[Comparing case management care models for people with dementia and their caregivers: the design of the COMPAS study]. / Implementatie, effecten en kosten van casemanagement voor mensen met dementie en hun mantelzorgers: beschrijving van de COMPAS studie.

BACKGROUND: Dementia care in The Netherlands is shifting from fragmented, ad hoc care to more coordinated and personalized care. Case management contributes to this shift. The linkage model and a combination of intensive case management and joint agency care models were selected based on their emerging prominence in The Netherlands. It is unclear if these different forms of case management are more effective than usual care in improving or preserving the functioning and well-being at the patient and caregiver level and at the societal cost. OBJECTIVE: The objective of this article is to describe the design of a study comparing these two case management care models against usual care. Clinical and cost outcomes are investigated while care processes and the facilitators and barriers for implementation of these models are considered. DESIGN: Mixed methods include a prospective, observational, controlled, cohort study among persons with dementia and their primary informal caregiver in regions of The Netherlands with and without case management including a qualitative process evaluation. Community-dwelling individuals with a dementia diagnosis with an informal caregiver are included. The primary outcome measure is the Neuropsychiatric Inventory for the people with dementia and the General Health Questionnaire for their caregivers. Costs are measured from a societal perspective. Semi-structured interviews with stakeholders based on the theoretical model of adaptive implementation are planned. RESULTS: 521 pairs of persons with dementia and their primary informal caregiver were included and are followed over two years. In the linked model substantially more impeding factors for implementation were identified compared with the model. DISCUSSION: This article describes the design of an evaluation study of two case management models along with clinical and economic data from persons with dementia and caregivers. The impeding and facilitating factors differed substantially between the two models. Further results on cost-effectiveness are expected by the beginning of 2015. This is a Dutch adaptation of MacNeil Vroomen et al., Comparing Dutch case management care models for people with dementia and their caregivers: The design of the COMPAS study.

Dr. Emil Flusser: forgotten precursor of the medical peace movement.

In 1932 the Bohemian paediatrician Emil Flusser published a book in which he argued that war was the result of a psychic epidemic, and that its prevention was a task for the medical profession. Einstein supported Flusser by writing a foreword to the work. The burning of the book in 1933 by the Nazis was followed by that of the author and his family in 1942. Both events help to explain the total oblivion which has befallen this early proposal for a medical peace movement.

Joseph Rivière: physician and peaceworker.

In 1905, Dr Joseph Rivière, a graduate of the Paris Medical Faculty, founded the International Medical Association against War (IMAW). By 1914 IMAW had members in over 40 countries. This paper looks at the work of Dr Rivière, both as physician and peaceworker.

Monocyte chemotactic properties in hereditary hemochromatosis.

Several observations indicate that the innate metabolic defect in hereditary hemochromatosis (HH) leads to a defective function of the monocyte-macrophage system. The present study was performed to investigate the possibility that a defect in migration of cells of the monocyte-macrophage system can explain the abnormal location of the submucosal macrophages in HH. Monocytes isolated from 14 patients with HH were investigated with regard to chemotactic responsiveness (MCR). Two different methods were used at two different laboratories. Casein and zymosan-activated serum were used as attractants. No difference in MCR was found between the control group and the group of HH patients. The conclusion can therefore be drawn that the abnormal location of the macrophages of the gut wall in HH cannot be explained by an inborn abnormality of the function of receptors responsible for the chemotactic activity of the monocyte-macrophage system. It is, however, still possible that local factors responsible for the macrophage migration (gut hormones?) may have defective activity in HH patients.

Transferrin receptors on circulating monocytes in hereditary haemochromatosis.

In patients with hereditary haemochromatosis (HH) abnormal functional properties of the macrophage system have been observed. The present study is a preliminary report of increased transferrin receptor expression on monocytes from 12 patients with HH. There was no correlation between the degree of iron overload and the transferrin receptor expression on the monocytes. The results obtained thus indicate that the observed increase in transferrin receptors is not a secondary phenomenon due to systemic iron overload but could be an expression of a primary inborn error of iron metabolism in HH. The functional aspects of the receptors were not evaluated as they were analyzed by means of monoclonal antibody technique.