Health-economic evaluation of meniscus tear treatments: a systematic review

PURPOSE

To evaluate the overall evidence of published health-economic evaluation studies on meniscus tear treatment.

METHODS

Our systematic review focuses on health-economic evaluation studies of meniscus tear treatment interventions found in PubMed and Embase databases. A qualitative, descriptive approach was used to analyze the studies' results and systematically report them following PRISMA guidelines. The health-economic evaluation method for each included study was categorized following one of the four approaches: partial economic evaluation (PEE), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA), or cost-utility analysis (CUA). The quality of each included study was assessed using the Consensus on Health Economic Criteria (CHEC) list. Comparisons of input variables and outcomes were made, if applicable.

RESULTS

Sixteen studies were included; of these, six studies performed PEE, seven studies CUA, two studies CEA, and one study combined CBA, CUA, and CEA. The following economic comparisons were analyzed and showed the respective comparative outcomes: (1) meniscus repair was more cost-effective than arthroscopic partial meniscectomy (meniscectomy) for reparable meniscus tear; (2) non-operative treatment or physical therapy was less costly than meniscectomy for degenerative meniscus tear; (3) physical therapy with delayed meniscectomy was more cost-effective than early meniscectomy for meniscus tear with knee osteoarthritis; (4) meniscectomy without physical therapy was less costly than meniscectomy with physical therapy; (5) meniscectomy was more cost-effective than either meniscus allograft transplantation or meniscus scaffold procedure; (6) the conventional arthroscopic instrument cost was lower than laser-assisted arthroscopy in meniscectomy procedures.

CONCLUSION

Results from this review suggest that meniscus repair is the most cost-effective intervention for reparable meniscus tears. Physical therapy followed by delayed meniscectomy is the most cost-effective intervention for degenerative meniscus tears. Meniscus scaffold should be avoided, especially when implemented on a large scale.

LEVEL OF EVIDENCE

Systematic review of level IV studies.

Car-borne survey and dose assessment from external radiation exposure in Bangka Island

With a history of more than 200 years of tin mining, Bangka Island has brought along a byproduct of heavy minerals containing radionuclide elements. There are some concerns about this byproduct material contributing to natural radiation in the environment. In this study, a car-borne survey was conducted to accurately assess natural background radiation in Bangka Island. Indoor and outdoor ambient dose rates in 146 houses were also measured to assess the radiation dose from external exposure received by the public. Soil samples were collected and measured using a gamma spectroscopy system to evaluate the contributions of specific radionuclides to external terrestrial exposure. From 3790 measurement points during the car-borne survey, the highest ambient dose equivalent rate was 596 nSv h-1 measured in Muntok area, with a mean value of 101 nSv h-1 and a median value of 95 nSv h-1. The ambient dose equivalent rate distribution map showed a relatively higher value in the northern coastal area of the island, where the Pemali tin deposit is located. The annual effective dose received from external radiation in the 146 houses in Bangka Island ranged from 0.44 to 1.30 mSv year-1, with a median value of 0.66 mSv year-1. The soil contained a relatively high amount of thorium (232Th), which contributed 69% to external radiation exposure in Bangka Island.

Clinical pharmacy services for tuberculosis management: a systematic review

Objective: This study aims to systematically review the content and potential effects of clinical pharmacy services in tuberculosis (TB) care management. Methods: Searches were performed in PubMed, Embase, Cochrane, Scopus, and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Study characteristics and outcomes were extracted, and clinical pharmacy service components were characterized using the Descriptive Elements of Pharmacist Intervention Characterization Tool. Results: Twenty articles were included for full-text assessment, of which 10 fulfilled inclusion criteria, comprising 1,168 patients (N = 39 to 258 per study). These articles included five prospective cohort studies, two case-control studies, two quasi-experimental studies, and one cross-sectional study. Intervention foci within clinical pharmacy services were medication adherence (50%), medication safety (40%), education to patients/caregivers regarding needs/beliefs (30%), optimizing medication/therapy effectiveness (30%), emphasizing HRQoL (10%), and drug selections (10%). The three most frequently applied interventions were drug information/patient counseling (80%), adverse drug reaction monitoring (50%), and drug use evaluation (20%). Based on the World Health Organization (WHO) outcome classification, treatment success ranged from 72% to 93%, with higher cure outcomes (53%-86%) than treatment completion (7%-19%). Other outcomes, including isoniazid metabolites, medication counts, sputum conversion, adherence/compliance, knowledge, and quality of life, were better in the intervention group than those in comparator groups, and/or they improved over time. Risk of bias analysis indicated that the included studies were not comparable to a randomized clinical trial. Conclusion: Clinical pharmacy services as single or composite interventions potentially improve TB outcomes, but its evidence is still inconsistent and limited due to the lack of randomized controlled studies using the WHO outcome classification. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=199028, identifier CRD42020199028.

A unique high natural background radiation area - Dose assessment and perspectives

The biological effects of low dose-rate radiation exposures on humans remains unknown. In fact, the Japanese nation still struggles with this issue after the Fukushima Dai-ichi Nuclear Power Plant accident. Recently, we have found a unique area in Indonesia where naturally high radiation levels are present, resulting in chronic low dose-rate radiation exposures. We aimed to estimate the comprehensive dose due to internal and external exposures at the particularly high natural radiation area, and to discuss the enhancement mechanism of radon. A car-borne survey was conducted to estimate the external doses from terrestrial radiation. Indoor radon measurements were made in 47 dwellings over three to five months, covering the two typical seasons, to estimate the internal doses. Atmospheric radon gases were simultaneously collected at several heights to evaluate the vertical distribution. The absorbed dose rates in air in the study area vary widely between 50 nGy h^-1 and 1109 nGy h^-1. Indoor radon concentrations ranged from 124 Bq m^-3 to 1015 Bq m^-3. That is, the indoor radon concentrations measured exceed the reference levels of 100 Bq m^-3 recommended by the World Health Organization. Furthermore, the outdoor radon concentrations measured were comparable to the high indoor radon concentrations. The annual effective dose due to external and internal exposures in the study area was estimated to be 27 mSv using the median values. It was found that many residents are receiving radiation exposure from natural radionuclides over the dose limit for occupational exposure to radiation workers. This enhanced outdoor radon concentration might be as a result of the stable atmospheric conditions generated at an exceptionally low altitude. Our findings suggest that this area provides a unique opportunity to conduct an epidemiological study related to health effects due to chronic low dose-rate radiation exposure.

RADON CONCENTRATIONS IN DWELLING OF SOUTH KALIMANTAN, INDONESIA

Determination radon concentrations in dwelling in South of Kalimantan Province by using a passive method had been conducted. South Kalimantan is a province in Indonesia and also known as a coal mining area which has the potential for internal exposure of Naturally Occurring Radioactive Materials (NORM) to the human. The research area divided into several sections called grid. Each grid represents a 60 km × 60 km area that installed passive radon monitoring 10 population. Passive radon monitors installed in the dwelling with exposures time approximately 3-4 months and then radon monitors were collected and brought to the laboratory for processing and then read the track to calculate the radon concentrations. The data concentrations of radon in the dwelling and GPS location as an input to the make a map of radon concentration by using MapInfo Software v.10.5. The results of the analysis of the concentration of radon in the dwelling of South Kalimantan in the ranged 3.1 ± 0.2 Bq m-3 up to 94.0 ± 6.7 Bq m-3. The result was lower than the reference level radon set by UNSCEAR was 300 Bq m-3. These data are useful in the development plans and regional development, as well as the basis for health policy analysis due to radon in Indonesia. Furthermore, these data will be the contribution of Indonesia in the international world through UNSCEAR, IAEA and WHO. The data obtained as an input in making a map of the concentration of radon in houses of Kalimantan Selatan as part of the map of the concentration of radon in Indonesia.

Health Risk Implications of Terrestrial Gamma Radiation Dose Rate in Central Jakarta, Indonesia: Short Communications

Terrestrial gamma radiation dose (TGRD) rate measurement has been conducted around downtown region of Central Jakarta Indonesia. The real time count data was taken 1 m above the ground in eight sub district locations by using a portable gamma Surveymeter of Exploranium GR-135 Plus Model. The reading position was detemined using  Garmin GPSMAP 62s. The average value of TGRD rate of  (47.76 ± 18.24) nSv h-1 ranged from 6.40 nSv h-1 to 120.90 nSv-1, it is higher than Indonesia. The annual effective dose rate of 0.058 mSv. Its  contributes to fatal cancer risk of about  3.22 x 10-5 per year for each individual in Central Jakarta. For the subdistrict TGRD rate value was variated, however all the result is not high enough to cause for alarm.

The transport mechanisms of 222Rn in soil at Tateishi as an anomaly spot in Japan

The (222)Rn concentration profiles in soil have been measured at an anomaly spot in Tateishi, Japan. In winter, the concentrations were low and showed a negative gradient with depth, but in other seasons, the concentration had both positive and negative gradients with depth, and dramatically changed by time. On the assumption that there was ventilation in deep layers and with driving forces of wind and temperatures, these phenomena were successfully explained. This finding would contribute to a numerical model for (222)Rn transport in soil.

Quantification of the dependency of radon emanation power on soil temperature

A study on the quantification of the dependency of the radon emanation power on soil temperature has been made using the accumulation method. The emanation from dry soil was studied at temperatures between -20 degrees C and 45 degrees C. A formula to calculate the radon emanation power as a function of the temperatures has been developed. The formula would contribute to the modeling of radon transport in soils and building materials.

Molecular systematics and biogeography of the fanged frogs of Southeast Asia

Our analysis of parts of the mitochondrial ribosomal 12S and 16S genes from 39 populations of Southeast Asian ranid frogs confirms that the fanged frogs are a monophyletic clade. This group, properly called Limnonectes, appears to have arisen in the early Tertiary at a time when free faunal exchange was possible among Southeast Asia, Borneo, Sumatra, Java, and, probably, Sulawesi. Four species groups are tentatively identified within the clade. Part of group 1 includes species related to L. kuhlii that occur in Borneo. Another part of group 1 includes species from Malay Peninsula and Thailand that are related to L. pileata. Species group 2, L. leporina, occurs only in Borneo. Species group 3 is restricted to species distributed in Sulawesi and the Philippines. Species group 4 includes L. blythii and relatives. There is a lack of compatibility between phylogenetic hypotheses generated from molecular and morphological data sets. These differences are related, in large part, to whether some species of Limnonectes have secondarily lost fangs or whether lack of fangs represents the primitive condition.

[Electrophoretic variability in a total of 11 structural sites in murine rodents (Muridae, Rodentia)]

Forty-six rodent species of the Muridae family were submitted to sequential electrophoresis for the study of 11 protein loci, using 12 buffer systems which differed in pH and ionic composition. The complete set of electrophoretic conditions yielded 135 variants of which 68 were detected through a single condition. The twofold increase of revealed variants was essentially limited to intergeneric comparisons because few additional variants within genera were revealed, despite the use of several buffers. These results show that estimation of the degree of genetic differentiation among taxa at a higher level than that of the genus by standard electrophoretic data may, although of current use, lead to erroneous results.