Principles and Practice of Clinical Research

Costs and economic impacts of type-1 diabetes from the dominican patient perspective

Anthony Gutierrez Martinez — 2021-07-12

Objective: Estimate the economic burden of type 1 diabetes (T1D) in the Dominican Republic and its impact on treatment adherence and patients’ quality of life (QoL).

Materials and Methods: Cross-sectional observational study about T1D treatment cost and adherence plus patients QoL. The total monthly cost of treatment regimes was calculated through microcosting analysis and correlated with a national minimum wage (NMW) and average household income. Sociodemographic, clinical, treatment adherence, and QoL data were obtained through an online questionnaire. In an exploratory approach, all variables were compared with the categorization of household income.

Results: Fixed doses (FD) regime has the lowest cost (46% of the NMW) and continuous subcutaneous insulin infusion (CSII) the highest (540% of the NMW). The lower household income group had less insurance coverage (P= 0.034), purchased fewer diabetes management supplies for cost-related reasons (P= 0.014), performed less glycemic monitoring (P= 0.016), and had more cost-related factors limiting appropriate treatment and follow-up (P= 0.030). Also, the FD treatment modality predominated in this group, while Multiple Daily Injections and constant subcutaneous insulin injection prevailed in the higher income group (P= 0.005). The QoL mean scores were 31.63 (SD 8.02) in the lower-income group and 32.52 (SD 8.81) in the higher-income one.

Conclusions: T1D has a high monthly economic impact, potentially worsening treatment adherence and QoL, especially in the lower socioeconomic status population. Efforts must be made by the healthcare system to enhance the economic support and management of this disease.

KEYWORDS: Type 1 diabetes, Microcosting, Dominican Republic, Public Health, Treatment adherence.

The NEAT Study (Novel ElectroAcupuncture) - Electroacupuncture After Laparoscopic Colon Cancer Resection: Thinking Outside The Box.

Carolina Vigna — 2021-07-14

Introduction: Colorectal cancer is the second leading cause of cancer-related death in the US; complete surgical resection is the only curative treatment for non-metastatic colorectal cancer (NMCC). Postoperative ileus (POI) frequently increases patient morbidity and healthcare costs. Enhanced recovery after surgery (ERAS) protocol is the standard of care in most institutions and has been shown to reduce postoperative complications, but there is no a completely effective treatment for this condition. Studies suggest that electroacupuncture (EA) can improve gastrointestinal tract function after surgery.

Objective: We aim to determine if including EA in the standard treatment of POI decreases the time to the first defecation, enhancing the return of normal bowel function after colon resection for NMCC.

Methods: We propose a phase II, single-center, randomized, triple-blinded, sham-controlled trial with two parallel arms and a 1:1 allocation ratio. Patients 40-80 years of age diagnosed with NMCC scheduled to undergo laparoscopic surgery for colon cancer resection will be included. The arms will be EA + standard treatment and sham EA + standard treatment. The standard treatment will follow the ERAS protocol.

Discussion: This will be the first randomized clinical trial to evaluate the impact of using EA along with the ERAS protocol for POI. This intervention may reduce patient morbidity and improve healthcare costs associated with the disease.

Maximizing learning in online courses using critical thinking, project-based learning, and flipped classroom approaches

Joao Arantes — 2021-08-10

Abstract:

Introduction: In this article, we present our findings regarding the lessons learned by using critical thinking, project-based learning, and flipped classroom educational approaches in an online course. The course, "Systems Thinking," was delivered to 20 graduate students during the Covid pandemic, in the second semester of 2020. The students worked in project teams to create short videos that analyzed the dynamics present in different real-life systems. The objective is to determine the effects of combining critical thinking, project-based learning, and flipped classrooms to maximize learning.

Methods: We followed a convergent parallel mixed-method approach. The quantitative data was collected through two multiple-choice tests (pre-test and a post-test). The qualitative data was collected from students' discussion forums and students' projects. We also collected data employing one questionnaire sent at the end of the course. The data were analyzed following a systemic approach.

Results: The course design led to the development of five interconnected dynamics that favored the learning. The flipped classroom made the synchronous meetings more effective. The way the synchronous meetings were conducted (using different learning tools, tests as extrinsic motivators, and praising the students' achievements) kept the students motivated to learn. The discussion forum fostered critical thinking and the project-based learning approach gave opportunities to the students to learn by doing.

Conclusions: The combination of critical thinking, project-based learning, and flipped classroom can be a very effective way of enhancing the learning experience in online courses.

Keywords: critical thinking, project-based learning, flipped classroom, systems thinking, learning