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Abstract: The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia. Methods. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included. Results. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to %3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was %1,900,757.80. Conclusions. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was %1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used is probably one of the reasons for the discrepancy between pay-outs and actual costs. We propose new method for more precise cost assessment in oncology.
Keywords: cost of treatment, metastatic colorectal cancer, cost of targeted therapy, monitoring costs
Published in DiRROS: 17.04.2024; Views: 112; Downloads: 34
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Abstract: Treatment options of recurrent malignant gliomas are very limited and with a poor survival benefit. The results from phase II trials suggest that the combination of bevacizumab and irinotecan is beneficial. Patients and methods. The medical documentation of 19 adult patients with recurrent malignant gliomas was retrospectively reviewed. All patients received bevacizumab (10 mg/kg) and irinotecan (340 mg/m2 or 125 mg/m2) every two weeks. Patient clinical characteristics, drug toxicities, response rate, progression free survival (PFS) and overall survival (OS) were evaluated. Results. Between August 2008 and November 2011, 19 patients with recurrent malignant gliomas (median age 44.7, male 73.7%, WHO performance status 0%2) were treated with bevacizumab/irinotecan regimen. Thirteen patients had glioblastoma, 5 anaplastic astrocytoma and 1 anaplastic oligoastrocytoma. With exception of one patient, all patients had initially a standard therapy with primary resection followed by postoperative chemoradiotherapy. Radiological response was confirmed after 3 months in 9 patients (1 complete response, 8 partial responses), seven patients had stable disease and three patients have progressed. The median PFS was 6.8 months (95% confidence interval [CI]: 5.3-8.3) with six-month PFS rate 52.6%. The median OS was 7.7 months (95% CI: 6.6-8.7), while six-month and twelve-month survival rates were 68.4% and 31.6%, respectively. There were 16 cases of hematopoietic toxicity grade (G) 1-2. Non-hematopoietic toxicity was present in 14 cases, all G1-2, except for one patient with proteinuria G3. No grade 4 toxicities, no thromboembolic event and no intracranial hemorrhage were observed. Conclusions. In recurrent malignant gliomas combination of bevacizumab and irinotecan might be an active regimen with acceptable toxicity.
Keywords: recurrent malignant glioma, systemic therapy, bevacizumab
Published in DiRROS: 17.04.2024; Views: 81; Downloads: 19
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Abstract: Purpose: Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) is a complex condition with debilitating symptoms that significantly impact individuals, particularly those in the working population. This study aims to investigate the effec-tiveness of Graded Exercise Therapy (GET) and Cognitive Behavioral Therapy (CBT) along with additional methods such as Graded Exercise Self-help (GES), Adaptive Pac-ing Therapy (APT), and Specialist Medical Care (SMC), in managing Chronic Fatigue Syndrome (CFS) / Myalgic Encephalomyelitis (ME) among the working population. Methods: A systematic analysis of five randomized controlled trials conducted be-tween 2013 and 2023, encompassing GET, CBT, APT, SMC, and GES was performed using PubMed.Results: The selected studies consistently demonstrate that GET positively impacts physical functioning and reduces fatigue levels in working individuals with CFS. Ad-ditionally, CBT proves valuable, emphasizing the importance of addressing the mental aspects of CFS in occupational contexts.Conclusion: This review underscores the need for further research, advocating for direct assessment methods like biomarkers to enhance our understanding of CFS and improve treatment outcomes. These insights are crucial for healthcare practitioners, researchers, and policymakers navigating the complexities of CFS within the work-place. Emphasizing the integration of psychological interventions with physical therapies is essential for a comprehensive approach to managing CFS among the working population.
Keywords: Chronic Fatigue Syndrome / Myalgic Encephalomyelitis, CFS/ME, graded exercise therapy, cognitive behavioral therapy, adaptive pacing therapy, specialist medical care, working population
Published in DiRROS: 17.04.2024; Views: 79; Downloads: 55
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Abstract: Purpose: The aim of this review was to determine the influence of physical activity on the arterial blood pressure of the elderly through a review of previous research.Methods: The search was performed on the Web of Science, Google Scholar and PubMed databases. The first search identified 1112 articles. In the initial assessment carried out in accordance with the inclusion and exclusion criteria, 15 articles were found suitable and were included in the study, while 1097 studies were excluded. The search was limited to articles published in period of 2002–2022.Results: After the applied exercise programs and evaluation at the final measure-ments, the mean values of systolic blood pressure, on the total sample, were 131 mmHg, while the values of diastolic blood pressure were 77 mmHg, which indicates that physi-cal activity (regardless of whether swimming, walking, yoga, resistance training, high interval training, Tai Chi) have a positive effect on the arterial blood pressure of the elderly.Conclusion: All studies, except one, showed a positive influence of physical activity on the arterial blood pressure of elderly people. In this regard, it can be concluded that physical activity, regardless of the type of activity, has a positive effect on the arterial blood pressure of the elderly, in the form of a reduction in blood pressure values.
Keywords: pshysical activity, arterial blood pressure, elderly
Published in DiRROS: 17.04.2024; Views: 70; Downloads: 46
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Abstract: A commonly used approach to represent the thermal load in a compartment fire is the Eurocode Parametric Fire Curve (EPFC), which specifies gas temperatures (or rather adiabatic surface temperatures). Recognizing the significant deviations between real fires and the EPFC framework, the concept of model uncertainty is explored. This study does not aim to assess or improve the EPFC, but introduces a model uncertainty, allowing for reliability-based structural fire engineering (SFE). It presents a stochastic correction factor for the fire load density, based on the maximum temperature in steel sections. The focus is on the fire load density, but in general other parameters can be jointly taken into account as well. This correction factor considers protected and un- protected sections, incorporating variations in section factor and protection thickness. The findings reveal that the fire load density within the EPFC framework can be modified to better represent the severity of fire ex- periments. This approach ensures physical consistency of the obtained compartment gas temperatures, as opposed to alternative approaches for addressing the EPFC model uncertainty. While promising results are evident in this proof of concept, exploration for other types of structural elements and evaluation for structural systems is necessary before integration into design practices.
Keywords: structural fire engineering, compartment fires, fire load density, steel structures, reliability, probability of failure
Published in DiRROS: 17.04.2024; Views: 71; Downloads: 23
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