Juliane Köberlein

The economic burden of visual impairment and blindness: a systematic review

Objectives Visual impairment and blindness (VI&B) cause a considerable and increasing economic burden in all high-income countries due to population ageing. Thus, we conducted a review of the literature to better understand all relevant costs associated with VI&B and to develop a multiperspective overview. Design Systematic review: Two independent reviewers searched the relevant literature and assessed the studies for inclusion and exclusion criteria as well as quality. Eligibility criteria for included studies Interventional, non-interventional and cost of illness studies, conducted prior to May 2012, investigating direct and indirect costs as well as intangible effects related to visual impairment and blindness were included. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement approach to identify the relevant studies. A meta-analysis was not performed due to the variability of the reported cost categories and varying definition of visual impairment. Results A total of 22 studies were included. Hospitalisation and use of medical services around diagnosis and treatment at the onset of VI&B were the largest contributor to direct medical costs. The mean annual expenses per patient were found to be US

Determinants of patient compliance in allergic rhinoconjunctivitis.

purchasing power parities (PPP) 12 175–14 029 for moderate visual impairment, US

Quality of life in patients with idiopathic sudden hearing loss: comparison of different therapies using the Medical Outcome Short Form (36) Health Survey questionnaire.

PPP 13 154–16 321 for severe visual impairment and US

General practitioners’ views on polypharmacy and its consequences for patient health care

PPP 14 882–24 180 for blindness, almost twofold the costs for non-blind patients. Informal care was the major contributor to other direct costs, with the time spent by caregivers increasing from 5.8 h/week (or US

Oralair(®): a causal treatment for grass pollen-induced allergic rhinoconjunctivitis.

PPP 263) for persons with vision >20/32 up to 94.1 h/week (or US

The Effectiveness of Modern Antihistamines for Treatment of Allergic Rhinitis - An IPD Meta-Analysis of 140,853 Patients

PPP 55 062) for persons with vision ≤20/250. VI&B caused considerable indirect costs due to productivity losses, premature mortality and dead-weight losses. Conclusions VI&B cause a considerable economic burden for affected persons, their caregivers and society at large, which increases with the degree of visual impairment. This review provides insight into the distribution of costs and the economic impact of VI&B.

What explains DRG upcoding in neonatology? The roles of financial incentives and infant health

Purpose of reviewNoncompliance to the prescribed therapeutic regimen is a worldwide problem, especially for diseases in which symptoms can vary with different patient factors and with seasons. The consequences are poor health outcomes, progression of disease and increased healthcare costs. Reviews conducted across countries and addressing different diseases are consistent in estimating noncompliance between 30 and 50%. To implement strategies and interventions that enhance compliance, a comprehensive analysis of its determinants is essential. Recent findingsLack of efficacy was reported as the number one reason for discontinuing the intake of medications prescribed for nasal allergies. Studies on glucocorticosteroids, allergen-specific immunotherapy and antihistamines highlighted the importance of patient education, demographic factors, duration of therapy, side-effects and treatment costs, as well as minor details, such as taste and odour, in improving compliance. SummaryThe variation in the methodologies used and the durations of treatments assessed in current compliance research in the field of allergic rhinoconjunctivitis decreases the comparability of results. Therefore, a clear definition of compliance measured in clinical trials with allergic rhinoconjunctivitis sufferers is needed. Moreover, a gold standard for measuring and reporting compliance should be determined to enable better interstudy comparability of the rates and determinants of compliance.

Determining factors of patient compliance to treatment in allergic rhinitis

Background Cause and underlying pathogenic mechanisms of idiopathic sudden hearing loss (ISHL) are not fully understood, resulting in the widespread use of different polypragmatic treatment approaches, which have not been finally validated in randomized controlled trials. Quality of life (QoL) can provide helpful additional information when selecting the most appropriate therapy within current options. Methods In a prospective, multicenter, randomized, controlled clinical study, Rheopheresis-a method of therapeutic apheresis-was compared with a standard therapy consisting of either intravenous corticosteroids or hemodilution using pure-tone and speech audiometry. Quality of life as secondary outcome parameter was documented using the German Medical Outcome Short Form (36) Health Survey questionnaire. Results Two hundred forty patients were included in this trial. All three treatment options proved to be of equal efficacy regarding absolute and relative hearing gain or speech discrimination. Quality of life measured in Medical Outcome Short Form (36) Health Survey scores was less than the level of the normal German population at baseline for all groups, and mentally, ISHL patients felt more impaired than patients who have chronic hearing impairment. Rheopheresis treatment led to a higher QoL at the time of the follow-up visit compared with the drug-based therapies and compared with a large representative sample of the German general population. Discussion Treatments leading to accelerated recovery in combination with a minimal number of therapeutic interventions, for example, Rheopheresis, seemed to have a considerable effect on QoL. Because there is a dearth of evidence of efficacy for any treatment option in ISHL, QoL can provide additional information when choosing the most appropriate treatment option.

First Do No Harm, Then Do Not Cheat: DRG Upcoding in German Neonatology

BackgroundMultimorbidity is defined as suffering from coexistent chronic conditions. Multimorbid patients demand highly complex patient-centered care which often includes polypharmacy, taking an average of six different drugs per day. Adverse drug reactions, adverse drug events and medication errors are all potential consequences of polypharmacy. Our study aims to detect the status quo of the health care situation in Saxony’s general practices for multimorbid patients receiving multiple medications. We will identify the most common clinical profiles as well as documented adverse drug events and reactions that occur during the treatment of patients receiving multiple medications. We will focus on exploring the motives of general practitioners for the prescription of selected drugs in individual cases where there is evidence of potential drug-drug-interactions and potentially inappropriate medications in elderly patients. Furthermore, the study will explore general practitioners’ opinions on delegation of skills to other health professions to support medical care and monitoring of patients receiving multiple medications.Methods/designThis is a retrospective cross sectional study using mixed methods. Socio-demographic data as well as diagnoses, medication regimens and clinically important events will be analyzed retrospectively using general practitioners documentation in patients’ records. Based on these data, short vignettes will be generated and discussed by general practitioners in qualitative telephone interviews.DiscussionTo be able to improve outpatient health care management for patients receiving multiple medications, the current status quo of care, risk factors for deficient treatment and characteristics of concerned patients must be investigated. Furthermore, it is necessary to understand the physicians’ decision making process regarding treatment.

Effectiveness of guidelines in treatment of allergic rhinitis: an analysis of individual patient data

Grass pollen-induced allergic rhinoconjunctivitis is a common disease, comprising more than just the classic symptoms of nasal obstruction, sneezing, rhinorrhea and itchy, watery eyes. Sufferers deal with severe impairments in daily life. Allergic rhinoconjunctivitis is also considered an important risk factor in the development of asthma. Allergen avoidance, medication for symptomatic treatment and allergen-specific immunotherapy are cornerstones in therapeutic management, but immunotherapy is the only available treatment that is able to affect the natural course of allergy. In recent decades, clinical trials have investigated the efficacy and safety of subcutaneous immunotherapy. To date, efforts have been made to develop more convenient routes of administration. Substantial improvement may be achieved through the application of sublingual tablets. This article discusses the development process of immunotherapy and the clinical background of the Oralair(®) (Stallergènes, Hauts-de-Seine, France) five-grass pollen tablet. Furthermore, it outlines this tablets efficacy and safety properties.