Economic evaluations of interventions against influenza at workplaces: systematic review

BACKGROUND

The burden of influenza is mostly felt by employees and employers because of increased absenteeism rates, loss of productivity and associated direct costs. Even though interventions against influenza among working adults are effective, patronage and compliance to these measures especially vaccination are low compared to other risk groups.

AIMS

This study was aimed to assess evidence of economic evaluations of interventions against influenza virus infection among workers or in the workplace setting.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline for systematic reviews was followed. Three databases, PubMed, Web of Science and EconLit, were searched using keywords to identify relevant articles from inception till 25 October 2020. Original peer-reviewed papers that conducted economic evaluations of influenza interventions using cost-benefit, cost-effectiveness or cost-utility analysis methods focused on working-age adults or work settings were eligible for inclusion. Two independent teams of co-authors extracted and synthesized data from identified studies.

RESULTS

Twenty-four articles were included: 21 were cost-benefit analyses and 3 examined cost-effectiveness analyses. Two papers also presented additional cost-utility analysis. Most of the studies were pharmaceutical interventions (n = 23) primarily focused on vaccination programs while one study was a non-pharmaceutical intervention examining the benefit of paid sick leave. All but two studies reported that interventions against influenza virus infection at the workplace were cost-saving and cost-effective regardless of the analytic approach.

CONCLUSIONS

Further cost-effectiveness research in non-pharmaceutical interventions against influenza in workplace settings is warranted. There is a need to develop standardized methods for reporting economic evaluation methods to ensure comparability and applicability of future research findings.

Point-of-care N-terminal pro B-type natriuretic peptide assay to screen apparently healthy cats for cardiac disease in general practice

Background

Point‐of‐care (POC) N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) ELISA test has been evaluated for screening cats for cardiac disease in the referral veterinary setting but less is known about its use in general practice (GP).

Objectives

To evaluate the diagnostic utility of a POC NT‐proBNP ELISA in cats seen in GPs.

Animals

Two hundred and seventeen apparently healthy cats from 21 GPs.

Methods

This was a prospective, cross‐sectional study. Cardiac auscultation and POC NT‐proBNP ELISA were done by veterinarians at their GPs. After enrollment at GPs, cats were sent to a cardiology referral hospital for cardiac auscultation and echocardiographic diagnosis. Results were interpreted based on whether cats had normal or abnormal echocardiographic findings.

Results

Point‐of‐care NT‐proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 43%, specificity of 96%. In cats with a heart murmur at GPs, POC NT‐proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 71% and a specificity of 92%.

Conclusion and Clinical Importance

In apparently healthy cats in GPs, positive POC NT‐proBNP results are associated with heart disease, warranting an echocardiogram, but negative results do not reliably exclude heart disease. These results suggest POC NT‐proBNP is not an effective screening test for apparently healthy cats in GPs, although its performance is improved if it is used only in cats that have a heart murmur.

Validation of finger test for necrotising soft tissue infection

Background:

Necrotising soft tissue infection (NSTI) is rare but fatal. Andreasen proposed finger test as an early diagnostic tool to differentiate NSTI from other soft tissue infections. We aim to evaluate the accuracy and reproducibility of the test for the diagnosis of NSTI.

Methods:

Patients who were admitted to our department from 2012 to 2016 with suspicion of NSTI and finger test done were retrospectively reviewed. Finger test was done and interpreted as described by Andreasen. Definitive diagnosis of NSTI was confirmed with surgical and pathological findings.

Results:

Among the 35 patients included in the study, NSTI was confirmed in 10 cases. Finger test had a sensitivity of 100%, a specificity of 80%, positive predictive value of 66.7%, negative predictive value of 100% and an overall accuracy of 85.7%. There was no difference in demographics or comorbidities between NSTI and non-NSTI groups. Surgeons involved had 76.7% agreement and moderate reproducibility (kappa = 0.48) on the diagnostic criteria of finger test.

Conclusion:

A negative finger test was reliable to exclude NSTI and a positive test suggested further surgical exploration. Yet, clinical judgement was still of paramount importance to treat NSTI promptly.

Long-term incidence and risk of noncardiovascular and all-cause mortality in apparently healthy cats and cats with preclinical hypertrophic cardiomyopathy

Background

Epidemiologic knowledge regarding noncardiovascular and all‐cause mortality in apparently healthy cats (AH) and cats with preclinical hypertrophic cardiomyopathy (pHCM) is limited, hindering development of evidence‐based healthcare guidelines.

Objectives

To characterize/compare incidence rates, risk, and survival associated with noncardiovascular and all‐cause mortality in AH and pHCM cats.

Animals

A total of 1730 client‐owned cats (722 AH, 1008 pHCM) from 21 countries.

Methods

Retrospective, multicenter, longitudinal, cohort study. Long‐term health data were extracted by medical record review and owner/referring veterinarian interviews.

Results

Noncardiovascular death occurred in 534 (30.9%) of 1730 cats observed up to 15.2 years. Proportion of noncardiovascular death did not differ significantly between cats that at study enrollment were AH or had pHCM (P = .48). Cancer, chronic kidney disease, and conditions characterized by chronic weight‐loss‐vomiting‐diarrhea‐anorexia were the most frequently recorded noncardiovascular causes of death. Incidence rates/risk of noncardiac death increased with age in AH and pHCM. All‐cause death proportions were greater in pHCM than AH (65% versus 40%, respectively; P < .001) because of higher cardiovascular mortality in pHCM cats. Comparing AH with pHCM, median survival (study entry to noncardiovascular death) did not differ (AH, 9.8 years; pHCM, 8.6 years; P = .10), but all‐cause survival was significantly shorter in pHCM (P = .0001).

Conclusions and Clinical Importance

All‐cause mortality was significantly greater in pHCM cats due to disease burden contributed by increased cardiovascular death superimposed upon noncardiovascular death.

Total knee arthroplasty in a knee with triple deformity of femur-tibia-extensor mechanism

By analyzing a case of total knee arthroplasty (TKA) in a knee with complex deformity and secondary osteoarthritis, we demonstrated the rationale of preoperative planning and the detail of intraoperative execution. The lady had right TKA with combined medial closing wedge femoral osteotomy, neutral wedge valgus derotational tibial osteotomy, fibular osteotomy, and quadriceplasty. Four months later, she had left TKA. Osteotomies healed well and she was pain-free at 18 months after right TKA. Combination of intra-articular and extra-articular correction of deformity was the key to achieve a well-aligned TKA with good soft tissue balancing in both coronal and sagittal planes. The choice of osteotomy fixation method should follow the principles of bone healing. Fibular osteotomy should have been made at the level of tibial osteotomy with caution. Use of appropriate TKA prosthesis could have enhanced the osteotomy fixation while decreasing the complication.

International collaborative study to assess cardiovascular risk and evaluate long-term health in cats with preclinical hypertrophic cardiomyopathy and apparently healthy cats: The REVEAL Study

Background

Hypertrophic cardiomyopathy is the most prevalent heart disorder in cats and principal cause of cardiovascular morbidity and mortality. Yet, the impact of preclinical disease is unresolved.

Hypothesis/Objectives

Observational study to characterize cardiovascular morbidity and survival in cats with preclinical nonobstructive (HCM) and obstructive (HOCM) hypertrophic cardiomyopathy and in apparently healthy cats (AH).

Animals

One thousand seven hundred and thirty client‐owned cats (430 preclinical HCM; 578 preclinical HOCM; 722 AH).

Methods

Retrospective multicenter, longitudinal, cohort study. Cats from 21 countries were followed through medical record review and owner or referring veterinarian interviews. Data were analyzed to compare long‐term outcomes, incidence, and risk for congestive heart failure (CHF), arterial thromboembolism (ATE), and cardiovascular death.

Results

During the study period, CHF, ATE, or both occurred in 30.5% and cardiovascular death in 27.9% of 1008 HCM/HOCM cats. Risk assessed at 1, 5, and 10 years after study entry was 7.0%/3.5%, 19.9%/9.7%, and 23.9%/11.3% for CHF/ATE, and 6.7%, 22.8%, and 28.3% for cardiovascular death, respectively. There were no statistically significant differences between HOCM compared with HCM for cardiovascular morbidity or mortality, time from diagnosis to development of morbidity, or cardiovascular survival. Cats that developed cardiovascular morbidity had short survival (mean ± standard deviation, 1.3 ± 1.7 years). Overall, prolonged longevity was recorded in a minority of preclinical HCM/HOCM cats with 10% reaching 9‐15 years.

Conclusions and Clinical Importance

Preclinical HCM/HOCM is a global health problem of cats that carries substantial risk for CHF, ATE, and cardiovascular death. This finding underscores the need to identify therapies and monitoring strategies that decrease morbidity and mortality.

Prevalence and epidemiology of canine and feline heartworm infection in Taiwan

Background

Heartworm, Dirofilaria immitis, has long been recognized in Taiwanese dogs but feline heartworm infection has been largely overlooked by veterinarians and pet owners. The main goal of this study was to determine the prevalence and epidemiology of canine and feline heartworm infection in Taiwan.

Methods

Household dogs and cats were selected from 103 veterinary hospitals in 13 cities throughout Taiwan. All animals were at least 1 year old, had received no heartworm prevention for more than 1 year, and had lived in the same city for at least 1 year. Client consent was obtained and an owner questionnaire was completed for each patient. Blood samples were collected from each canine patient and tested at each veterinary hospital for microfilariae and for circulating antigen. A positive result on either test was considered to confirm mature heartworm infection. Blood was collected from each feline patient and examined for microfilariae and a feline heartworm antigen/antibody test was performed. Descriptive statistics were used for heartworm prevalence. Multivariate logistic regression analysis was used to determine the relationships between heartworm infection and multiple risk factors.

Results

A total of 2064 household dogs and 616 household cats from 103 veterinary hospitals throughout Taiwan were included in the study. The overall prevalence of canine heartworm disease was 22.8% (471/2064). In heartworm-positive dogs, 63% were both microfilaria positive and antigen positive, 35% were microfilaria negative and antigen positive, and only 2% were microfilaria positive and antigen negative. In the comparison of different life style groups, outdoor dogs (N = 797) had significantly higher heartworm prevalence rate than indoor dogs (N = 1267; p = 0.000). The heartworm prevalence rate in dogs presented with dyspnea and cough was as high as 51%. The overall prevalence of antibody-positive cats was 6.7% (41/616) and the antigen-positive prevalence rate was 3.1% (19/616). In 41 antibody-positive cats, 6 of them were also antigen-positive. In 19 antigen-positive cats, 13 of them were antibody negative. In antibody-positive and antigen-negative cats, half had no clinical signs. In antigen-positive cats, 21% had no clinical signs and only 38% had classic heartworm clinical signs (dyspnea, cough, or gastrointestinal signs).

Conclusions

Our canine study showed that southern and eastern Taiwan have the highest heartworm prevalence. Dogs not receiving preventive and living outdoors or those that have either cough or dyspnea have a high incidence of heartworm infection. We also confirmed that feline heartworm exposure exists in most cities in Taiwan. The diagnosis of feline heartworm infection will remain challenging for clinicians, however, without a consistent relationship between the presence of heartworm infection and clinical signs and the vagaries of microfilaria and antigen/antibody testing.

Electronic supplementary material

The online version of this article (10.1186/s13071-017-2435-7) contains supplementary material, which is available to authorized users.

Mechanism and epidemiology of paediatric finger injuries at Prince of Wales Hospital in Hong Kong

OBJECTIVES

To determine the mechanism and epidemiology of paediatric finger injuries in Hong Kong during 2003-2005 and 2010-2012.

DESIGN

Comparison of two case series.

SETTING

University-affiliated teaching hospital, Hong Kong.

PATIENTS

This was a retrospective study of two cohorts of children (age, 0 to 16 years) admitted to Prince of Wales Hospital with finger injuries during two 3-year periods. Comparisons were made between the two groups for age, involved finger(s), mechanism of injury, treatment, and outcome. Telephone interviews were conducted for parents of children who sustained a crushing injury of finger(s) by door.

RESULTS

A total of 137 children (group A) were admitted from 1 January 2003 to 31 December 2005, and 109 children (group B) were admitted from 1 January 2010 to 31 December 2012. Overall, the mechanisms and epidemiology of paediatric finger injuries were similar between groups A and B. Most finger injuries occurred in children younger than 5 years (group A, 56%; group B, 76%) and in their home (group A, 67%; group B, 69%). The most common mechanism was crushing injury of finger by door (group A, 33%; group B, 41%) on the hinge side (group A, 63%; group B, 64%). The right hand was most commonly involved. The door was often closed by another child (group A, 37%; group B, 23%) and the injury often occurred in the presence of adults (group A, 60%; group B, 56%). Nailbed injury was the commonest type of injury (group A, 31%; group B, 39%). Fractures occurred in 24% and 23% in groups A and B, respectively. Traumatic finger amputation requiring replantation or revascularisation occurred in 12% and 10% in groups A and B, respectively.

CONCLUSIONS

Crushing injury of finger by door is the most common mechanism of injury among younger children and accounts for a large number of hospital admissions. Serious injuries, such as amputations leading to considerable morbidity, can result. Crushing injury of finger by door occurs even in the presence of adults. There has been no significant decrease in the number of crushing injuries of finger by door in the 5 years between the two studies despite easily available and affordable preventive measures. It is the authors' view that measures aimed at promoting public awareness and education, and safety precautions are needed.

Local review of treatment of hand enchondroma (artificial bone substitute versus autologous bone graft) in a tertiary referral centre: 13 years' experience

OBJECTIVE

To evaluate the treatment outcomes of enchondroma of the hand with artificial bone substitute versus autologous (iliac) bone graft.

DESIGN

Historical cohort study.

SETTING

Tertiary referral centre, Hong Kong.

PATIENTS

A total of 24 patients with hand enchondroma from January 2001 to December 2013 who underwent operation at the Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital in Hong Kong were reviewed. Thorough curettage of the tumour was performed in all patients, followed by either autologous bone graft impaction under general anaesthesia in 13 patients, or artificial bone substitute in 11 patients (10 procedures were performed under local or regional anaesthesia and 1 was done under general anaesthesia). The functional outcomes and bone incorporation were measured by QuickDASH (shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire) scores and radiological appearance, respectively. The mean follow-up period was 59 months.

RESULTS

There were eight men and 16 women, with a mean age of 40 years. Overall, 17 cases involved phalangeal bones and seven involved metacarpal bones. Among both groups of patients, most of the affected digits had good range of motion and function after surgery. One patient in each study group had complications of local soft tissue inflammation. One patient in the artificial bone substitute group was suspected to have recurrence 8 years after operation. Among the autologous bone graft group, four patients had persistent donor site morbidity at the last follow-up. In all patients, radiographs showed satisfactory bone incorporation.

CONCLUSIONS

Artificial bone substitute is a safe and effective treatment option for hand enchondroma, with satisfactory functional and radiographic outcomes. Artificial bone substitute offers the additional benefits of enabling the procedure to be done under local anaesthesia on a day-case basis with minimal complications.

Surgical excision for challenging upper limb nerve sheath tumours: a single centre retrospective review of treatment results

OBJECTIVE

To review the accuracy of different investigation modalities for upper limb nerve sheath tumours and the resulting surgical outcomes, and propose a standard algorithm to deal with such tumours to minimise complications.

DESIGN

Retrospective review.

SETTING

Regional hospital, Hong Kong.

PATIENTS

All patients with upper limb nerve sheath tumours being excised in our hospital from 1999 to 2008.

MAIN OUTCOME MEASURES

The accuracy rate of different investigations, as well as corresponding neurological deficits after excision and recurrence rates.

RESULTS

A total of 23 (10 male and 13 female) patients, aged between 28 and 72 (mean, 46) years, underwent excision of 25 lesions during the study period. The mean duration of symptom was 2.5 years and tumour size ranged from 1 to 10.5 cm (mean, 2.6 cm). A majority (80%) presented with a typical triad; only one had a true neurological deficit. Twenty-two ultrasonography and 20 magnetic resonance images were obtained, with a diagnostic accuracy of 77% and 100%, respectively. Eight fine-needle aspiration cytology examinations and two core biopsies were performed, which had respective accuracy rates of 13% and 100%. Fifteen patients experienced neurological deficits after the operation; three showed spontaneous recovery. Among 12 patients with long-term residual neurological sequelae, five had both motor and sensory deficits and four had moderate-to-severe disability. No recurrence was reported.

CONCLUSION

Nerve sheath tumours in the hand need to be managed with care. Among the different investigation modalities, magnetic resonance imaging was considered to be the gold standard. Yet ultrasonography is still the most easily accessible and least invasive investigation in public hospital setting. Complications are liable to ensue even if patients are managed by hand specialists. Thus, well-planned operations and detailed discussions with the patient are important prerequisites before operation.

90Y-labeled monoclonal antibodies for cancer therapy

Monoclonal antibody 17-1A, which has specificity for colorectal carcinoma, was labeled with 90Y (10-20% radiolabeling yield). Tissue distribution studies in tumor-bearing nude mice were carried out. 90Y-labeled 17-1A showed good uptake in the SW 948 colon carcinoma cell line. However, 90Y-labeled A5C3, a monoclonal antihepatitis virus antibody studied as a control, showed similar uptake in this tumor. Neither antibody was taken up well by a WM-9 melanoma. It is believed that the loss of specificity observed is due to the low specific activity of the 90Y-labeled monoclonal antibody preparations used. This hypothesis is supported by radioimmunoassay data.