Archive for July, 2010
Posted by James
Although it occurs in less than 10% of transplant recipients with chronic HCV, a severe and rapidly progressive form of recurrent HCV infection characterized by cholestatic disease has a major impact on survival. In contrast to a chronic hepatitis observed in most patients with recurrent HCV, this syndrome is defined by a total serum bilirubin of more than 6 mg/dL, elevated alkaline phosphatase or gamma glutamyltransferase levels more than 5 times the upper limit of normal, high serum HCV RNA levels, and histologic features including central hepatocyte ballooning without necrosis, cholangiolar proliferation without loss of bile ducts, and intrahepatic cholestasis in the absence of significant inflammation, biliary obstructive disease, or vascular complications.15,18 Onset typically occurs within the first 6 months following liver transplantation, and rapid progression to allograft failure may occur within 1 year. In addition, patient survival following repeat liver transplantation for fibrosing cholestatic HCV is severely compromised; thus, retransplantation is not an acceptable management option in this case.
Read the rest of this entry »
Posted by James
Recurrence of Chronic Infection
Recurrence of hepatitis C viremia following liver transplantation occurs in all patients with chronic HCV infection who have detectable serum HCV RNA levels prior to transplant. A significant decline in serum HCV RNA levels has been observed during the anhepatic phase of transplantation and immediately following reperfusion of the allograft; however, this decline is followed by a rapid increase in HCV RNA levels within hours, and pretrans- plantation serum HCV RNA levels can be reached within days. A progressive rise in HCV RNA levels has been described over several weeks following transplantation, resulting in a new baseline viral load that is typically greater than the viral load prior to transplant.
Read the rest of this entry »
Posted by James
Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the United States, affecting over 4 million individuals, with a prevalence of approximately 1.6%. Recent reports have suggested that up to two thirds of newly diagnosed chronic liver disease in the United States results from HCV. Most individuals exposed to HCV during adulthood develop chronic infection, and up to 20% may progress to end- stage liver disease. Consequently, chronic HCV infection has become a major source of liver-related mortality. The prevalence of HCV-associated advanced liver disease is expected to rise over the next several decades. HCV is currently the most frequent indication for liver transplantation, comprising approximately 40-50% of all cases.
Read the rest of this entry »
Posted by James
These results are exploratory and are limited by the small number of participants and managed care organizations represented. No attempt was made to obtain a random or representative sample of managed care decision-makers, so the findings cannot be generalized beyond the study participants. However, a number of the findings are consistent with results reported by other investigators.
Read the rest of this entry »
Posted by James
To obtain the target of 10 focus group participants, 29 prospective participants from the conference pre-registrant list were identified and contacted. Although eight men and three women met the inclusion criteria and agreed to participate, three of them were unable to attend, leaving a total of eight (i.e., six men and two women) focus group participants. These participants were on P&T committees that made pharmaceutical benefit decisions for over 500,000 enrolled lives.
Read the rest of this entry »
Posted by James
To fulfill the research objectives, two focus groups with five participants each were planned. Potential participants were identified, based on their job titles, from among pre-registrants of a conference sponsored by the University of Arizona’s Center for Health Outcomes and PharmacoEconomic Research. They were contacted by telephone to determine interest in participation and eligibility. Specific inclusion criteria required that they: 1) be 18 years of age or older; 2) be in a position in which they make pharmaceutical benefit decisions; 3) be able to successfully communicate in English in a group setting; and 4) have signed written informed consent to participate. This project was conducted under the auspices of the University of Arizona’s Human Subjects Committee. The participants were provided with an honorarium.
Read the rest of this entry »
Posted by James
The pattern of illness in the U.S. has shifted from mostly acute disease to one in which chronic conditions predominate. Although there are many diseases that can shorten life expectancy, it is more likely that a disease will have adverse health consequences that result in dysfunction and decreased well-being. Hence, patient self-reports of functioning and well-being, or health-related quality of life (HRQOL), are increasingly viewed as important measures of therapeutic outcome. Sanders and colleagues found that the reporting of quality-of-life therapeutic endpoints in randomized controlled trials increased more than 650% between 1980 and 1997.
Read the rest of this entry »