Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain.

Cost-effectiveness is a major criterion underpinning decisions in mainstream health care. Acupuncture is increasingly used in patients with chronic lower back pain (LBP), but there is a lack of evidence on cost-effectiveness. The objective of this study was to assess the cost-effectiveness of acupuncture in alleviating chronic LBP either alone or in conjunction with standard care compared with patients receiving routine care, and/or sham. To determine effectiveness, we undertook meta-analyses which found a significant improvement in pain in those receiving acupuncture and standard care compared with those receiving standard care alone. For acupuncture and standard care vs. standard care and sham, a weak positive effect was found for weeks 12 to 16, but this was not significant. For acupuncture alone vs. standard care alone, a significant positive effect was found at week 8, but not at weeks 26 or 52. The main outcome parameters for our cost-effectiveness analysis were the incremental cost-effectiveness ratio (ICER) of acupuncture treatment presented as cost (A$) per disability-adjusted life-year (DALY) saved. The WHO benchmark for a very highly cost-effective intervention is one that costs less than gross domestic product per capita per quality-adjusted life-year (QALY) gained or DALY averted, or less than around $A52,000 in 2009 (the base year for the analysis). According to this threshold, acupuncture as a complement to standard care for relief of chronic LBP is highly cost-effective, costing around $48,562 per DALY avoided. When comorbid depression is alleviated at the same rate as pain, cost is around $18,960 per DALY avoided. Acupuncture as a substitute for standard care was not found to be cost-effective unless comorbid depression was included. According to the WHO cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic LBP.

Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program.

INTRODUCTION: Significant physical sequelae exist for some survivors of a critical illness. There are, however, few studies that have examined specific interventions to improve their recovery, and none have tested a home-based physical rehabilitation program incorporating trainer visits to participants' homes. This study was designed to test the effect of an individualised eight-week home-based physical rehabilitation program on recovery. METHODS: A multi-centre randomised controlled trial design was used. Adult intensive care patients (length of stay of at least 48 hours and mechanically ventilated for 24 hours or more) were recruited from 12 Australian hospitals between 2005 and 2008. Graded, individualised endurance and strength training intervention was prescribed over eight weeks, with three physical trainer home visits, four follow-up phone calls, and supported by a printed exercise manual. The main outcome measures were blinded assessments of physical function; SF-36 physical function (PF) scale and six-minute walk test (6MWT), and health-related quality of life (SF-36) conducted at 1, 8 and 26 weeks after hospital discharge. RESULTS: Of the 195 participants randomised, 183, 173 and 161 completed the 1, 8 and 26 weeks assessments, respectively. Study groups were similar at Week 1 post-hospital; for the intervention and control groups respectively, mean norm-based PF scores were 27 and 29 and the 6MWT distance was 291 and 324 metres. Both groups experienced significant and clinically important improvements in PF scores and 6MWT distance at 8 weeks, which persisted at 26 weeks. Mixed model analysis showed no significant group effects (P = 0.84) or group by time interactions (P = 0.68) for PF. Similar results were found for 6MWT and the SF-36 summary scores. CONCLUSIONS: This individualised eight-week home-based physical rehabilitation program did not increase the underlying rate of recovery in this sample, with both groups of critically ill survivors improving their physical function over the 26 weeks of follow-up. Further research should explore improving effectiveness of the intervention by increasing exercise intensity and frequency, and identifying individuals who would benefit most from this intervention. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register ACTRN12605000166673.

Economic impact of primary open-angle glaucoma in Australia.

BACKGROUND: Glaucoma is the World's leading cause of irreversible blindness, and poses serious public health and economic concerns. DESIGN: Review. SAMPLES: Published randomized trials and population-based studies since 1985. METHODS: We report the economic impact of primary open-angle glaucoma and model the effect of changes in detection rates and management strategies. MAIN OUTCOME MEASURES: The cost-effectiveness of different interventions to prevent vision loss from primary open-angle glaucoma was measured in terms of financial cost (Australian dollars) and disability-adjusted life years. RESULTS: The prevalence of glaucoma in Australia is expected to increase from 208 000 in 2005 to 379 000 in 2025 because of the aging population. Health system costs over the same time period are estimated to increase from $AU355 million to $AU784 million. Total costs (health system costs, indirect costs and costs of loss of well-being) will increase from $AU1.9 billion to $AU4.3 billion in Australia. CONCLUSION: Primary open-angle glaucoma poses a significant economic burden, which will increase substantially by 2025. This dynamic model provides a valuable tool for ongoing policy formulation and determining the economic impact of interventions to better prevent visual impairment and blindness from glaucoma.

Coronary Health Improvement Project (CHIP) is associated with improved nutrient intake and decreased depression.

OBJECTIVE: We evaluated the efficacy of the Coronary Health Improvement Project (CHIP) at lowering depression by modifying selected daily nutrients from food. METHODS: A randomized controlled trial was used, with 348 participants 24 to 81 y of age from metropolitan Rockford, Illinois. Participants were assessed at baseline and at 6 wk and 6 mo of follow-up. The Beck Depression Inventory (BDI) was used to measure depression. RESULTS: Those in the intervention group compared with the control group were 63% more likely to show a decrease in BDI through 6 wk (P < 0.0001) and 34% more likely to experience a decrease through 6 mo (P < 0.0001). Baseline levels of saturated fat were negatively associated with BDI (P < 0.0001) after adjusting for age, sex, exercise, body mass index, and exercise. Decrease in saturated fat over the study period was directly associated with a decrease in BDI. Increase in pyridoxine (B6) was also associated with a decrease in BDI. The intervention indirectly lowered BDI by lowering saturated fat and increasing dietary pyridoxine (B6). It also directly lowered BDI, possibly because of social interaction, positive reinforcement, and distraction. CONCLUSION: The CHIP, which improves daily nutrients from food and cardiovascular risk factors, also lowers depression.

An introduction to stomas: reasons for their formation.

The word 'stoma' comes from the Greek word meaning 'mouth' or 'opening'. Three types of stoma are discussed in this article: colostomy, ileostomy and ileal conduit. All are involved in the elimination of either faeces or urine.

How increased nurse prescribing can improve stoma care practice.

Stoma care nurse specialists have a comprehensive knowledge of the range and use of stoma-related products, yet few are actually nurse prescribers. This article looks at why stoma care nurse specialists should consider becoming nurse prescribers and also examines ways to assist prescribing decisions.