Using an economic evaluation approach to support specialist nursing services for people with Parkinson's in a regional community.

AIM: This study aims to provide economic evidence of the cost-effectiveness of employing specialist Parkinson's nurses in a regional community in Australia. STUDY DESIGN: This retrospective study utilized hospital service usage data to compare outcomes for people with Parkinson's disease before and after the employment of a specialist Parkinson's nurse in a regional community. METHODS: A representative sample was drawn from the target population of people with a diagnosis of Parkinson's admitted to a regional hospital over a 4-year period (2013-2014 and 2016-2017). A multiple regression approach and cost-benefit analysis were used to examine hospital costs related to length of stay based on hospital records. All costs were attributed to resource allocation according to service category and the national funding system. Quantitative data were analysed using Strata Analytics. RESULTS: Statistical findings demonstrated a reduction in hospital length of stay ranging from 0.37 (AUD$1924) to 0.755 day (AUD$3926) after the establishment of the specialist Parkinson's nurse. The cost-benefit analysis showed a net dollar benefit, or savings in hospital costs, of up to $8600.00 per person over a 3-year period, as a result of the specialist Parkinson's nurse intervention. CONCLUSION: The statistical results show significant cost benefits associated with reduced length of hospital stay following introduction of the specialist Parkinson's nurse. These findings support advocacy for sustainable specialist Parkinson's nurse positions and have the potential to inform and influence policy and systemic changes within the health care system. IMPACT: The benefits of embedding specialist nursing services for people with Parkinson's disease in primary health settings include the direct impact on the potential to avoid hospital admissions due to worsening symptoms, improving quality of life for the person with Parkinson's and slowing the trajectory of the disease. Additional benefits are increased access to specialist services and reduced family caregiver burden.

Dopamine D1 Receptor Agonist PET Tracer Development: Assessment in Nonhuman Primates.

Non-catechol-based high-affinity selective dopamine D1 receptor (D1R) agonists were recently described, and candidate PET ligands were selected on the basis of favorable properties. The objective of this study was to characterize in vivo in nonhuman primates 2 novel D1R agonist PET radiotracers, racemic 18F-MNI-800 and its more active atropisomeric (-)-enantiomer, 18F-MNI-968. Methods: Ten brain PET experiments were conducted with 18F-MNI-800 on 2 adult rhesus macaques and 2 adult cynomolgus macaques, and 8 brain PET experiments were conducted with 18F-MNI-968 on 2 adult rhesus macaques and 2 adult cynomolgus macaques. PET data were analyzed with both plasma-input-based methods and reference-region-based methods. Whole-body PET images were acquired with 18F-MNI-800 from 2 adult rhesus macaques for radiation dosimetry estimates. Results:18F-MNI-800 and 18F-MNI-968 exhibited regional uptake consistent with D1R distribution. Specificity and selectivity were demonstrated by dose-dependent blocking with the D1 antagonist SCH-23390. 18F-MNI-968 showed a 30% higher specific signal than 18F-MNI-800, with a nondisplaceable binding potential of approximately 0.3 in the cortex and approximately 1.1 in the striatum. Dosimetry radiation exposure was favorable, with an effective dose of about 0.023 mSv/MBq. Conclusion:18F-MNI-968 has significant potential as a D1R agonist PET radiotracer, and further characterization in human subjects is warranted.

Improving the accuracy of weight status assessment in infancy research.

Both researchers and primary care providers vary in their methods for assessing weight status in infants. The purpose of the present investigation was to compare standing-height-derived to recumbent-length-derived weight-for-length standardized (WLZ) scores, using the WHO growth curves, in a convenience sample of infants who visited the lab at 18 and 21 months of age. Fifty-eight primarily White, middle class infants (25 girls) from a semi-rural region of southern Appalachia visited the lab at 18 months, with 45 infants returning 3 months later. We found that recumbent-length-derived WLZ scores were significantly higher at 18 months than corresponding standing-height-derived WLZ scores. We also found that recumbent-length-derived WLZ scores, but not those derived from standing height measures, decreased significantly from 18 to 21 months. Although these differential results are attributable to the WHO database data entry syntax, which automatically corrects standing height measurements by adding 0.7 cm, they suggest that researchers proceed cautiously when using standing-height derived measures when calculating infant BMI z-scores. Our results suggest that for practical purposes, standing height measurements may be preferred, so long as they are entered into the WHO database as recumbent length measurements. We also encourage basic science infancy researchers to include BMI assessments as part of their routine assessment protocols, to serve as potential outcome measures for other basic science variables of theoretical interest.