Effectiveness and cost-effectiveness of an in-home respite care program in supporting informal caregivers of people with dementia : design of a comparative study

Background: Frequent hospitalization and permanent nursing home placement not only affect the well-being of persons with dementia, but also place great financial strain on society. Therefore, it is important to create effective strategies to support informal caregivers so that they can continue to perform their demanding role. Preliminary qualitative evidence suggests that community-based respite services can actually be important for caregivers, and that the level of evidence should be further established in terms of effectiveness. Therefore, a comparative study to assess the effectiveness and cost-effectiveness of an in-home respite care program will be initiated. Methods: This manuscript described a quasi-experimental study to assess (cost)-effectiveness of an in-home respite care program to support informal caregivers of persons with dementia. Study population: 124 informal caregivers and persons with dementia will be included in the intervention group and will receive an in-home respite care program by an organization called Baluchon Alzheimer. 248 dyads will be included in the control group and will receive standard dementia care. The primary outcome is caregiver burden. Secondary outcomes are: quality of life of caregivers, frequency of behavioral problems of persons with dementia and the reactions of caregivers to those problems, intention to institutionalize the care-recipient, time to nursing home placement, resource use of the care-recipient, and willingness to pay for in-home respite care. When the trial demonstrates a difference in outcomes between both groups, within-trial and modeled cost-effectiveness analyses will be conducted in a separate economic evaluation plan to evaluate possible cost-effectiveness of the in-home respite care program compared to the control group receiving standard dementia care. Finally, the model based cost-effectiveness analyses will allow to extrapolate effects over a longer time horizon than the duration of the trial. Discussion: This study will have great added value because to date no studies measured effectiveness and cost-effectiveness of an in-home respite care program of the Baluchon type. Results of this trial can thus give much more insight in potential benefits and disadvantages of community-based respite care. Conclusions based on this trial can help policy-makers in elaborating future directions of dementia care

Effectiveness of an in-home respite care program to support informal dementia caregivers : a comparative study

Objectives: Dementia is a major public health problem with important physical, psychosocial, emotional, and financial consequences for patients, their caregivers, and society. Since patients prefer to be managed at home, extensive research has been conducted into effectiveness of psychosocial interventions to support informal caregivers. The aim of this study was to assess the effectiveness of an in-home respite care program. Methods: In a prospective quasi-experimental study, 99 dyads who received an in-home respite care program were compared at 6 months post-baseline, with 99 matched dyads receiving standard dementia care. Additionally, the short-term effect of the program was evaluated 14 to 15 days post-intervention. The primary outcome was caregiver burden. The secondary outcomes were: desire to institutionalize the patient, caregiver quality of life, and frequency and impact of behavioral problems. Mixed model analyses were performed to evaluate the impact of the intervention. Results: After 6 months, no significant difference on caregiver burden was observed, but intervention group caregivers had a significant lower desire to institutionalize the patient compared with control group caregivers (adj.diff = -0.51; p = .02). Shortly after the program, intervention group caregivers also had a significant lower role strain (adj.diff = 0.75; p = .05), and a lower burden on social and family life (adj.diff = 0.55; p = .05) compared with baseline. Conclusions: This study was the first comparative study to investigate effectiveness of an in-home respite care program to support informal caregivers of persons with dementia. The results partly confirm earlier positive findings from explorative studies

Return to sport after patellar dislocation or following surgery for patellofemoral instability

Patellofemoral instability may occur in a young population as a result of injury during sporting activities. This review focuses on return to sport after one episode of dislocation treated no operatively and as well after surgery for chronic patellofemoral instability. With or without surgery, only two-thirds of patients return to sports at the same level as prior to injury. A high-quality rehabilitation programme using specific exercises is the key for a safe return to sporting activities. To achieve this goal, recovery of muscle strength and dynamic stability of the lower limbs is crucial. The focus should be directed to strengthen the quadriceps muscle and pelvic stabilizers, as well as lateral trunk muscle training. Patient education and regularly performed home exercises are other key factors that can lead to a successful return to sports. The criteria for a safe return to sports include the absence of pain, no effusion, a complete range of motion, almost symmetrical strength, and excellent dynamic stability. Level of evidence IV

Factors associated with costs of care in community-dwelling persons with dementia from a third party payer and societal perspective : a cross-sectional study

Background: Besides the importance of estimating the global economic impact of care for persons with dementia, there is an emerging need to identify the key factors associated with this cost. The aim of this study was to analyze associations between the cost of care in community-dwelling persons with dementia and caregiver characteristics from both the healthcare third party payer perspective and the societal perspective. Methods: Several characteristics based on the cross-sectional data of 355 dyads of informal caregivers and persons with dementia living in Belgium were identified to include in a log-gamma generalized linear model and were used in a multiple linear regression model with bootstrapping to test robustness. Results: The mean monthly cost of care for a community-dwelling person with dementia was estimated at euro 2339 (95% CI euro 2133 - euro 2545) per person from a societal perspective and at euro 968 (95% CI euro 825 - euro 1111) per person from a third party payer viewpoint. Informal care accounted for the majority of the monthly costs from the societal perspective. Community based healthcare resource use represented the largest cost from the third party perspective. According to the regression analyses, a higher level of functional dependency of the person with dementia and a higher educational level of the caregiver were associated with a higher monthly cost from both a third party payer perspective and a societal perspective. In addition, being retired and a higher quality of life in the caregivers were associated with a lower monthly cost of care from the societal perspective. Conclusions: Several characteristics of the caregiver and the person with dementia were associated with the monthly costs of care from a third party payer and a societal perspective. Despite the lack of clear causal relationships, the results of this study can assist policy makers in planning and financing future dementia care

Ten-year survival and complications of total knee arthroplasty for osteoarthritis secondary to trauma or surgery: A French multicentre study of 263 patients

BACKGROUND: Previous surgical procedures raise technical challenges in performing total knee arthroplasty (TKA) and may affect TKA outcomes. Survival rates of TKA done after trauma or surgery to the knee have not been accurately determined in large populations. The objectives of this retrospective study in 263 patients with TKA after knee trauma or surgery and a follow-up of 10 years were to assess survival, functional outcomes, and the nature and frequency of complications. HYPOTHESIS: Knee trauma or surgery before TKA increases the risk of complications and decreases implant survival. MATERIAL AND METHODS: Two hundred and sixty-three patients (122 [47%] females and 141 [53%] males) underwent TKA between 2005 and 2009 at nine centres in France. Mean age at surgery was 61 years. The patients had knee osteoarthritis secondary to a fracture (n=66), osteotomy (n=131), or ligament injury (n=66). Mean time from trauma or surgery to TKA was 145 months (range, 72-219 months). RESULTS: Major complications were infection (n=12, 4.5%), skin problems (n=8, 3%), and stiffness (n=8, 3%). Ten-year survival to implant exchange for any reason was 89%±2.8%. Flexion range increased by 2.5°±17° (p=0.02) to a mean of 110° (range, 30° to 140°); extension range increased by 4°±7° (p<0.001) to a mean of -1.19 (range, -20° to 0°). Of the 263 patients, 157 (60%) reported little or no pain at last follow-up. Mean postoperative hip-knee-ankle angle was 179°±3.2° (range, 171°-188°). CONCLUSION: TKA performed after knee injury or surgery carries a risk of specific complications (infection, skin problems, and stiffness) and may have a lower survival rate compared to primary TKA

The first myriapod genome sequence reveals conservative arthropod gene content and genome organisation in the centipede Strigamia maritima.

Myriapods (e.g., centipedes and millipedes) display a simple homonomous body plan relative to other arthropods. All members of the class are terrestrial, but they attained terrestriality independently of insects. Myriapoda is the only arthropod class not represented by a sequenced genome. We present an analysis of the genome of the centipede Strigamia maritima. It retains a compact genome that has undergone less gene loss and shuffling than previously sequenced arthropods, and many orthologues of genes conserved from the bilaterian ancestor that have been lost in insects. Our analysis locates many genes in conserved macro-synteny contexts, and many small-scale examples of gene clustering. We describe several examples where S. maritima shows different solutions from insects to similar problems. The insect olfactory receptor gene family is absent from S. maritima, and olfaction in air is likely effected by expansion of other receptor gene families. For some genes S. maritima has evolved paralogues to generate coding sequence diversity, where insects use alternate splicing. This is most striking for the Dscam gene, which in Drosophila generates more than 100,000 alternate splice forms, but in S. maritima is encoded by over 100 paralogues. We see an intriguing linkage between the absence of any known photosensory proteins in a blind organism and the additional absence of canonical circadian clock genes. The phylogenetic position of myriapods allows us to identify where in arthropod phylogeny several particular molecular mechanisms and traits emerged. For example, we conclude that juvenile hormone signalling evolved with the emergence of the exoskeleton in the arthropods and that RR-1 containing cuticle proteins evolved in the lineage leading to Mandibulata. We also identify when various gene expansions and losses occurred. The genome of S. maritima offers us a unique glimpse into the ancestral arthropod genome, while also displaying many adaptations to its specific life history.This work was supported by the following grants: NHGRIU54HG003273 to R.A.G; EU Marie Curie ITN #215781 “Evonet” to M.A.; a Wellcome Trust Value in People (VIP) award to C.B. and Wellcome Trust graduate studentship WT089615MA to J.E.G; Marine rhythms of Life” of the University of Vienna, an FWF (http://www.fwf.ac.at/) START award (#AY0041321) and HFSP (http://www.hfsp.org/) research grant (#RGY0082/2010) to KT-­‐R; MFPL Vienna International PostDoctoral Program for Molecular Life Sciences (funded by Austrian Ministry of Science and Research and City of Vienna, Cultural Department -­‐Science and Research to T.K; Direct Grant (4053034) of the Chinese University of Hong Kong to J.H.L.H.; NHGRI HG004164 to G.M.; Danish Research Agency (FNU), Carlsberg Foundation, and Lundbeck Foundation to C.J.P.G.; U.S. National Institutes of Health R01AI55624 to J.H.W.; Royal Society University Research fellowship to F.M.J.; P.D.E. was supported by the BBSRC via the Babraham Institute;This is the final version of the article. It first appeared from PLOS via http://dx.doi.org/10.1371/journal.pbio.100200

Hip and knee scores in orthopedics : validation of a score, definition of a minimal clinically important difference and mapping methods

Les scores d’autoévaluation (PROM = Patient Reported Outcome Measurement) font partie intégrante de l’évaluation moderne des patients. Ils permettent par exemple en orthopédie de définir un statut de base pour ces patients et ensuite après un traitement chirurgical ou médical, de définir une amélioration. Ces scores nécessitent des étapes de validation permettant leur utilisation (validité interne et externe, effet plancher et plafond, répétabilité, sensibilité au changement, traduction dans différentes langues,). Une fois ces étapes effectuées, la différence minimale cliniquement importante (DMCI ou MCID pour Minimal Clinical Important Difference) pour le patient peut être définie afin de fixer un niveau minimum d’amélioration. La DMCI, qui est une notion variable d’un pays à l’autre, peut être calculée par différentes méthodes notamment la méthode des ancres nécessitant une question supplémentaire afin de définir si le patient se juge comme amélioré ou non. Malgré ces données, le manque d’harmonisation dans le choix des scores rend difficile la comparaison de ces scores notamment pour les méta-analyses ou les revues de la littérature. Ainsi pour cette thèse, une cohorte prospective de patients souffrant d’une arthrose de hanche et du genou a été créée afin : 1) de valider différents scores, 2) de définir la DMCI pour ces scores en France, 3) de permettre d’obtenir par un processus statistique, un moyen de connaitre le résultat d’un score en n’ayant à sa disposition que le résultat d’un autre score (mapping ou crosswalk). A l’occasion de cette thèse, les score HOOS-12 et KOOS-12, version réduite à 12 items du score HOOS (40 items) et du score KOOS (42 items) ont bénéficié d’une validation en français. La DMCI pour les scores HOOS et Oxford-12 hanche a pu être définie. Cette thèse a permis d’explorer une option de calcul de la DMCI en utilisant un item du score lui-même permettant d’envisager l’usage de la méthode des ancres en l’absence d’une question supplémentaire. Différentes méthodes de mapping ont été testées sur le score HOOS et tous ses dérivés afin de définir la méthode la plus optimale ainsi que le score le plus adapté pour obtenir un mapping avec le score Oxford-12. La méthode equipercentile a permis de réaliser une table de conversion entre le score Oxford-12 Hanche et le score HOOS-12.Patient reported outcome measurement scores (PROMs) are part of modern patient’s assessment. For example, in orthopedics they are used to define a baseline level and after a surgical or medical treatment, to define an improvement. These scores require a validation procedure (internal and external validity, Responsiveness, reliability, translation in different languages, assessment of floor and ceiling effect…). Patient’s satisfaction after a surgical procedure can be measured through MCID (Minimal Clinical Important Difference). The MCID represents the minimum clinically relevant difference for the patient but is different between countries. MCID can be calculated by various methods, including the anchor method requiring an additional question to define the improvement. Despite these data, the lack of harmonization in the choice of scores makes difficult to compare these scores, especially for meta-analyzes or systematic reviews. In this thesis, a prospective hip and knee cohort was created to: 1) validate different scores, 2) define the MCID of these scores in France, 3) define a statistical process to deduct a score result from another score (Mapping or crosswalk).The HOOS-12 and KOOS-12 scores (abridged versions to 12 items of the HOOS score (40 items) and the KOOS score (42 items)) were validated in French. The MCID for HOOS and hip Oxford scores has been defined for the French population. An option to calculate the MCID using a score item itself was explored, which allowed us to consider using the anchor method in the absence of additional questions. Different methods have been tested to define the most optimal method and the most optimal score for mapping between HOOS and Oxford-12. A conversion table was created between the Oxford-12 hip score and HOOS-12 by the equipercentile method

Les scores hanche et genou en orthopédie : validation d’un score, définition d’une différence minimale cliniquement importante et méthodes de Mapping

Patient reported outcome measurement scores (PROMs) are part of modern patient’s assessment. For example, in orthopedics they are used to define a baseline level and after a surgical or medical treatment, to define an improvement. These scores require a validation procedure (internal and external validity, Responsiveness, reliability, translation in different languages, assessment of floor and ceiling effect…). Patient’s satisfaction after a surgical procedure can be measured through MCID (Minimal Clinical Important Difference). The MCID represents the minimum clinically relevant difference for the patient but is different between countries. MCID can be calculated by various methods, including the anchor method requiring an additional question to define the improvement. Despite these data, the lack of harmonization in the choice of scores makes difficult to compare these scores, especially for meta-analyzes or systematic reviews. In this thesis, a prospective hip and knee cohort was created to: 1) validate different scores, 2) define the MCID of these scores in France, 3) define a statistical process to deduct a score result from another score (Mapping or crosswalk).The HOOS-12 and KOOS-12 scores (abridged versions to 12 items of the HOOS score (40 items) and the KOOS score (42 items)) were validated in French. The MCID for HOOS and hip Oxford scores has been defined for the French population. An option to calculate the MCID using a score item itself was explored, which allowed us to consider using the anchor method in the absence of additional questions. Different methods have been tested to define the most optimal method and the most optimal score for mapping between HOOS and Oxford-12. A conversion table was created between the Oxford-12 hip score and HOOS-12 by the equipercentile method.Les scores d’autoévaluation (PROM = Patient Reported Outcome Measurement) font partie intégrante de l’évaluation moderne des patients. Ils permettent par exemple en orthopédie de définir un statut de base pour ces patients et ensuite après un traitement chirurgical ou médical, de définir une amélioration. Ces scores nécessitent des étapes de validation permettant leur utilisation (validité interne et externe, effet plancher et plafond, répétabilité, sensibilité au changement, traduction dans différentes langues,). Une fois ces étapes effectuées, la différence minimale cliniquement importante (DMCI ou MCID pour Minimal Clinical Important Difference) pour le patient peut être définie afin de fixer un niveau minimum d’amélioration. La DMCI, qui est une notion variable d’un pays à l’autre, peut être calculée par différentes méthodes notamment la méthode des ancres nécessitant une question supplémentaire afin de définir si le patient se juge comme amélioré ou non. Malgré ces données, le manque d’harmonisation dans le choix des scores rend difficile la comparaison de ces scores notamment pour les méta-analyses ou les revues de la littérature. Ainsi pour cette thèse, une cohorte prospective de patients souffrant d’une arthrose de hanche et du genou a été créée afin : 1) de valider différents scores, 2) de définir la DMCI pour ces scores en France, 3) de permettre d’obtenir par un processus statistique, un moyen de connaitre le résultat d’un score en n’ayant à sa disposition que le résultat d’un autre score (mapping ou crosswalk). A l’occasion de cette thèse, les score HOOS-12 et KOOS-12, version réduite à 12 items du score HOOS (40 items) et du score KOOS (42 items) ont bénéficié d’une validation en français. La DMCI pour les scores HOOS et Oxford-12 hanche a pu être définie. Cette thèse a permis d’explorer une option de calcul de la DMCI en utilisant un item du score lui-même permettant d’envisager l’usage de la méthode des ancres en l’absence d’une question supplémentaire. Différentes méthodes de mapping ont été testées sur le score HOOS et tous ses dérivés afin de définir la méthode la plus optimale ainsi que le score le plus adapté pour obtenir un mapping avec le score Oxford-12. La méthode equipercentile a permis de réaliser une table de conversion entre le score Oxford-12 Hanche et le score HOOS-12

Etude comparative de deux couples de frottement en arthroplastie primaire de hanche chez des patients actifs de moins de 50 ans (étude au recul minimal de 12 ans)

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