Lege Artis Medicinae

[Abscessus lienis?]

HAJDU Mária, KRUTSAY Miklós, CHANIS William

AUGUST 20, 2010

Lege Artis Medicinae - 2010;20(08)

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[Up until now, angiotensin-receptor blockers have been considered to be the safest cardio-, cerebro-, reno- and vasculoprotective drugs. In a previous metaanalysis, ARBs were accused of increasing the risk of myocardial infarction, but a number of metaanalyses and randomised, controlled trials have disproved this hypothesis. In a recent metaanalysis, ARBs were associated with an increased risk of tumours. The author reviews this issue, discusses the flaws of the above metaanalysis and, on the basis of the most up-to-date data in the literature, expert opinions and official statements (FDA, EMA), concludes that members of this drug class should continue to be used according to their approved indications, which is supported by their cardio-, reno-, cerebro- and vasculoprotective effects demonstrated in a number of appropriate, large-scale clinical studies.]

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[INTRODUCTION - The reduction of need-adjusted inequalities in the use of healthcare results in higher efficiency and fairer allocation of resources. PATIENTS AND METHODS - Data for all patients who received inpatient care (same-day or hospital treatment) in 2007 were used in the analysis. Beyond the diagnostic and diagnosisrelated group’s weight information and the number of inpatient days, the patients’ record contained data on age, sex, and postal code of residency. Besides personal data, socio-economic characteristics and general indicators of healthcare capacity have been included in the applied multilevel statistical analysis. Inequalities were estimated for all patients, and separately for those treated for malignant tumour, cardio-vascular diseases, or other diseases. RESULTS - Significant regional inequalities were observed in one-day care but an order of magnitude less in longer inpatient care. Comparing the two major diagnostic groups, the inequalities were greater among patients with cardiovascular diseases than for those with cancer. Only a small fraction of the observed inequalities was explained by the differences in the composition of population of small regions. The inequalities in the use of healthcare were largely explained by socio-economic characteristics of the regions. CONCLUSIONS - Need-adjusted inequalities in the use of healthcare supported the hypothesis that efficiency of the Hungarian healthcare system can be significantly improved by allocating the available resources according to the patients’ need.]

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