Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free

Objectives: To estimate the cost-effectiveness of an adjuvant treatment course of spa treatment compared with usual care only in patients with fibromyalgia syndrome (FM). - \ud Methods: 134 patients with FM, selected from a rheumatology outpatient department and from members of the Dutch FM patient association were randomly assigned to a 2½ week spa treatment course in Tunisia or to usual care only. Results are expressed as quality-adjusted life years (QALYs) for a 6-month as well as a 12-month time horizon. Utilities were derived form the Short Form 6D (SF-6D) scores and the visual analogue scale (VAS) rating general health. Costs were reported from societal perspective. Mean incremental cost per patient and the incremental cost utility ratio (ICER) were calculated; 95% confidence intervals (CIs) were estimated using double-sided bootstrapping. -\ud Results: The data of 128 (55 spa and 73 controls) of the 134 patients (96%) could be used for analysis. Improvement in general health was found in the spa group until 6 months of follow-up by both the SF-6D (AUC 0.32 vs 0.30, P<0.05) and the VAS (AUC 0.23 vs 0.19, P<0.01). After 1yr no significant between-group differences were found. Mean incremental cost of spa treatment was E1311 per patient (95% CI 369–2439), equalling the cost of the intervention (thalassotherapy including airfare and lodging), or E885 per patient based on a more realistic cost estimate. -\ud Conclusions: The temporary improvement in quality of life due to an adjuvant treatment course of spa therapy for patients with FM is associated with limited incremental costs per patient

Psychological contract development: An integration of existing knowledge to form a temporal model

The psychological contract has received substantial theoretical attention over the past two decades as a popular framework within which to examine contemporary employment relationships. Previous research mostly examines breach and violation of the psychological contract and its impact on employee organization outcomes. Few studies have employed longitudinal, prospective research designs to investigate the psychological contract and as a result, psychological contract content and formation are incompletely understood. It is argued that employment relationships may be better proactively managed with greater understanding of formation and changes in the psychological contract. We examine existing psychological contract literature to identify five key factors proposed to contribute to the formation of psychological contracts. We extend the current research by integrating these factors for the first time into a temporal model of psychological contract development

An adequate strategy for the thermodilution technique in patients during mechanical ventilation

The application of the thermodilution method in conditions associated with variations in blood flow implies a misuse of the Stewart Hamilton equation. Therefore, we studied the reliability of the thermodilution method for the estimation of mean cardiac output (CO) during mechanical ventilation in patients (n=9). Variation of the injection moment in the ventilatory cycle elicited a cyclic variation of CO estimates. This variation was not the same for all patients neither in phase nor in amplitude. Therefore, no specific phase in the ventilatory cycle could be selected for an accurate estimation of mean CO. Averaging CO estimates randomly distributed in the ventilatory cycle led to an improvement of accuracy with the square root of the number of observations. The averaging of CO estimates spread equally over the ventilatory cycle led to a much better result, e.g., the variation in the average of two estimates equally spread in the ventilatory cycle was similar to the variation in the average of four random estimates. We conclude that averaging of 3 or 4 estimates spread equally over the ventilatory cycle is an adequate strategy to estimate mean cardiac output in patients reliably

Inhoud en functionaliteit Koepelvisie Bos : een verkenning naar een hernieuwde benadering voor het verbinden van doelstellingen aan terreinbeheer van bossen

De koepvisie van Staatsbosbeheer geeft algemene handvatten aan het beheer door doelstellingen te koppelen aan maatregelen die in het terreinbeheer mogelijk, wenselijk of noodzakelijk zij