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Rhabdomyolysis in association with simvastatin and dosage increment in clarithromycin

Clarithromycin is the most documented cytochrome P450 3A4 (CYP3A4) inhibitor to cause an adverse interaction with simvastatin. This particular case is of interest as rhabdomyolysis only occurred after an increase in the dose of clarithromycin. The patient developed raised cardiac biomarkers without any obvious cardiac issues, a phenomenon that has been linked to rhabdomyolysis previously. To date, there has been no reported effect of rhabdomyolysis on the structure and function of cardiac muscle. Clinicians need to be aware of prescribing concomitant medications that increase the risk of myopathy or inhibit the CYP3A4 enzyme. Our case suggests that troponin elevation could be associated with statin induced rhabdomyolysis, which may warrant further studies.

A Systematic Review and Narrative Synthesis of Health Economic Studies Conducted for Hereditary Haemochromatosis

BackgroundHereditary haemochromatosis (HH) is a common genetic condition amongst people of northern European heritage. HH is associated with increased iron absorption leading to parenchymal organ damage and multiple arthropathies. Early diagnosis and treatment prevents complications. Population screening may increase early diagnosis, but no programmes have been introduced internationally: a paucity of health economic data is often cited as a barrier.ObjectiveTo conduct a systematic review of all health economic studies in HH.MethodsStudies were identified through electronic searching of economic/biomedical databases. Any study on HH with original economic component was included. Study quality was formally assessed. Health economic data were extracted and analysed through narrative synthesis.ResultsThirty-eight studies met the inclusion criteria. The majority of papers reported on costs or cost effectiveness of screening programmes. Whilst most concluded screening was cost effective compared with no screening, methodological flaws limit the quality of these findings. Assumptions regarding clinical penetrance, effectiveness of screening, health-state utility values (HSUVs), exclusion of early symptomatology (such as fatigue, lethargy and multiple arthropathies) and quantification of costs associated with HH were identified as key limitations. Treatment studies concluded therapeutic venepuncture was the most cost-effective intervention.ConclusionsThere is a paucity of high-quality health economic studies relating to HH. The development of a comprehensive HH cost-effectiveness model utilising HSUVs is required to determine whether screening is worthwhile.

Costs associated with hereditary haemochromatosis in Australia: a cost-of-illness study

Objective The aim of the present study was to assess health sector, other sector and time-related (productivity) costs associated with hereditary haemochromatosis from societal, government and patient perspectives for the Australian setting. Methods A national web-based survey of people with haemochromatosis was conducted between November 2013 and February 2015. Participants completed a health survey and resource use diaries. Costs were calculated using a bottom-up approach and calculated in 2015 Australian dollars. Results Cost data were available for 157 participants. From a societal perspective, the estimated annual cost of haemochromatosis was A

Quality of life utility values for hereditary haemochromatosis in Australia

274million. The mean (95% confidence interval) cost for symptomatic patients was almost threefold greater than that of asymptomatic patients (A

Putting professionalism and delivery of value-added healthcare at the heart of physician training and continuing professional development.

10030 (7705-12670) vs A

Pokemon Go: ubiquitous computing delivering better health or co-incidential health benefits from technology use? A participatory observational study

3701 (2423-5296) respectively). Health sector and productivity-related time loss were the main cost drivers. When extrapolating costs to the Australian population level, asymptomatic haemochromatosis accounted for higher costs than symptomatic haemochromatosis (A

Cost-Effectiveness of Different Population Screening Strategies for Hereditary Haemochromatosis in Australia

183million vs A

Exploring socio-technical insights for safe nursing handover

91million), reflecting the low clinical penetrance estimate used. Total costs increased when higher clinical penetrance estimates were used. Conclusion The present cost-of-illness study, the first to be published for haemochromatosis, found that although costs were substantial, they could be decreased by reducing clinical penetrance. Development of cost-effective strategies to increase early diagnosis is likely to result in better health outcomes for patients and lower total costs. What is known about the topic? To date, no cost-of-illness study has been conducted for haemochromatosis. Previous economic work in this area has relied on cost estimates based on expert opinion. What does the paper add? This paper provides the first cost estimates for haemochromatosis for the Australian population. These estimates, calculated using a bottom-up approach, were extrapolated to the population level based on the most robust epidemiological estimates available for the Australian population. What are the implications for practitioners? Population screening programs have been widely suggested as an approach to reduce clinical penetrance; however, the lack of high-quality economic analyses has been cited as a barrier to implementation. The present study provides the most robust cost estimates to date, which may be used to populate economic models. In addition, the present study illustrates that reducing clinical penetrance of haemochromatosis is likely to result in substantial reductions in cost.

Clinical supervision of interns: Understanding the view of interns and the potential of ICT to deliver supervision for safer patient care

BackgroundHereditary hemochromatosis (HH) is a common autosomal recessive disorder amongst persons of northern European heritage. If untreated, iron accumulates in parenchymal tissues causing morbidity and mortality. As diagnosis often follows irreversible organ damage, screening programs have been suggested to increase early diagnosis. A lack of economic evidence has been cited as a barrier to establishing such a program. Previous analyses used poorly estimated utility values. This study sought to measure utilities directly from people with HH in Australia.MethodsVolunteers with HH were recruited to complete a web-based survey. Utility was assessed using the Assessment of Quality of Life 4D (AQOL-4D) instrument. Severity of HH was graded into four categories. Multivariable regression analysis was performed to identify parameters associated with HSUV.ResultsBetween November 2013 and November 2014, 221 people completed the survey. Increasing severity of HH was negatively associated with utility. Mean (standard deviation) utilities were 0.76 (0.21), 0.81 (0.18), 0.60 (0.27), and 0.50 (0.27) for categories 1–4 HH respectively. Lower mean utility was found for symptomatic participants (categories 3 and 4) compared with asymptomatic participants (0.583 v. 0.796). Self-reported HH-related symptoms were negatively associated with HSUV (r = −0.685).ConclusionsSymptomatic stages of HH and presence of multiple self-reported symptoms were associated with decreasing utility. Previous economic analyses have used higher utilities which likely resulted in underestimates of the cost effectiveness of HH interventions. The utilities reported in this paper are the most robust available, and will contribute to improving the validity of future economic models for HH.

Collecting data in real time with postcards

Recent initiatives of the Royal College of Physicians (RCP) and the American College of Physicians (ACP) recognise that physicians, both now and more so in the future, need to be much more than specialists delivering expert clinical care to individual patients. We will be required to be system leaders, policy advocates, champions of innovation and providers of value-added, cost-conscious care. In short, we need to be responsible stewards of the healthcare system, and a generator and enactor of system of care improvements. This means more than simple awareness of, and casual participation in, quality and safety improvement activities. It means being prepared to challenge and transform entrenched clinical practices and long-held traditional beliefs about specialist care. It means being prepared to identify, and disinvest the healthcare system from, ineffective or outmoded clinical processes and policies while at the same time advocating for the speedy introduction of new, effective interventions and models of care. Such major reform will be necessary if future healthcare is to cope with the rising demands of an ageing population with complex conditions amid increasingly constrained healthcare budgets. The physician community risks being marginalised and perceived as irrelevant (or worse) by government and society if it fails to assume a leadership role in driving such reform. The Royal Australasian College of Physicians (RACP) has responded to these imperatives in creating the Professional Qualities Curriculum (PQC) that formalises key professional attributes that underpin high-quality care. It has convened the Professionalism in the 21st Century: Fit, Safe and Competent seminar in Melbourne in March 2012 and has released, in partnership with the Royal College of Physicians and Surgeons of Canada, and the Royal Australasian College of Surgeons, a statement that defines the contemporary characteristics of professionalism. At its annual Congress in May 2012, it launched the Supporting Physicians’ Professionalism and Performance (SPPP) program (http://www.racp.edu.au/page/sppp) that provides guidance around how professional attributes might be assessed and enhanced. In keeping with these initiatives, it is of interest to see what is happening in other jurisdictions.