expectancy, life expectancy, lifetime costs, and incremental cost-effectiveness ratios for two main strategies: targeted screening-human papillomavirus testing is added to the initial two cervical cytology smears obtained after an HIV diagnosis and subsequent screening intervals are modified based on the test results; and universal screening-no testing for human papillomavirus is performed, and a single cytology screening interval is applied to all women. RESULTS: In HIV-infected women on anti-retroviral therapy, a targeted screening strategy in which cervical cytology screening was conducted every 6 months for women with detected human papillomavirus DNA, and annually for all others, cost $10,000 to $14,000 per quality-adjusted life year gained compared with no screening. A universal screening strategy consisting of annual cervical cytology for all women was 15% less effective and had a less attractive cost-effectiveness ratio. Targeted screening remained economically attractive in multiple sensitivity analyses, although when the overall incidence of cervical cancer precursor lesions was lowered by 75%, the screening interval for women with detected human papillomavirus DNA could be widened to 1 year. CONCLUSIONS: Adding human papillomavirus testing to the two cervical cytology smears obtained in the year after an HIV diagnosis, and modifying subsequent cytology screening intervals based on the results, appears to be an effective and cost-effective modification to current recommendations for annual cytology screening in HIV-infected women.

AIDS-Related Opportunistic Infections↗
PubMed2002

Development and preliminary evaluation of a clinical guidance programme for the decision about prophylactic oophorectomy in women undergoing a hysterectomy.

OBJECTIVES: To develop a decision analysis based and computerised clinical guidance programme (CGP) that provides patient specific guidance on the decision whether or not to undergo a prophylactic oophorectomy to reduce the risk of subsequent ovarian cancer and to undertake a preliminary pilot and evaluation. SUBJECTS: Women who had already agreed to have a hysterectomy who otherwise had no ovarian pathology. SETTING: Oophorectomy decision consultation at the outpatient or pre-admission clinic. METHODS: A CGP was developed with advice from gynaecologists and patient groups, incorporating a set of Markov models within a decision analytical framework to evaluate the benefits of undergoing a prophylactic oophorectomy or not on the basis of quality adjusted life expectancy, life expectancy, and for varying durations of hormone replacement therapy. Sensitivity analysis and preliminary testing of the CGP were undertaken to compare its overall performance with established guidelines and practice. A small convenience sample of women invited to use the CGP were interviewed, the interviews were taped and transcribed, and a thematic analysis was undertaken. RESULTS: The run time of the programme was 20 minutes, depending on the use of opt outs to default values. The CGP functioned well in preliminary testing. Women were able to use the programme and expressed overall satisfaction with it. Some had reservations about the computerised formal and some were surprised at the specificity of the guidance given. CONCLUSIONS: A CGP can be developed for a complex healthcare decision. It can give evidence-based health guidance which can be adjusted to account for individual risk factors and reflects a patient's own values and preferences concerning health outcomes. Future decision aids and support systems need to be developed and evaluated in a way which takes account of the variation in patients' preferences for inclusion in the decision making process.

Adult↗
PubMed2004

Cost-effectiveness analysis of carvedilol for the treatment of chronic heart failure in Japan.

BACKGROUND: The cost-effectiveness of beta-blocker use in patients with chronic heart failure (CHF) has never been elucidated in a Japanese study. METHODS AND RESULTS: A Markov model for outpatients with CHF was constructed to simulate remaining life expectancy and expected medical costs for each patient. Each patient was assumed that they received either carvedilol in addition to conventional therapies (ie, digitalis, diuretics, and angiotensin-converting enzyme inhibitors) or conventional therapies alone. Analyses were conducted both for each patient's remaining lifetime and for a period of 5 years. Analyses were performed from the perspective of Japanese healthcare insurance. Analysis for treatment over the course of each patient's expected life span with carvedilol plus conventional therapies versus conventional therapies alone yielded expected medical costs of 3.5 million yen and 5.5 million yen respectively, and a life expectancy of 121 months and 88 months, respectively. The analysis of a 5-year period yielded 1.4 million yen and 2.8 million yen in expected medical costs and 49 and 45 months life expectancy, respectively, for carvedilol versus conventional therapy. CONCLUSIONS: Carvedilol treatment for CHF patients is a highly cost-effective method of therapy in the Japanese medical environment.

Adrenergic beta-Antagonists↗
PubMed2002

Decision-tree sensitivity analysis for cost-effectiveness of whole-body FDG PET in the management of patients with non-small-cell lung carcinoma in Japan.

BACKGROUND: Whole-body 2-fluoro-2-D-[18F]deoxyglucose [FDG] positron emission tomography (WB-PET) may be more cost-effective than chest PET because WB-PET does not require conventional imaging (CI) for extrathoracic staging. METHODS: The cost-effectiveness of WB-PET for the management of Japanese patients with non-small-cell lung carcinoma (NSCLC) was assessed. Decision-tree sensitivity analysis was designed, based on the two competing strategies of WB-PET vs. CI. WB-PET was assumed to have a sensitivity and specificity for detecting metastases, of 90% to 100% and CI of 80% to 90%. The prevalences of M1 disease were 34% and 20%. One thousand patients suspected of having NSCLC were simulated in each strategy. We surveyed the relevant literature for the choice of variables. Expected cost saving (CS) and expected life expectancy (LE) for NSCLC patients were calculated. RESULTS: The WB-PET strategy yielded an expected CS of $951 US to $1,493US per patient and an expected LE of minus 0.0246 years to minus 0.0136 years per patient for the 71.4% NSCLC and 34% M1 disease prevalence at our hospital. PET avoided unnecessary bronchoscopies and thoracotomies for incurable and benign diseases. Overall, the CS for each patient was $833US to $2,010US at NSCLC prevalences ranging from 10% to 90%. The LE of the WB-PET strategy was similar to that of the CI strategy. The CS and LE minimally varied in the two situations of 34% and 20% M1 disease prevalence. CONCLUSIONS: The introduction of a WB-PET strategy in place of CI for managing NSCLC patients is potentially cost-effective in Japan.

Algorithms↗