“
“Background: Socioeconomic disadvantage is known to prejudice certain health-related outcomes.
Methods: Our objective
was to establish whether adverse social circumstances are linked to rejection events after pediatric cardiac transplant in a UK context. A retrospective observational cohort study was conducted including 78 of 85 children who underwent cardiac transplantation between 2001 and 2005.
Results: Family social circumstances included: 36 (46%) unemployed/manual occupation; 29 (37%) non-homeowners; 16 (21%) single parents; income-support in 31 (40%); and 2 or more further children in 34 (44%). Adverse social risk factors were evenly distributed throughout the cohort in terms of other demographic AZD5153 cost variables. The rate for a first rejection event was 0.10 (95% confidence interval [CI] 0.07 to 0.15) episode per patient per year, and for late rejection was 0.04 (95% CI 0.02 to 0.07) episode per patient per year. There was some evidence that children from non-home-owning families (hazard ratio[HR] 0.31, 95% CI 0.11 to 0.82, p = 0.02) and those on income support (HR 0.43, 95% CI
0.18 to 1.04, p = 0.06) had reduced risk of early/all first-time rejection episodes. Other social risk factors were unrelated to early rejection. No relationship was found between any social selleckchem factor and late rejection episodes or low immunosuppression levels at clinic visits 3, 6 or 12 months post-transplant.
Conclusions: Children from more adverse circumstances were not predisposed to rejection episodes. To date, there is no evidence to support a policy of declining children for transplantation on psychosocial grounds in the UK. J Heart Lung Transplant 2009;28:1267-72. Copyright (C) 2009 by the International Society for Heart and Lung Transplantation.”
“There is an inevitable tension between robust reimbursement processes and providing speedy access to new and novel technologies, given uncertainties about key pieces of evidence and subsequent concerns regarding their overall efficiency. The public perception
of these treatments as ‘break-through’, combined with substantial clinical pressure, has led to healthcare payers looking for schemes that allow the new technology to be made available AG-881 in vitro to (some) patients, while (at least partially) protecting the principles of their reimbursement decision-making processes. Current literature on these schemes is almost completely descriptive and provides little help in planning future schemes. We propose a framework for evaluating current schemes and informing the design of future schemes. We examine the value of the framework using the UK Multiple Sclerosis Risk-Sharing Scheme as a case study.”
“Background: The preferred treatment of type-II supracondylar humeral fractures remains controversial.
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