Cost-effectiveness of a specialist palliative care nurse-patient consultation followed by an interprofessional case conference for patients with non-oncological palliative care needs: results of the KOPAL trial.

BACKGROUND: Worldwide, progressive chronic, non-malignant diseases are highly prevalent. Especially with increasing age, they are characterised by high hospitalisation rates and high healthcare costs. Improved interprofessional collaboration between general practitioners (GPs) and specialist palliative home care (SPHC) teams might reduce hospitalisation while improving symptoms and quality of life, or preventing them from deterioration. The aim of this study was to examine the cost-effectiveness of a newly developed intervention in patients with advanced chronic, non-malignant diseases consisting of a structured palliative care nurse-patient consultation followed by an interprofessional telephone case conference. METHODS: The analysis was based on data from 172 participants of the KOPAL multi-centre, cluster randomised controlled trial. Patients with advanced congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), or dementia were randomised into intervention group (IG) and control group (CG, usual care). Cost-effectiveness was examined over 48 weeks from a societal and healthcare payer's perspective. Effects were quantified as quality-adjusted life years (QALYs, EQ-5D-5L). Incremental cost-effectiveness ratios were calculated and cost-effectiveness acceptability curves were constructed. RESULTS: Baseline imbalances in costs and effects could be observed between IG and CG. After adjusting for these imbalances and compared to the CG, mean costs in the IG were non-significantly higher from a societal and lower from a payer's perspective. On the effect side, the IG had marginally lower mean QALYs. The results were characterized by high statistical uncertainty, indicated by large confidence intervals for the cost and effect differences between groups and probabilities of cost-effectiveness between 18% and 65%, depending on the perspective and willingness-to-pay. CONCLUSIONS: Based on the results of this study, the cost-effectiveness of the KOPAL intervention was uncertain. The results highlighted (methodological) challenges of economic evaluations in patients with chronic, non-malignant diseases related to sample size, heterogeneity of participants, and the way the intervention effectiveness is typically captured in economic evaluations.

Inefficient resource allocation is associated with reduced alpha activity in parietal regions in individuals with Parkinson's disease.

The brain's ability to act as an input filter and to suppress actions is crucial to navigate everyday life and impairments in these abilities affect quality of life substantially. Although Parkinson's disease (PD) is primarily known as a movement disorder, recent research has redefined it as a multisystem disorder affecting cognition, in particular inhibitory control and attentional resource allocation. Analysing the neural mechanisms underlying this cognitive deficit provides a better understanding of brain changes observed in patients affected by PD. Therefore, this study aimed to identify resource allocation to relevant and irrelevant stimuli in patients affected by PD. Besides neuropsychological tests, we employed electroencephalographic recordings during an auditory oddball paradigm in 13 patients suffering from idiopathic PD and 11 healthy controls (HC). Participants were instructed to ignore the standard stimulus and to respond as fast as possible to the rarely presented target tone. Event-related potentials (ERP) and time-frequency representations (TFR) were analyzed. Patients affected by PD showed faster response latencies to the task-irrelevant standard tones, but slower response latencies to target tones compared to HC. This observation was prominent at frontal sites during later P3-like processing stages. Reaction time, however, was prolonged in patients with PD, suggesting inefficient resource allocation. Additionally, TFR revealed reduced parietal alpha activity, which is associated with distractor suppression and functional inhibition in patients with PD compared to healthy controls. Thus, our results point towards inefficient resource allocation in patients with PD possibly driven by less functional inhibition through parietal alpha activity.

Endosulfan and gamma-HCH in the arctic: an assessment of surface seawater concentrations and air-sea exchange.

Arctic seawater concentrations of two currently used pesticides, endosulfan and gama-HCH, were collated from a variety of cruises undertaken throughout the 1990s up to 2000 for different regions of the Arctic Ocean. Surface seawater concentrations for alpha- and beta-endosulfan ranged from <0.1-8.8 (mean 2.3) pg/L and 0.1-7.8 (mean 1.5) pg/L, while gamma-HCH concentrations were approximately 100 fold higher than alpha-endosulfan, ranging between <0.70 and 894 (mean 250) pg/L. Geographical distributions for alpha-endosulfan revealed the highest concentrations in the western Arctic, specifically in the Bering and Chukchi Seas with lowest levels toward the central Arctic Ocean. In contrast, gamma-HCH revealed higher concentrations toward the central Arctic Ocean, with additional high concentrations in the coastal regions near Barrow, Alaska and the White Sea in northwest Russia, respectively. A fugacity approach was employed to assess the net direction of air-water transfer of these two pesticides, using coupled seawater and air concentrations. For alpha-endosulfan, water-air fugacity ratios (FR) were all <1 indicating net deposition to all regions of the Arctic Ocean, with the lowest values (0.1-0.2) evident in the Canadian Archipelago. Given the uncertainty in the temperature-adjusted Henry's Law constant (factor approximately10), it is plausible that equilibrium may have been reached for this compound in the western fringes of the Arctic Ocean where the highest water concentrations were observed. Similarly, FR values for gamma-HCH were generally <1 and in agreement

NOPPAIN: a nursing assistant-administered pain assessment instrument for use in dementia.

The Non-Communicative Patient's Pain Assessment Instrument (NOPPAIN) is a nursing assistant-administered instrument for assessing pain behaviors in patients with dementia. This study investigated the validity of the NOPPAIN. Twenty-one nursing assistants (NAs) with no prior training in using the NOPPAIN watched six videos, each portraying a bed-bound patient with severe dementia receiving personal care from a nursing assistant and responding with a different level of pain intensity. The NAs completed a NOPPAIN rating for each video. The NAs were also presented with each possible pair of videos and asked to identify the video showing the most pain. Results indicated the NAs were quite accurate in their ratings of the videos, providing excellent preliminary evidence on the use of the NOPPAIN for detecting pain in nursing home patients with dementia.