Hepatitis B virus(HBV)is one of the major micro-pathogens in the progression of chronic liver infections worldwide.Despite a vaccine and anti-virus drugs used in the management of HBV infection,the prognosis and outco...Hepatitis B virus(HBV)is one of the major micro-pathogens in the progression of chronic liver infections worldwide.Despite a vaccine and anti-virus drugs used in the management of HBV infection,the prognosis and outcomes of this chronic infection remain complex and the infection can easily recur.Several parameters such as host age,viral mutations and genotypes,regional distributions,etc.have an effect on the outcome of hepatitis B infection following preventive measures and therapy around viral life cycle in the clinic.In addition,the economic status in different regions and groups of patients also affect disease progression.A costeffectiveness analysis is considered to play a critical role in the management of chronic HBV infection.This mini-review investigates the above-mentioned aspects and provides a perspective viewpoint for the management of HBV infection in the future.展开更多
Patient specific instrumentation(PSI) in total knee arthroplasty(TKA) promises faster operation time(by using less instruments and individual cutting jigs), less blood loss, faster rehabilitation, better implant sizin...Patient specific instrumentation(PSI) in total knee arthroplasty(TKA) promises faster operation time(by using less instruments and individual cutting jigs), less blood loss, faster rehabilitation, better implant sizing and accuracy, superior overall outcome, and at the end- less costs. However, as evident for every new development, its superiority remains to be provenover the conventional systems. Whilst dissatisfaction is reported to be eminent in up to 30% of patients having undergone conventional TKA, it is unclear, whether PSI can address to these patients as a suitable option in the future. The author believes that the current evidence does not support superiority of PSI in TKA over conventional systems. However, future long-term level I and II studies might aid to show its cost-effectiveness stating same results, accuracy, and overall outcome with less operation time.展开更多
objective:Two cycles of induction chemotherapy(IC)followed by 2 cycles of platinum-based concurrent chemoradiotherapy(CCRT)(2IC+2CCRT)for locoregionally advanced nasopharyngeal carcinoma(LA-NPC)is widely adopted but n...objective:Two cycles of induction chemotherapy(IC)followed by 2 cycles of platinum-based concurrent chemoradiotherapy(CCRT)(2IC+2CCRT)for locoregionally advanced nasopharyngeal carcinoma(LA-NPC)is widely adopted but not evidence-confirmed.This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy,toxicity and cost-effectiveness.Methods:This real-world study from two epidemic centers used propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)analyses.The enrolled patients were divided into three groups based on treatment modality:Group A(2IC+2CCRT),Group B(3IC+2CCRT or 2IC+3CCRT)and Group C(3IC+3CCRT).Long-term survival,acute toxicities and cost-effectiveness were compared among the groups.We developed a prognostic model dividing the population into high-and low-risk cohorts,and survivals including overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS)and locoregional relapse-free survival(LRRFS)were compared among the three groups according to certain risk stratifications.Results:Of 4,042 patients,1,175 were enrolled,with 660,419,and 96 included in Groups A,B and C,respectively.Five-year survivals were similar among the three groups after PSM and confirmed by IPTW.Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A(52.1%vs.41.5%vs.25.2%;41.7%vs.32.7%vs.25.0%)as were grade 3-4 nausea/vomiting and oral mucositis(29.2%vs.15.0%vs.6.1%;32.3%vs.25.3%vs.18.0%).Cost-effective analysis suggested that 2IC+2CCRT was the least expensive,while the health benefits were similar to those of the other groups.Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients,while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals,mainly reflected by LRRFS.Conclusions:In LA-NPC patients,2IC+2CCRT was the optimal choice regarding efficacy,toxicity and costeffectiveness;however,2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high-and low-risk populations,respectively.展开更多
Gastroenterology is a particularly data-rich field,generating vast repositories of data that are a fruitful ground for artificial intelligence(AI)and machine learning(ML)applications.In this opinion review,we initiall...Gastroenterology is a particularly data-rich field,generating vast repositories of data that are a fruitful ground for artificial intelligence(AI)and machine learning(ML)applications.In this opinion review,we initially elaborate on the current status of the application of AI/ML-based software in gastroenterology.Currently,AI/ML-based models have been developed in the following applications:Models integrated into the clinical setting following real-time patient data flagging patients at high risk for developing a gastrointestinal disease,models employing non-invasive parameters that provide accurate diagnoses aiming to either replace,minimize,or refine the indications of endoscopy,models utilizing genomic data to diagnose various gastrointestinal diseases,computer-aided diagnosis systems facilitating the interpretation of endoscopy images,models to facilitate treatment allocation and predict the response to treatment,and finally,models in prognosis predicting complications,recurrence following treatment,and overall survival.Then,we elaborate on several challenges and how they may negatively impact the widespread application of AI in healthcare and gastroenterology.Specifically,we elaborate on concerns regarding accuracy,cost-effectiveness,cybersecurity,interpretability,oversight,and liability.While AI is unlikely to replace physicians,it will transform the skillset demanded by future physicians to practice.Thus,physicians are expected to engage with AI to avoid becoming obsolete.展开更多
Objective:Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are approved for heart failure with reduced ejection fraction(HFrEF).However,their cost-effectiveness remains unknown.We aimed to compare the cost-effectivene...Objective:Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are approved for heart failure with reduced ejection fraction(HFrEF).However,their cost-effectiveness remains unknown.We aimed to compare the cost-effectiveness of SGLT2i versus mineralocorticoid antagonists(MRAs).Methods:Data from the RALES,EPHESUS,EMPHASIS,DAPA-HF,and EMPEROR-Reduced trials were includ-ed.We calculated the risk-ratio(RR)for a composite of cardiovascular death or heart failure hospitalization(CV death-HHF),all-cause mortality,and heart failure hospitalization(HHF)between MRAs and SGLT2i.A Markov model was developed to simulate the progression of HFrEF over 5 years.The primary outcome was incremental cost-effectiveness ratio(ICER),measured by cost per quality-adjusted life-year(QALY)gained.Results:We observed a similar benefit in CV death-HHF(RR 1.04;95%CI 0.82–1.31),all-cause mortality(RR 0.91;95%CI 0.78–1.06),and HHF(RR 1.05;95%CI 0.84–1.31)between MRAs and SGLT2i.In a 5-year model,no difference in survival was observed between treatments.MRAs were associated with lower cost($63,135.52 vs.$80,365.31)and more QALYs gained per patient(2.53 versus 2.49)than SGLT2i.The ICER for SGLT2i versus MRAs was$-172,014.25/QALY,in favor of MRAs.Conclusion:MRAs and SGLT2i provided similar benefits;however,MRAs were a more cost-effective treatment than SGLT2i.展开更多
Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for ga...Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer(GC) development. There are several approaches to identifying these subjects,including noninvasive methods, esophagogastroduodenoscopy and histology.The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate-and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient’s risk level. In addition, imaging enhanced endoscopy(IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However,resource limitations are an important barrier in many regions worldwide. Thus,for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resourcesensitive approach.展开更多
BACKGROUND A modified Valsalva maneuver(VM)has been suggested to be superior to the standard VM for conversion of paroxysmal supraventricular tachycardia(PSVT).AIM To evaluate the efficacy and economic benefits of a m...BACKGROUND A modified Valsalva maneuver(VM)has been suggested to be superior to the standard VM for conversion of paroxysmal supraventricular tachycardia(PSVT).AIM To evaluate the efficacy and economic benefits of a modified VM in Chinese patients.METHODS Patients with PSVT admitted to our center between October 2017 and September 2019 were randomly assigned to the modified and standard VM groups.Conversion via VM was performed up to three times.The primary outcome of the study was the success rate of PSVT conversion to sinus rhythm.The secondary outcomes included the incidence of adverse events,economic cost during the visit,and the degree of patient acceptance of the treatment.RESULTS Overall,361 patients were enrolled,with 180 allocated to the modified VM group and 181 to the standard VM group.Baseline characteristics were well matched in the groups.Overall,the modified VM group had higher success rates of PSVT conversion after single(47.78%vs 15.38%,P<0.001)and multiple(62.22%vs 19.78%,P<0.001)VM sessions.No significant differences in the incidences of adverse events and rates of patient acceptance were detected between the two groups(both P>0.05).Moreover,the economic cost of the clinic visit was significantly lower for the modified VM group than for the standard VM group(P<0.05).CONCLUSION The modified VM may confer both therapeutic and economic benefits as compared with the standard VM for conversion of PSVT.展开更多
Requirements elicitation is a fundamental phase of software development in which an analyst discovers the needs of different stakeholders and transforms them into requirements.This phase is cost-and time-intensive,and...Requirements elicitation is a fundamental phase of software development in which an analyst discovers the needs of different stakeholders and transforms them into requirements.This phase is cost-and time-intensive,and a project may fail if there are excessive costs and schedule overruns.COVID-19 has affected the software industry by reducing interactions between developers and customers.Such a lack of interaction is a key reason for the failure of software projects.Projects can also fail when customers do not know precisely what they want.Furthermore,selecting the unsuitable elicitation technique can also cause project failure.The present study,therefore,aimed to identify which requirements elicitation technique is the most cost-effective for large-scale projects when time to market is a critical issue or when the customer is not available.To that end,we conducted a systematic literature review on requirements elicitation techniques.Most primary studies identified introspection as the best technique,followed by survey and brainstorming.This finding suggests that introspection should be the first choice of elicitation technique,especially when the customer is not available or the project has strict time and cost constraints.Moreover,introspection should also be used as the starting point in the elicitation process of a large-scale project,and all known requirements should be elicited using this technique.展开更多
基金Supported by Natural Science Foundation of Shanghai,No.17ZR1431400.
文摘Hepatitis B virus(HBV)is one of the major micro-pathogens in the progression of chronic liver infections worldwide.Despite a vaccine and anti-virus drugs used in the management of HBV infection,the prognosis and outcomes of this chronic infection remain complex and the infection can easily recur.Several parameters such as host age,viral mutations and genotypes,regional distributions,etc.have an effect on the outcome of hepatitis B infection following preventive measures and therapy around viral life cycle in the clinic.In addition,the economic status in different regions and groups of patients also affect disease progression.A costeffectiveness analysis is considered to play a critical role in the management of chronic HBV infection.This mini-review investigates the above-mentioned aspects and provides a perspective viewpoint for the management of HBV infection in the future.
文摘Patient specific instrumentation(PSI) in total knee arthroplasty(TKA) promises faster operation time(by using less instruments and individual cutting jigs), less blood loss, faster rehabilitation, better implant sizing and accuracy, superior overall outcome, and at the end- less costs. However, as evident for every new development, its superiority remains to be provenover the conventional systems. Whilst dissatisfaction is reported to be eminent in up to 30% of patients having undergone conventional TKA, it is unclear, whether PSI can address to these patients as a suitable option in the future. The author believes that the current evidence does not support superiority of PSI in TKA over conventional systems. However, future long-term level I and II studies might aid to show its cost-effectiveness stating same results, accuracy, and overall outcome with less operation time.
基金supported by grants from the National Natural Science Foundation of China(No.81872375 and 82172863)the Natural Science Foundation of Guangdong Province(No.2021A1515010118).
文摘objective:Two cycles of induction chemotherapy(IC)followed by 2 cycles of platinum-based concurrent chemoradiotherapy(CCRT)(2IC+2CCRT)for locoregionally advanced nasopharyngeal carcinoma(LA-NPC)is widely adopted but not evidence-confirmed.This study aimed to determine the clinical value of 2IC+2CCRT regarding efficacy,toxicity and cost-effectiveness.Methods:This real-world study from two epidemic centers used propensity score matching(PSM)and inverse probability of treatment weighting(IPTW)analyses.The enrolled patients were divided into three groups based on treatment modality:Group A(2IC+2CCRT),Group B(3IC+2CCRT or 2IC+3CCRT)and Group C(3IC+3CCRT).Long-term survival,acute toxicities and cost-effectiveness were compared among the groups.We developed a prognostic model dividing the population into high-and low-risk cohorts,and survivals including overall survival(OS),progression-free survival(PFS),distant metastasis-free survival(DMFS)and locoregional relapse-free survival(LRRFS)were compared among the three groups according to certain risk stratifications.Results:Of 4,042 patients,1,175 were enrolled,with 660,419,and 96 included in Groups A,B and C,respectively.Five-year survivals were similar among the three groups after PSM and confirmed by IPTW.Grade 3-4 neutropenia and leukocytopenia were significantly higher in Groups C and B than in Group A(52.1%vs.41.5%vs.25.2%;41.7%vs.32.7%vs.25.0%)as were grade 3-4 nausea/vomiting and oral mucositis(29.2%vs.15.0%vs.6.1%;32.3%vs.25.3%vs.18.0%).Cost-effective analysis suggested that 2IC+2CCRT was the least expensive,while the health benefits were similar to those of the other groups.Further exploration showed that 2IC+2CCRT tended to be associated with a shorter PFS in high-risk patients,while 3IC+3CCRT potentially contributed to poor PFS in low-risk individuals,mainly reflected by LRRFS.Conclusions:In LA-NPC patients,2IC+2CCRT was the optimal choice regarding efficacy,toxicity and costeffectiveness;however,2IC+2CCRT and 3IC+3CCRT probably shortened LRRFS in high-and low-risk populations,respectively.
文摘Gastroenterology is a particularly data-rich field,generating vast repositories of data that are a fruitful ground for artificial intelligence(AI)and machine learning(ML)applications.In this opinion review,we initially elaborate on the current status of the application of AI/ML-based software in gastroenterology.Currently,AI/ML-based models have been developed in the following applications:Models integrated into the clinical setting following real-time patient data flagging patients at high risk for developing a gastrointestinal disease,models employing non-invasive parameters that provide accurate diagnoses aiming to either replace,minimize,or refine the indications of endoscopy,models utilizing genomic data to diagnose various gastrointestinal diseases,computer-aided diagnosis systems facilitating the interpretation of endoscopy images,models to facilitate treatment allocation and predict the response to treatment,and finally,models in prognosis predicting complications,recurrence following treatment,and overall survival.Then,we elaborate on several challenges and how they may negatively impact the widespread application of AI in healthcare and gastroenterology.Specifically,we elaborate on concerns regarding accuracy,cost-effectiveness,cybersecurity,interpretability,oversight,and liability.While AI is unlikely to replace physicians,it will transform the skillset demanded by future physicians to practice.Thus,physicians are expected to engage with AI to avoid becoming obsolete.
文摘Objective:Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are approved for heart failure with reduced ejection fraction(HFrEF).However,their cost-effectiveness remains unknown.We aimed to compare the cost-effectiveness of SGLT2i versus mineralocorticoid antagonists(MRAs).Methods:Data from the RALES,EPHESUS,EMPHASIS,DAPA-HF,and EMPEROR-Reduced trials were includ-ed.We calculated the risk-ratio(RR)for a composite of cardiovascular death or heart failure hospitalization(CV death-HHF),all-cause mortality,and heart failure hospitalization(HHF)between MRAs and SGLT2i.A Markov model was developed to simulate the progression of HFrEF over 5 years.The primary outcome was incremental cost-effectiveness ratio(ICER),measured by cost per quality-adjusted life-year(QALY)gained.Results:We observed a similar benefit in CV death-HHF(RR 1.04;95%CI 0.82–1.31),all-cause mortality(RR 0.91;95%CI 0.78–1.06),and HHF(RR 1.05;95%CI 0.84–1.31)between MRAs and SGLT2i.In a 5-year model,no difference in survival was observed between treatments.MRAs were associated with lower cost($63,135.52 vs.$80,365.31)and more QALYs gained per patient(2.53 versus 2.49)than SGLT2i.The ICER for SGLT2i versus MRAs was$-172,014.25/QALY,in favor of MRAs.Conclusion:MRAs and SGLT2i provided similar benefits;however,MRAs were a more cost-effective treatment than SGLT2i.
文摘Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer(GC) development. There are several approaches to identifying these subjects,including noninvasive methods, esophagogastroduodenoscopy and histology.The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate-and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient’s risk level. In addition, imaging enhanced endoscopy(IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However,resource limitations are an important barrier in many regions worldwide. Thus,for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resourcesensitive approach.
基金Supported by Key Research and Development Project of Shandong Province,No.2016GST201224and Jinan Clinical Medicine Science and Technology Innovation Plan,No.201907056.
文摘BACKGROUND A modified Valsalva maneuver(VM)has been suggested to be superior to the standard VM for conversion of paroxysmal supraventricular tachycardia(PSVT).AIM To evaluate the efficacy and economic benefits of a modified VM in Chinese patients.METHODS Patients with PSVT admitted to our center between October 2017 and September 2019 were randomly assigned to the modified and standard VM groups.Conversion via VM was performed up to three times.The primary outcome of the study was the success rate of PSVT conversion to sinus rhythm.The secondary outcomes included the incidence of adverse events,economic cost during the visit,and the degree of patient acceptance of the treatment.RESULTS Overall,361 patients were enrolled,with 180 allocated to the modified VM group and 181 to the standard VM group.Baseline characteristics were well matched in the groups.Overall,the modified VM group had higher success rates of PSVT conversion after single(47.78%vs 15.38%,P<0.001)and multiple(62.22%vs 19.78%,P<0.001)VM sessions.No significant differences in the incidences of adverse events and rates of patient acceptance were detected between the two groups(both P>0.05).Moreover,the economic cost of the clinic visit was significantly lower for the modified VM group than for the standard VM group(P<0.05).CONCLUSION The modified VM may confer both therapeutic and economic benefits as compared with the standard VM for conversion of PSVT.
基金funding this work through research group no.RG-1441-490.
文摘Requirements elicitation is a fundamental phase of software development in which an analyst discovers the needs of different stakeholders and transforms them into requirements.This phase is cost-and time-intensive,and a project may fail if there are excessive costs and schedule overruns.COVID-19 has affected the software industry by reducing interactions between developers and customers.Such a lack of interaction is a key reason for the failure of software projects.Projects can also fail when customers do not know precisely what they want.Furthermore,selecting the unsuitable elicitation technique can also cause project failure.The present study,therefore,aimed to identify which requirements elicitation technique is the most cost-effective for large-scale projects when time to market is a critical issue or when the customer is not available.To that end,we conducted a systematic literature review on requirements elicitation techniques.Most primary studies identified introspection as the best technique,followed by survey and brainstorming.This finding suggests that introspection should be the first choice of elicitation technique,especially when the customer is not available or the project has strict time and cost constraints.Moreover,introspection should also be used as the starting point in the elicitation process of a large-scale project,and all known requirements should be elicited using this technique.
