Stmarys Hospital

Japan

Stmarys Hospital

Japan
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Beck E.J.,Coordinating and Analytic Center | Beck E.J.,London School of Hygiene and Tropical Medicine | Beck E.J.,Chelsea and Westminster Hospital | Mandalia S.,Coordinating and Analytic Center | And 17 more authors.
PLoS ONE | Year: 2012

Aim: Investigate the cost and effects of a single-pill versus two- or three pill first-line antiretroviral combinations in reducing viral load, increasing CD4 counts, and first-line failure rate associated with respective regimens at 6 and 12 months. Methods: Patients on first-line TDF+3TC+EFV, TDF+FTC+EFV, Truvada®+EFV or Atripla® between 1996-2008 were identified and viral load and CD4 counts measured at baseline, six and twelve months respectively. Factors that independently predicted treatment failure at six and twelve months were derived using multivariate Cox's proportional hazard regression analyses. Use and cost of hospital services were calculated at six and twelve months respectively. Results: All regimens reduced viral load to below the limit of detection and CD4 counts increased to similar levels at six and twelve months for all treatment regimens. No statistically significant differences were observed for rate of treatment failure at six and twelve months. People on Atripla® generated lower healthcare costs for non-AIDS patients at £5,340 (£5,254 to £5,426) per patient-semester and £9,821 (£9,719 to £9,924) per patient-year that was £1,344 (95%CI £1,222 to £1,465) less per patient-semester and £1,954 (95%CI £1,801 to £2,107) less per patient-year compared with Truvada®+EFV; healthcare costs for AIDS patients were similar across all regimens. Conclusion: The single pill regimen is as effective as the two- and three-pill regimens of the same drugs, but if started as first-line induction therapy there would be a 20% savings on healthcare costs at six and 17% of costs at twelve months compared with Truvada®+EFV, that generated the next lowest costs. © 2012 Beck et al.


Beck E.J.,Coordinating and Analytic Center | Beck E.J.,London School of Hygiene and Tropical Medicine | Beck E.J.,Chelsea and Westminster Hospital | Mandalia S.,Coordinating and Analytic Center | And 23 more authors.
PLoS ONE | Year: 2011

Aim: Calculate time to first-line treatment failure, annual cost and cost-effectiveness of NNRTI versus PIboosted first-line HAART regimens in the UK, 1996-2006. Background: Population costs for HIV services are increasing in the UK and interventions need to be effective and efficient to reduce or stabilize costs. 2NRTIs + NNRTI regimens are cost-effective regimens for first-line HAART, but these regimens have not been compared with first-line PIboosted regimens. Methods: Times to first-line treatment failure and annual costs were calculated for first-line HAART regimens by CD4 count when starting HAART (2006 UK prices). Cost-effectiveness of 2NRTIs+NNRTI versus 2NRTIs+PIboosted regimens was calculated for four CD4 strata. Results: 55% of 5,541 people living with HIV (PLHIV) started HAART with CD4 count ≤200 cells/mm3, many of whom were Black Africans. Annual treatment cost decreased as CD4 count increased; most marked differences were observed between starting HAART with CD4 ≤200 cells/mm3 compared with CD4 count >200 cells/mm3. 2NRTI+PIboosted and 2NRTI+NNRTI regimens were the most effective regimens across the four CD4 strata; 2NRTI+NNRTI was cost-saving or cost-effective compared with 2NRTI + PIboosted regimens. Conclusion: To ensure more effective and efficient provision of HIV services, 2NRTI+NNRTI should be started as first-line HAART regimen at CD4 counts ≤350 cell/mm3, unless specific contra-indications exist. This will increase the number of PLHIV receiving HAART and will initially increase population costs of providing HIV services. However, starting PLHIV earlier on cost-effective regimens will maintain them in better health and use fewer health or social services, thereby generating fewer treatment and care costs, enabling them to remain socially and economically active members of society. This does raise a number of ethical issues, which will have to be acknowledged and addressed, especially in countries with limited resources. © 2011 Beck et al.


Washio M.,St. Mary's College | Washio M.,Stmarys Hospital | Kondo K.,Osaka City University | Fujisawa N.,Stmarys Hospital | And 27 more authors.
Geriatrics and Gerontology International | Year: 2016

Aim: Pneumonia is the third largest cause of death in Japan. Pneumonia continues to be one of the most common causes of morbidity, hospitalization and mortality, especially in the elderly. The aim of the present study was to evaluate the factors related to the development of pneumonia acquired outside hospitals among the Japanese elderly. Methods: We carried out a hospital-based, case-control study. Cases were patients who had been newly diagnosed with pneumonia acquired outside hospitals. For each case, one to three controls were defined as outpatients with other diseases (not pneumonia) at the same hospitals. All participants (i.e. 50 cases and 110 controls) were aged 65 years and older. Results: Compared with control participants, hypoalbuminemia (<3.5g/dL) and low body mass index (<18.0) were more common in pneumonia patients, whereas the proportion of those who could go out by themselves (i.e. self-support in activities of daily living) and the vaccination rate of seasonal influenza were lower in patients with pneumonia than control participants. Even after controlling for age, sex, hospital and aforementioned four factors, hypoalbuminemia (OR 9.19, 95% CI 3.70-22.81) increased the risk of pneumonia, whereas seasonal influenza vaccination (OR 0.37, 95% CI 0.16-0.85) reduced the risk. Even after excluding those who lived in a nursing home, hypoalbuminemina (OR 12.19, 95% CI 4.29-34.63) increased the risk of pneumonia. Conclusions: Hypoalbuminemia might be a risk factor for pneumonia among the elderly living in the community. © 2016 Japan Geriatrics Society.


Makihara N.,Kyushu University | Kamouchi M.,Kyushu University | Hata J.,Kyushu University | Matsuo R.,Kyushu University | And 24 more authors.
Atherosclerosis | Year: 2013

Background and purpose: The findings of recent clinical trials suggest that treatment with high-dose statins reduces the risk of stroke recurrence. However, the doses approved in Japan are much lower than those in the previous studies. This study aimed to elucidate whether prescribed doses of statins reduce the risks of cerebrovascular events (CVEs: stroke recurrence or transient ischemic attack) and all-cause mortality in a cohort of Japanese patients with first-ever ischemic stroke. Methods: The 2822 eligible patients registered in the Fukuoka Stroke Registry with first-ever acute ischemic stroke from June 2007 to February 2011 were classified into statin users (n=993) and non-users (n=1829) at discharge, and followed up until March 2012. We assessed the cumulative risks of CVE and all-cause mortality by the Kaplan-Meier method, and calculated hazard ratios (HRs) and 95% confidential intervals (CIs) using the Cox proportional hazards model. Results: During the follow-up time (median, 2.0 years), 305 patients had CVEs and 345 died. The cumulative risks of CVE and death after 4 years were significantly lower in statin users than in non-users (13.8% versus 19.5%, P=0.005 for CVE; 11.8% versus 21.7%, P<0.001 for death). After adjusting for multiple confounding factors, statin treatment significantly reduced the risks of CVE (HR, 0.70; 95% CI, 0.53 to 0.92; P=0.011) and all-cause mortality (HR, 0.67; 95% CI, 0.50 to 0.89; P=0.006). Conclusions: Our findings suggest that low-dose statin may reduce the risks of CVE and death in Japanese patients with acute ischemic stroke. © 2013 Elsevier Ireland Ltd.


Mohiyiddeen L.,Stmarys Hospital | Salim S.,Stmarys Hospital | Mulugeta B.,Stmarys Hospital | McBurney H.,University of Manchester | And 4 more authors.
Gynecological Endocrinology | Year: 2012

Objectives: To determine if an association exists between the follicle-stimulating hormone receptor (FSHR) gene p.Asn680Ser polymorphism and polycystic ovary syndrome (PCOS) or with high anti-mullerian hormone (AMH) levels without PCOS. Patients: Fifty-eight women with PCOS, 24 women with high AMH (>44.5 pmol/L) without PCOS and 80 healthy ethnically matched female controls. Main outcome measures: Prevalence of the FSHR p.Asn680Ser polymorphism, baseline serum AMH levels and response to ovulation induction with clomiphene citrate. Results: The frequency of FSHR p.Asn680Ser genotypes were not significantly different between PCOS patients, patients with high AMH without PCOS and controls (p = 0.88). Of the women with PCOS, 34/58 were on clomiphene citrate treatment and 12/34 were resistant. There was no association between sensitivity or resistance to clomiphene and p.Asn680Ser genotypes (p = 0.38). Conclusions: There is no evidence that FSHR p.Asn680Ser genotypes are associated with PCOS, high AMH levels or response to clomiphene citrate. © 2012 Informa UK, Ltd.


PubMed | Stmarys Hospital, Osaka City University, Nagoya Chikusa Public Health Center, St. Mary's College and 2 more.
Type: Journal Article | Journal: Geriatrics & gerontology international | Year: 2016

Pneumonia is the third largest cause of death in Japan. Pneumonia continues to be one of the most common causes of morbidity, hospitalization and mortality, especially in the elderly. The aim of the present study was to evaluate the factors related to the development of pneumonia acquired outside hospitals among the Japanese elderly.We carried out a hospital-based, case-control study. Cases were patients who had been newly diagnosed with pneumonia acquired outside hospitals. For each case, one to three controls were defined as outpatients with other diseases (not pneumonia) at the same hospitals. All participants (i.e. 50 cases and 110 controls) were aged 65 years and older.Compared with control participants, hypoalbuminemia (<3.5g/dL) and low body mass index (<18.0) were more common in pneumonia patients, whereas the proportion of those who could go out by themselves (i.e. self-support in activities of daily living) and the vaccination rate of seasonal influenza were lower in patients with pneumonia than control participants. Even after controlling for age, sex, hospital and aforementioned four factors, hypoalbuminemia (OR 9.19, 95% CI 3.70-22.81) increased the risk of pneumonia, whereas seasonal influenza vaccination (OR 0.37, 95% CI 0.16-0.85) reduced the risk. Even after excluding those who lived in a nursing home, hypoalbuminemina (OR 12.19, 95% CI 4.29-34.63) increased the risk of pneumonia.Hypoalbuminemia might be a risk factor for pneumonia among the elderly living in the community.


Biswas B.,Burdwan Medical College and Hospital | Mondal M.,Burdwan Medical College and Hospital | Thapa R.,Syracuse University | Mallick D.,Stmarys Hospital | Datta A.K.,Burdwan Medical College and Hospital
Journal of Clinical and Diagnostic Research | Year: 2014

Klebsiella pneumoniae (K. pneumoniae) causing brain abscess in newborn infants is rare. Presented herein, is a 27-day-old male neonate who developed two frontal lobe abscesses in association with K. pneumoniae sepsis and meningitis. Antibiotic susceptibility testing utilizing the double-disk synergy method (Cefotaxime and Amoxycillin-Clavulanate) confirmed the extended spectrum beta-lactamase (ESBL) production by the isolate. He was treated simultaneously with antibiotics (Meropenem and Amikacin) and abscess aspiration through the anterior fontanelle, with less than satisfactory outcome. ESBL producing K. pneumoniae brain abscess in neonates is extremely rare in the English literature. Emperical carbapenems and aminoglycoside coverage in neonates with K. pneumoniae sepsis and brain abscess, especially in areas with high rate of ESBL producing bacteria may be warranted. © 2014, Journal of Clinical and Diagnostic Research. All rights reserved.

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