An economic evaluation of an early palliative care intervention among patients with advanced cancer.

BACKGROUND: Early integration of palliative care into oncology care has shown positive effects on patient symptoms and quality of life. It may also reduce health care costs. However given the heterogeneity of settings and interventions and the lack of information on the minimally effective dose for influencing care utilisation and costs, it remains uncertain whether early palliative care reduces costs. OBJECTIVES: We sought to determine whether an early palliative care intervention integrated in usual oncology care in a Swiss hospital setting reduced utilisation and costs of health care in the last month of life when compared with usual oncology care alone. METHODS: We performed a cost-consequences analysis alongside a multicentre trial. We extracted costs from administrative health insurance data and health care utilisation from family caregiver surveys to compare two study arms: usual oncology care and usual oncology care plus the palliative care intervention. The intervention consisted of a single-structured, multiprofessional conversation with the patient about symptoms, end-of-life decisions, network building and support for carers (SENS). The early palliative care intervention was performed within 16 weeks of the diagnosis of a tumour stage not amenable or responsive to curative treatment. RESULTS: We included 58 participants with advanced cancer in our economic evaluation study. Median overall health care costs in the last month of life were 7892 Swiss Francs (CHF) (interquartile range: CHF 5637-13,489) in the intervention arm and CHF 8492 [CHF 5411-12,012] in the control arm. The average total intervention treatment cost CHF 380 per patient. Integrating an early palliative care intervention into usual oncology care showed no significant difference in health care utilisation or overall health care costs between intervention and control arms (p = 0.98). CONCLUSION: Although early palliative care is often presented as a cost-reducing care service, we could not show a significant effect of the SENS intervention on health care utilisation and costs in the last month of life. However, it may be that the intervention was not intensive enough, the timeframe too short or the study population too small for measurable effects. Patients appreciated the intervention. Single-structured early palliative care interventions are easy to implement in clinical practice and present low treatment costs. Further research about the economic impact of early palliative care should focus on extracting large, detailed cost databases showing potential shifts in cost and cost-effectiveness. CLINICAL TRIALS: gov Identifier: NCT01983956.

Establishment of a system to analyze effects of airborne ultra-fine particulate matter from brake wear on plants under realistic exposure conditions.

Research on airborne ultrafine particles (UFP) is driven by an increasing awareness of their potential effects on human health and on ecosystems. Brake wear is an important UFP source releasing largely metallic and potentially hazardous emissions. UFP uptake into plant tissues could mediate entry into food webs. Still, the effects of these particles on plants have barely been studied, especially in a realistic setting with aerial exposure. In this study, we established a system designed to mimic airborne exposure to ultrafine brake dust particles and performed experiments with the model species Arabidopsis thaliana. Using advanced analytical methods, we characterized the conditions in our exposure experiments. A comparison with data we obtained on UFP release at different outdoor stations showed that our controlled exposures are within the same order of magnitude regarding UFP deposition on plants at a traffic-heavy site. In order to assess the physiological implications of exposure to brake derived-particles we generated transcriptomic data with RNA sequencing. The UFP treatment led to diverse changes in gene expression, including the deregulation of genes involved in Fe and Cu homeostasis. This suggests a major contribution of metallic UFPs to the elicitation of physiological responses by brake wear derived emissions.

LASER treatment in gynaecology -A randomized controlled trial in women with symptomatic lichen sclerosus.

OBJECTIVE: Aim of our study was to evaluate the therapeutic effect of laser treatment in vulvar lichen sclerosus, mainly the reduction of existing symptoms as itching, burning and pain. We asked about the different outcome by using different application doses. STUDY DESIGN: We conducted a prospective randomized double-blind dose-controlled trial in our dysplasia unit specializing vulvar disorders. 67patients with active LS were included. LS was confirmed by biopsy or by the validated CSS (clinical scoring system of vulvar LS). Computer generated randomization resulted in two groups, each group received a different application dose.(LDG- low dose group, NDG- normal dose group) During the study period of 18 weeks all participants received three laser applications in three subsequent sessions of three weeks. Two follow-ups six and twelve weeks after the first application was performed. At every visit, the participants filled in the VAS (visual analogue scale) for recording the actual vulvar symptoms as itching burning or pain on a range from 0 to 10. RESULTS: Before treatment the mean VAS-Score was 4.3 (STD ± 2.4) in the NDG and 5.1(±2.6) in the LDG. After 18 weeks, the mean reduction was -2.4 (±2.3) for NDG and -2.7 (±2.8) for LDG. Four patients (two of each group) reported more pain after than before treatment. Both groups show significant lower VAS-Scores 18 weeks after the treatment than before therapy (p < 0.0001). The reduction of symptoms after 18 weeks between NDG and LDG was not significant (p = 0.6244). CONCLUSION: Laser treatment with the microablative CO2 laser leads to a significant improvement for symptoms of LS. A higher dosage of laser radiation shows no benefit concerning the symptoms. We have not observed any serious adverse events during this study.

Using critical flicker frequency in the evaluation of visual impairment in preeclamptic women.

OBJECTIVE: To assess critical flicker frequency (CFF) in normal uneventful pregnancy and preeclampsia. STUDY-DESIGN: Case-control observational study at the University Hospital Jena and Outpatient Institute for Prenatal Diagnosis and Preventive Medicine. 25 non-pregnant women, 75 uncomplicated pregnant women in first, second and third trimester, and 15 women with overt preeclampsia. For comparison with preeclamptic patients we matched 15 normal pregnant women (mNP) for age, parity, body mass index, current smoking and family history of cardiovascular disease (CVD). We measured CFF using the portable HEPAtonorm Analyzer (nevoLAB GmbH, Germany). This device generates a flickering red light, starting with a frequency of 60Hz, giving the subjective an impression of a steady light. The participant signifies once the impression of a flickering light is recognized, and this CFF is recorded. Mean CFF and standard deviation is automatically calculated. Statistical analysis was performed using SPSS Version 22 for Windows. Following assessment of normal distribution with Kolmogorov-Smirnow test, comparisons were made with univariate and multivariate ANOVA and with unpaired and paired t test for continuous data and with χ2 test for categorical data. RESULTS: Critical flicker frequency in healthy pregnant women does not differ from nonpregnant women. No significant differences in CFF measurements exist in first, second, and third trimester. In preeclampsia, CFF is significantly decreased compared to normal pregnant women (PE 38.80±2.16 vs. mNP 46.23±3.37; p=0.000). This alteration persists even some weeks postpartum (PE 41.17±1.13 vs. mNP 46.45±3.44; p=0.003). CONCLUSION: In preeclamptic women, CFF is decreased indicating an altered endothelial situation. The finding that CFF remains reduced postpartum may be explained by either the effect of preeclampsia on maternal endothelium causing longer lasting damage or indicate a preexisting endothelial disorder. Up to this point, precise responsible mechanisms for altered CFF in preeclampsia are currently unclear and further studies are needed.

Determination of traffic-related palladium in tunnel dust and roadside soil.

Roadside dust and soil samples were collected at different sites in the area of Ulm and Munich in Germany. Road dust samples were collected in tunnels where the traffic-related dust is less influenced by atmospheric conditions. Soil samples were taken with a drill bar at varying distances to motorways, district and regional roads with different traffic densities. The soil cylinders of 30cm length were divided into four sections in order to obtain depth profiles for palladium (Pd) distribution. Determination of Pd in total digests of the samples was performed by ligand-assisted selective separation and preconcentration of Pd(II) using solid phase extraction followed by high-resolution continuum source graphite furnace spectrometry. The analytical procedure was successfully validated using the certified reference material BCR-723 Road Tunnel Dust and by recovery experiments in spiked soil samples. The average Pd concentration found in the road dusts was 311µgkg-1, the maximum Pd concentration in the topsoil layer was 193µgkg-1. Pd depth profiles reveal transportation of Pd into deeper soil layers, where even at a depth of 25 to 30cm a Pd concentration of 19µgkg-1 was found, proving the high mobility of Pd. Different factors like traffic density and age of the soils are discussed in the context of the found Pd depth profiles.

Pd-nanoparticles cause increased toxicity to kiwifruit pollen compared to soluble Pd(II).

In the present study, endpoints including in vitro pollen performance (i.e., germination and tube growth) and lethality were used as assessments of nanotoxicity. Pollen was treated with 5-10 nm-sized Pd particles, similar to those released into the environment by catalytic car exhaust converters. Results showed Pd-nanoparticles altered kiwifruit pollen morphology and entered the grains more rapidly and to a greater extent than soluble Pd(II). At particulate Pd concentrations well below those of soluble Pd(II), pollen grains experienced rapid losses in endogenous calcium and pollen plasma membrane damage was induced. This resulted in severe inhibition and subsequent cessation of pollen tube emergence and elongation at particulate Pd concentrations as low as 0.4 mg L(-1). Particulate Pd emissions related to automobile traffic have been increasing and are accumulating in the environment. This could seriously jeopardize in vivo pollen function, with impacts at an ecosystem level.