The use of humour in diversional therapy

Humour is a natural phenomenon that every human being possesses. But humour is often not fully utilized and often taken for granted. It is only recently that there has been an upsurge in research in the area of humour that has began to highlight and prove the many benefits that come from its effective utilization. Although humour is a natural phenomenon, there are times in our lives when humour needs to be formally initiated such as in times of illness. Diversional Therapists because of the nature of their work, have ample opportunities to initiate humour. Humour is one of the many tools diversional therapists can use to increase the effectiveness of their activities programmes. This paper examines the definitions of humour and laughter, the beneficial functions of humour, why the use of humour is important in diversional therapy practice and the applications of humour in practice. The paper aims to give diversional therapists background information about humour, highlight the many benefits of humour and give some practical ideas of how humour can be formally incorporated into their diversional therapy programmes. It is envisaged that this paper will increase diversional therapists knowledge of humour, encourage the use of formal humour programmes with clients and encourage diversional therapists to research the various ways of using humour in their practice

Global Alliance for Chronic Disease researchers' statement on multimorbidity

Comment -No Abstract available

Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Sustainable policy:Higher medication use & adherence during reimbursement of pharmacologic smoking cessation treatments

Background: The discussion on the reimbursement of Smoking Cessation Treatment (SCT) has known many stages in The Netherlands. From January 2011, SCTs were reimbursed, until January 2012 when the reimbursement of nicotine replacement therapies (NRTs) and pharmacotherapeutic SCT (pSCT) was discontinued. As of 2013, NRTs and pSCTs were again reimbursed for a maximum of one attempt per calendar year, provided they are accompanied by behavioural counselling. Objectives: To assess the impact of changes in reimbursement policy of pSCT on use and adherence. Methods: A retrospective dispensing database analysis was performed on real-world observational data from the years 2010-2013 in The Netherlands. Data on use and adherence was collected, in patients who were dispensed bupropion or varenicline in community pharmacies for the first time. Adherence was defined a using minimal 80% of the in guidelines recommended duration and intensity of use. Results: The study cohort consisted of 4,412 users of pSCT. The number of prescriptions was stable at 0.5 prescriptions per 1,000 inhabitants (dispensing prevalence, dp) during 2010. The prevalence was on average 0.8 dp, with peaks in the the 1st and 4th quarters of 2011. In 2012, the prevalence was stable at 0.4 dp. In 2013 was on average 0.5 dp, with a small peak in the 1st quarter. Adherence was 18% in 2010 and 2012 (non-reimbursement period), and 21% in 2011 and 2013 (reimbursement period). Conclusions: Not only the likelihood of starting smoking cessation, but also the extent of adherence to pharmacologic smoking cessation is higher during reimbursement. Increasing the awareness of health care providers on adherence issues is warranted

Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD

Contains fulltext : 175759.pdf (publisher's version ) (Open Access)BACKGROUND: COPD often coexists with chronic conditions that may influence disease prognosis. We investigated associations between chronic (co)morbidities and exacerbations in primary care COPD patients. METHOD: Retrospective cohort study based on 2012-2013 electronic health records from 179 Dutch general practices. Comorbidities from patients with physician-diagnosed COPD were categorized according to International Classification of Primary Care (ICPC) codes. Chi-squared tests, uni- and multivariable logistic, and Cox regression analyses were used to study associations with exacerbations, defined as oral corticosteroid prescriptions. RESULTS: Fourteen thousand six hundred three patients with COPD could be studied (mean age 67 (SD 12) years, 53% male) for two years. At baseline 12,826 (88%) suffered from >/=1 comorbidities, 3263 (22%) from >/=5. The most prevalent comorbidities were hypertension (35%), coronary heart disease (19%), and osteoarthritis (18%). Several comorbidities showed statistically significant associations with frequent (i.e., >/=2/year) exacerbations: heart failure (odds ratio [OR], 95% confidence interval: 1.72; 1.38-2.14), blindness & low vision (OR 1.46; 1.21-1.75), pulmonary cancer (OR 1.85; 1.28-2.67), depression 1.48; 1.14-1.91), prostate disorders (OR 1.50; 1.13-1.98), asthma (OR 1.36; 1.11-1.70), osteoporosis (OR 1.41; 1.11-1.80), diabetes (OR 0.80; 0.66-0.97), dyspepsia (OR 1.25; 1.03-1.50), and peripheral vascular disease (OR 1.20; 1.00-1.45). From all comorbidity categories, having another chronic respiratory disease beside COPD showed the highest risk for developing a new exacerbation (Cox hazard ratio 1.26; 1.17-1.36). CONCLUSION: Chronic comorbidities are highly prevalent in primary care COPD patients. Several chronic comorbidities were associated with having frequent exacerbations and increased exacerbation risk

The economic impact of COPD in patients of working age: Results from 'COPD uncovered' the Netherlands

OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) poses a significant burden on health care budgets. The impact of impaired and lost productivity is less known. The aim of this study was to explore the economic burden of COPD in patients of working age in The Netherlands across three areas: health care utilization, impaired productivity and lost productivity resulting from early retirement due to COPD. METHODS: Dutch direct medical costs were derived from a literature review and applied to individual COPD patients. Costs of productivity impairment due to COPD were estimated from the 'COPD uncovered' survey, adopted for The Netherlands. Costs due to lost productivity due to early retirement were based on a cohort of COPD patients of working age followed in a Markov model for 20 years until (early) retirement or death. The costing year was 2011. RESULTS: The annual health care costs for patients with COPD aged 45-64 years in The Netherlands were estimated at around €70 million. The annual impaired productivity costs were €120 million. Lost productivity due to early retirement were estimated at around €510 million per year; the majority of €350 million for men and €160 million for women. These lost productivity costs represented 21% of the productivity that may have been generated by COPD patients if they had not retired early. CONCLUSIONS: The 'COPD UNCOVERED' model was used to estimate the economic burden of COPD in The Netherlands. Costs due to impaired and lost productivity in COPD patients of working age was considerable and several times higher than the medical cost of COPD. Young working population provide a main target for interventions aimed to improve COPD disease management

Urging Europe to put non-adherence to inhaled respiratory medication higher on the policy agenda: a report from the First European Congress on Adherence to Therapy

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Cost-effectiveness of increasing statin adherence for primary and secondary prevention in community pharmacies

Objectives: Therapy persistence is important to achieve optimal clinical benefits of statin therapy. The aim of this study was to determine the cost-effectiveness of pharmaceutical care in community pharmacies, aimed to increase persistence with statin therapy for both primary and secondary prevention of cardiovascular events (CVEs). Methods: The effectiveness of the Dutch pharmaceutical care program MeMO on improving statin therapy persistence was measured in 500 patients and compared to 502 control patients. Time-investments of the program were also collected. Markov models with lifelong time-horizons were developed to estimate the influence of the program on CVEs: Stroke, myocardial infarction (MI), revascularization and mortality. The efficacy of statins, taken from large clinical trials in primary and secondary prevention, were adjusted for therapy persistence. A Dutch health care provider's perspective was adopted for the analysis and probabilistic sensitivity analyses were performed. Results: Patients in the MeMO program had a lower risk for non-persistence, RR = 0.50 (0.40-0.63), the effect was similar in primary and secondary prevention. In a cohort of 1,000 patients, 60% of whom had a history of CVE, the MeMO program resulted in a reduction of 8 non-fatal strokes 2 fatal strokes, 16 non-fatal MIs, 7 fatal MIs and 14 revascularizations. Additional medication, disease management and intervention costs in the MeMO program were € 375,000; the cost-savings due to reduced CVEs were € 450,000. Thus, the MeMO program resulted in 83 quality-adjusted life-years (QALYs) gained and cost-savings of € 75,000. Clinical benefits and cost-savings were highest in the secondary prevention population. Conclusions: Pharmaceutical care in community pharmacies can improve statin therapy persistence, resulting in more optimal prevention of CVEs. The MeMO program resulted in considerable clinical benefits and overall cost-savings. Persistence and adherence improving programs in community pharmacies may provide good value for money and health care insurers should consider reimbursing these activities in The Netherlands