Search tips
Search criteria

Results 1-3 (3)

Clipboard (0)

Select a Filter Below

Year of Publication
Document Types
1.  Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios 
Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications.
The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients.
This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks.
This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine health care system costs alone, in-person follow-up is $38 CAD ($35 USD) more expensive than mobile app follow-up care over the first postoperative month. The baseline difference in effect is modeled to be zero based on clinical trials examining the effectiveness of telephone follow-up care in similar patient populations. An incremental cost-effectiveness ratio (ICER) is not reportable in this scenario. An incremental net benefit (INB) is reportable, and reflects merely the cost difference between the two interventions for any willingness-to-pay value (INB=$245 CAD). The cost-effectiveness of mobile app follow-up even holds in scenarios where all mobile patients attend one in-person follow-up.
Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients. It can be cost-effective from a societal and health care system perspective.
PMCID: PMC4211032  PMID: 25245774
cost-effectiveness; ambulatory surgical procedures; mobile apps; ambulatory monitoring
2.  Pyogenic granulomas during isotretinoin therapy 
A review of scientific literature reveals a sparse documentation of periungual pyogenic granulomas as an adverse effect of isotretinoin therapy
Main observations
Periungual pyogenic granulomas appeared in four patients receiving isotretinoin therapy for severe acne. Oral and topical antibiotic treatments were ineffective and all cases spontaneously resolved once isotretinoin is discontinued.
This report demonstrates the idiosyncratic nature of this side effect. We suggest that, although infection is possible due to the transformed nature of the normally protective skin barrier, oral and topical antibiotic treatments appear ineffective. Pyogenic granulomas spontaneously resolve once isotretinoin is discontinued.
PMCID: PMC3163353  PMID: 21886758
acne; fingers; granulation tissue; isotretinoin; nails; paronychia; pyogenic granuloma; retinoids; toes
3.  BMI and Physical Activity Among at-Risk Sixth- and Ninth-Grade Students, Hillsborough County, Florida, 2005-2006 
Preventing Chronic Disease  2010;7(3):A48.
During the past 3 decades, the number of overweight adolescents increased while adolescent engagement in physical activity decreased. We investigated the prevalence of overweight and physical activity levels among economically disadvantaged and minority middle- and high-school students in a school district in Florida. In particular, data on physical activity levels of middle-school students are limited and needed for prevention and intervention planning. In addition, because of state education policies, students in Florida are less likely than students nationally to enroll in physical education, placing them at a higher risk for decreased physical activity levels.
We used multivariate methodology to analyze physical activity levels among 526 students from 3 middle and 2 high schools in southwest Florida.
Forty percent of students met criteria for overweight or obesity. Overall, less than 45% of students reported engaging in daily physical activity. Boys reported higher levels of physical activity than did girls, and a decline in physical activity levels was observed between grades 6 and 9, especially among minority girls (ie, African American and Latino). Lack of time was identified as the greatest barrier to engaging in physical activity.
This study documents health disparities among minority students from economically disadvantaged backgrounds in an urban school district. Participation in daily physical activity was below recommended guidelines across grades. We found numerous barriers to engaging in physical activity, which will enable local education agencies to evaluate their current physical activity policies and identify alternative physical activities for these youth.
PMCID: PMC2879980  PMID: 20394687

Results 1-3 (3)