Integration of economic appraisal and health care policy in a health insurance system; The Dutch case

This article discusses the role of economic appraisal in insurance based health care systems, taking the case of the Netherlands as an example. The public health insurance system in this country is governed by the Health Insurance Executive Board, which policies are firmly based on the results of economic appraisal. Furthermore, reimbursement policies regarding pharmaceutical products are described, emphasizing again the position of information from economic appraisal in these policies. The article concludes with the identification of some trends in health policy and in the way it is supported by economic appraisal studies

Simultaneous flow cytometric detection of antibodies against platelets, granulocytes and lymphocytes

We present a time-saving and objective flow cytometric immunofluorescence assay for the simultaneous detection of antibodies against platelets, granulocytes or lymphocytes using a reconstituted mixture of these cell populations. Platelets, granulocytes and lymphocytes could be distinguished on the basis of their forward (FSC) and sideways (SSC) light scattering properties plotted on scales of 4 log orders. After setting FSC/SSC gates around the platelets, granulocytes and lymphocytes, the reactivity of the sera with the cell populations was determined by histogram analyses of immunofluorescence for each gate. The flow cytometric assay of reconstituted cell mixtures showed a strong, positive correlation with a reference microscopic immunofluorescence assay of separate cell suspensions. The reproducible procedures for the isolation and staining of the cells and the electronic stability of the flow cytometer permitted the use of the same gate and marker settings throughout the experiments. Consequently, the entire analysis of data stored in list mode could be performed using a keystroke, so that time consuming and subjective manual analyses were avoided

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

Background: Psychological distress (PD) has a major impact on quality of life. We studied the incidence of PD before and after radiotherapy for painful bone metastases. Furthermore, we aimed to identify factors predictive for PD.Methods: Between 1996 and 1998, the Dutch Bone Metastasis Study included 1157 patients with painful bone metastases. Patients were randomized between two fractionation schedules. The study showed a pain response of 74% in both groups. Patients filled out weekly questionnaires for 13 weeks, then monthly for two years. The questionnaires included a subscale for PD on the Rotterdam Symptom Checklist. We used generalized estimating equations and multivariable logistic regression analyses.Results: At baseline, 290 patients (27%) had a high level of PD. For the entire group, the level of PD remained constant over time. The majority of patients with a low level of PD at baseline remained at a low level during follow-up. In patients with a high level of PD at baseline, the mean level of PD decreased after treatment and stabilized around the cutoff level. Female patients, higher age, worse performance, lower pain score and worse self-reported QoL were associated with an increased chance of PD, although the model showed moderate discriminative power.Conclusions: A substantial proportion of patients had a high level of PD before and after radiotherapy for painful bone metastases. Most patients who reported high levels of PD when referred for palliative radiotherapy remained at high levels thereafter. Therefore, screening of PD prior to treatment seems appropriate, in order to select patients requiring intervention.</p

Why going green feels good

Re​cent re​search found that when asked ex​plic​itly, peo​ple as​so​ci​ate (fu​ture) sus​tain​able ac​tions with pos​i​‐ tive in​stead of neg​a​tive emo​tions. This em​pir​i​cal find​ing im​plies that pol​icy mak​ers could har​ness peo​ple's in​trin​sic mo​ti​va​tion to pro​mote sus​tain​able ac​tions. It is how​ever not clear where this as​so​ci​a​tion be​tween sus​tain​able ac​tions and pos​i​tive emo​tions stems from. Why would peo​ple re​port that go​ing green feels good, given that such ac​tions of​ten re​quire more ef​fort or in​con​ve​nience? We ar​gue and show that the pre​‐ vi​ously found re​la​tion​ship be​tween sus​tain​able ac​tions and an​tic​i​pated pos​i​tive emo​tions is not merely a mat​ter of so​cial de​sir​abil​ity, but rather a mat​ter of mean​ing: act​ing sus​tain​ably is of​ten per​ceived as a moral choice and thus as a mean​ing​ful course of ac​tion, which can elicit pos​i​tive emo​tions. Specif​i​cally, we found that par​tic​i​pants also as​so​ci​ate sus​tain​able ac​tions with pos​i​tive in​stead of neg​a​tive emo​tions when us​ing an im​plicit as​so​ci​a​tion mea​sure – one that re​duces the like​li​hood of so​cially de​sir​able re​sponses (Study 1). More​over, par​tic​i​pants an​tic​i​pated more in​tense emo​tions when those ac​tions were mean​ing​ful to them: they felt more pos​i​tive about sus​tain​able ac​tions, and more neg​a​tive about un​sus​tain​able ac​tions, when they chose to en​gage in those ac​tions and when those ac​tions are con​sid​ered per​son​ally rel​e​vant to the in​di​vid​ual (Study 2). To​gether, these stud​ies ex​plain why act​ing green feels good, and sup​port the no​‐ tion that sus​tain​able ac​tions are in​deed ex​pected (not merely re​ported) to be in​trin​si​cally mo​ti​vat​ing

Early mobilisation versus plaster immobilisation of simple elbow dislocations: Results of the FuncSiE multicentre randomised clinical trial

Background/aim To compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery. Methods From August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial. Patients were randomised to early mobilisation (n=48) or 3 weeks plaster immobilisation (n=52). Primary outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. Secondary outcomes were the Oxford Elbow Score, Mayo Elbow Performance Index, pain, range of motion, complications and activity resumption. Patients were followed for 1 year. Results Quick-DASH scores at 1 year were 4.0 (95% CI 0.9 to 7.1) points in the early mobilisation group versus 4.2 (95% CI 1.2 to 7.2) in the plaster immobilisation group. At 6 weeks, early mobilised patients reported less disability (Quick-DASH 12 (95% CI 9 to 15) points vs 19 (95% CI 16 to 22); p<0.05) and had a larger arc of flexion and extension (121° (95% CI 115° to 127°) vs 102° (95% CI 96° to 108°); p<0.05). Patients returned to work sooner after early mobilisation (10 vs 18 days; p=0.020). Complications occurred in 12 patients; this was unrelated to treatment. No recurrent dislocations occurred. Conclusions Early active mobilisation is a safe and effective treatment for simple elbow dislocations. Patients recovered faster and returned to work earlier without increasing the complication rate. No evidence was found supporting treatment benefit at 1 year

221st ENMC International Workshop : Foot Surgery in Charcot-Marie-Tooth disease June 10th-12th, 2016 Naarden, The Netherlands

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