Community Psychiatric Nurse Teams: Cost-effectiveness of Intensive Support Versus Generic Care

1994 ◽  
Vol 165 (2) ◽  
pp. 218-221 ◽  
Author(s):  
Paul McCrone ◽  
Jennifer Beecham ◽  
Martin Knapp
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Community Support ◽  
Case Managers ◽  
Psychiatric Nurse ◽  
Short Term ◽  
Community Psychiatric ◽  
Support Team ◽  
The Difference ◽  
And Control

Background.Part of the community psychiatric nurse (CPN) service was reorganised into a community support team (CST), with staff acting as case managers. An economic evaluation ran parallel to the comparison with generic CPN care.Method.Eighty-two clients were randomly allocated to experimental and control groups. Costs were comprehensively measured over a pre-referral period (three months), and then at 6, 12, and 18 months.Results.The economic evaluation found a cost difference between the groups. Generic group costs averaged £89 per patient per week more than CST group costs. The difference was only significant for the first six months. Changes in the burden of cost across agencies were observed.Conclusions.Although CPN inputs and costs were higher for the CST group, there was a significant short-term reduction in total cost. Beyond the short term, the CST did not confer cost or cost-effectiveness advantages.

scholarly journals Protocol for economic evaluation alongside the SHINE (Supporting Healthy Image, Nutrition and Exercise) cluster randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038050
Author(s):  
Victoria Brown ◽  
Joanne Williams ◽  
Lisa McGivern ◽  
Susan Sawyer ◽  
Liliana Orellana ◽  
...  
Keyword(s):  
Body Image ◽  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Incremental Cost ◽  
Randomised Control Trial ◽  
Usual Practice ◽  
Cluster Randomised ◽  
Life Years ◽  
The Difference ◽  
Intervention Costs

IntroductionLimited evidence exists on the cost-effectiveness of interventions to prevent obesity and promote healthy body image in adolescents. The SHINE (Supporting Healthy Image, Nutrition and Exercise) study is a cluster randomised control trial (cRCT) aiming to deliver universal education about healthy nutrition and physical activity to adolescents, as well as targeted advice to young people with body image concerns who are at risk of developing disordered eating behaviours. This paper describes the methods for the economic evaluation of the SHINE cRCT, to determine whether the intervention is cost-effective as an obesity prevention measure.Methods and analysisA public payer perspective will be adopted, with intervention costs collected prospectively. Within-trial cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) will quantify the incremental costs and health gains of the intervention as compared with usual practice (ie, teacher-delivered curriculum). CEA will present results as cost per body mass index unit saved. CUA will present results as cost per quality-adjusted life year gained. A modelled CUA will extend the target population, time horizon and decision context to provide valuable information to policymakers on the potential for incremental cost offsets attributable to disease prevention arising from intervention. Intervention costs and effects will be extrapolated to the population of Australian adolescents in Grade 7 of secondary school (approximate age 13 years) and modelled over the cohort’s lifetime. Modelled CUA results will be presented as health-adjusted life years saved and healthcare cost-savings of diseases averted. Incremental cost-effectiveness ratios will be calculated as the difference in costs between the intervention and comparator divided by the difference in benefit. Semi-structured interviews with key intervention stakeholders will explore the potential impact of scalability on cost-effectiveness. These data will be thematically analysed to inform sensitivity analysis of the base case economic evaluation, such that cost-effectiveness evidence is reflective of the potential for scalability.Ethics and disseminationEthics approval was obtained from the Deakin University Human Research Ethics Committee (#2017–269) and the Victorian Department of Education and Training (#2018_003630). Study findings will be disseminated through peer-reviewed academic papers and participating schools will receive annual reports over the 3 years of data collection.Trial registration numberACTRN 12618000330246; Pre-results.

scholarly journals Alternative duty work as workplace-initiated procedure to reduce sickness absence

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pauliina Mattila-Holappa ◽  
Johanna Kausto ◽  
Ville Aalto ◽  
Leena Kaila-Kangas ◽  
Mika Kivimäki ◽  
...  
Keyword(s):  
Sickness Absence ◽  
Repeated Measures ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Occupational Class ◽  
Short Term ◽  
Time Interaction ◽  
Binomial Regression ◽  
The Difference ◽  
And Control

Abstract Purpose Alternative duty work is a procedure that enables an employee with a short-term disability to perform modified duties as an alternative to sickness absence. We examined whether the implementation of an alternative duty policy was associated with reduced sickness absence in the Finnish public sector. Methods Two city administrations (A and D) that implemented an alternative duty work policy to their employees (n = 5341 and n = 7538) served as our intervention cities, and two city administrations (B and C) that did not implement the policy represented the reference cities (n = 6976 and n = 6720). The outcomes were the number of annual days, all episodes, and short-term (< 10 days) episodes during the 2 years before versus the 2 years after the intervention year. We applied repeated measures negative binomial regression analyses, using the generalized estimating equations method and the difference-in-difference analysis to compare the intervention and control cities (adjusted for sex, age, type of job contract, occupational class). Results During the five-year study period, the number of sickness absence days and episodes increased in both the intervention and control cities. Covariate-adjusted analysis of relative risk showed that the overall increase in post- versus pre-intervention sickness absence days was smaller in intervention City A, RR = 1.14 (95% CI = 1.09–1.21) than in control cities B and C, RR = 1.19 (95% CI =1.14–1.24), group × time interaction p < 0.02. In intervention City D, we found a corresponding result regarding all sickness absence episodes and short-term sickness absence episodes but not days. Conclusions This follow-up suggests that implementing an alternative duty work policy may marginally decrease employees’ sickness absences.

scholarly journals How do they cope with the situation when the caterpillars of beet armyworms, Spodoptera exigua, attack their host plant under different fertilization conditions?

2017 ◽  
Author(s):  
Sifang Wang ◽  
Tianbo Ding ◽  
Manlin Xu ◽  
Bin Zhang
Keyword(s):  
Ache Activity ◽  
Host Plants ◽  
Spodoptera Exigua ◽  
Economic Loss ◽  
Short Term ◽  
Significant Difference ◽  
Care Activity ◽  
Antioxidant Enzymes Activities ◽  
The Difference ◽  
And Control

Fertilizer with different ration of nitrogen (N) to phosphorus (P) could influence performance of plants including crops and vegetables. Spodoptera exigua is an important agriculture pest that has caused serious economic loss especially recent decades. In the present study, we explored that the response of host plants and S. exigua after S. exigua caterpillars damaged on the way of different level intensity and frequency under five fertilizer treatments with different ratio of N to P. The results indicated that fertilizer can significantly influence the interaction between host plants and caterpillars. Compensatory growth was detected under definite fertilizer with N : P = 3 : 1. Higher N proportion in fertilizer appears to contribute to maintain similar stem biomass in defoliated seedlings to control ones. Root biomass had almost no significant difference between defoliation and control, but it can not compensate under definite fertilizer. Higher proportion of N in fertilizer also contributed to enhance antioxidant enzymes activities: antioxidase catalase (CAT), superoxide dismutase (SOD), at low-level intensity caterpillars on host plants.However, when the herbivorous intensity was increasing, higher proportion of P in fertilizer seemed to play more important role on increase the activities of CAT and SOD. Higher phosphorus likely contributes to enhance acetylcholin esterase (AChE) activity at lower degree of defoliation, but higher nitrogen proportion could result in higher AChE activity at higher degree of defoliation. Higher content of nitrogen in definite range contributed to reduce the carboxylesterase (CarE) activity at high intensity within short-term defoliation. However, when defoliation intensity enhanced, the difference of CarE activity between fertilizer categories was small.

scholarly journals Effects of Short-term Low- to Moderate- Dose Glucocorticoids on Immuno-inflammatory Indicators and Prognosis of Patients With Regular and Severe COVID-19: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Jing Zhang ◽  
Yi Kang ◽  
Hai-Bo Wang ◽  
Hai-Yang Liu ◽  
Ya-Nan Qi ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Control Group ◽  
C Reactive Protein ◽  
Moderate Dose ◽  
Short Term ◽  
Blood Examination ◽  
Reactive Protein ◽  
The Difference ◽  
And Control ◽  
Severe Type

Abstract Background: To explore the effects of short-term low- to moderate- dose glucocorticoids on the immune-inflammatory indicators and 28-d prognoses of patients with regular or severe coronavirus disease 2019 (COVID-19).Methods: The clinical data and laboratorial examination results of 66 patients with regular or severe type of COVID-19 that treated in Henan Provincial People’s Hospital and Nanyang Central Hospital between January 20 and February 14, 2020 were retrospectively analyzed. Here, 36 patients that had been treated with glucocorticoids were categorized in the glucocorticoids group (GC group), while the other 30 patients that had not been treated with glucocorticoids were categorized in the control group.Results: The immune-inflammatory indicators and prognoses of the patients in the two groups were compared. The sex, age, clinical types, and complications were not significantly different between the two groups (all P>0.05). After hospitalization, 33.3% and 6.7% of the patients in the GC group and control group were with chest distress, respectively, and the difference was statistically significant (P=0.019). The duration of fever was also significantly different between the two groups (6.91 ± 4.41 vs. 9.21 ± 4.46 days, P=0.036), but the blood examination results within 24 h after hospitalization were not significantly different between the two groups (all P>0.05). The C-reactive protein (CRP) and Interleukin-6 (IL-6) levels were lower in the GC group than control group on day 7 (P=0.012, P=0.035) but were not significantly different between the two groups on day 14. The CRP and IL-6 levels were significantly reduced after glucocorticoids treatment on day 3, 5 and 7 (all P<0.05) in GC group. The median time of hospital stay, and 28-d prognoses were not significantly different between the two groups (P=0.080, P>0.999).Conclusions: Glucocorticoids could decrease the levels of inflammatory indicators, but did not significantly influence other immune-related indicators and 28-d prognoses.

scholarly journals Effect of short-term peripheral myopic defocus on ocular biometrics using Fresnel “press-on” lenses in humans 

2021 ◽  
Author(s):  
Ryo Kubota ◽  
Nabin R Joshi ◽  
Inna Samandarova ◽  
Maksud Oliva ◽  
Arkady Selenow ◽  
...  
Keyword(s):  
Axial Length ◽  
Choroidal Thickness ◽  
Fresnel Lens ◽  
Short Term ◽  
Full Field ◽  
Before And After ◽  
The Mean ◽  
The Difference ◽  
The Right ◽  
And Control

Abstract This study assessed axial length and choroidal thickness changes following short-term peripheral myopic defocus in normal adult subjects. Twenty subjects underwent defocus sessions by viewing a full-field projected movie 4 meters away for 4 hours in the morning, while wearing spectacle lenses, corrected for distance vision in both eyes. The right eye, serving as the test eye, was peripherally defocused using a Fresnel lens overlay of + 3.50D with a central aperture of 11.5 mm, while the left eye served as the control. A subset of 10 subjects from the same cohort also underwent additional defocus sessions with + 5.00D of peripheral defocus. Axial length was measured and radial sub-foveal choroidal scans were obtained before and after the defocus sessions. The mean increase in axial length of the test eyes was 8 µm (p < 0.05) less than that of the control eyes with + 3.50D peripheral defocus condition and 14 µm (p < 0.05) less than the control eyes with + 5.00 D peripheral defocus condition. The difference in mean changes for choroidal thickness between test and control eyes were not significant for both dioptric conditions. Our results demonstrated that short-term peripheral myopic defocus significantly inhibited axial elongation in adult humans, without significant changes in choroidal thickness.

A randomized controlled trial to evaluate the effectiveness and cost-effectiveness of psychodynamic counselling for general practice patients with chronic depression

2003 ◽  
Vol 33 (2) ◽  
pp. 229-239 ◽  
Author(s):  
S. SIMPSON ◽  
R. CORNEY ◽  
P. FITZGERALD ◽  
J. BEECHAM
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Randomized Controlled Trial ◽  
Cost Effectiveness ◽  
Controlled Trial ◽  
Short Term ◽  
Randomized Controlled ◽  
And Control ◽  
Experimental Group ◽  
Over Time

Background. Counsellors have been employed in general practice with little evidence of effectiveness. This study examined the effectiveness and cost-effectiveness of short-term counselling in general practice for patients with chronic depression either alone or combined with anxiety.Method. A randomized controlled trial with an economic evaluation was carried out in Derbyshire. One hundred and forty-five patients were recruited at seven GP practices by screening using the Beck Depression Inventory. Both the experimental and control group received routine GP treatment but the experimental group were also referred to the practice counsellor. Depression, anxiety and other mental health symptoms, social and interpersonal functioning and social support were measured at baseline, 6 months and 12 months. Comprehensive costs were also estimated.Results. There was an overall significant improvement in the actual scores over time, but there were no significant differences between the two groups on any of the measures at either 6 or 12 months. However fewer experimental group patients were still ‘cases’ on the BDI than controls at 12 months. There were no significant differences in the mean total costs, aggregate costs of services, or any service-group costs except for primary care, between the experimental and control groups over time.Conclusions. This trial demonstrates only very limited evidence of improved outcomes in those referred to counselling and increased primary care treatment costs in the short-term. Stricter referral criteria to exclude the more severely depressed in the group (BDI[ges ]24) might have yielded more conclusive results.

scholarly journals Reduction of routine use of radiography in patients with ankle fractures leads to lower costs and has no impact on clinical outcome: an economic evaluation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
P. van Gerven ◽  
◽  
J. M. van Dongen ◽  
S. M. Rubinstein ◽  
M. F. Termaat ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Usual Care ◽  
Functional Outcome ◽  
Ankle Fractures ◽  
Clinical Indication ◽  
Imaging Protocol ◽  
The Difference

Abstract Background To evaluate the cost-effectiveness of a reduction in the number of routine radiographs in the follow-up of patients with ankle fractures. Methods We performed an economic evaluation alongside the multicentre, randomised WARRIOR trial. Participants were randomised to a reduced imaging follow-up protocol (i.e. radiographs at week 6 and 12 follow-up obtained on clinical indication) or usual care (i.e. routine radiography at weeks 6 and 12). The Olerud & Molander Ankle Score (OMAS) was used to assess ankle function and the EQ-5D-3L was used to estimate Quality-Adjusted Life Years (QALYs). Costs and resource use were assessed using self-reported questionnaires and medical records, and analysed from a societal perspective. Multiple imputation was used for missing data, and data were analysed using seemingly unrelated regression analysis and bootstrapping. Results In total, 246 patients had data available for analysis (reduced imaging = 118; usual care = 128). Fewer radiographs were obtained in the reduced imaging group (median = 4) compared with the usual-care group (median = 5). Functional outcome was comparable in both groups. The difference in QALYs was − 0.008 (95% CI:-0.06 to 0.04) and the difference in OMAS was 0.73 (95% CI:-5.29 to 6.76). Imaging costs were lower in the reduced imaging group (−€48; 95% CI:- €72 to -€25). All other cost categories did not statistically differ between the groups. The probability of the reduced imaging protocol being cost-effectiveness was 0.45 at a wiliness-to-pay of €20,000 per QALY. Conclusions Reducing the number of routine follow-up radiographs has a low probability of being cost-effective compared with usual care. Functional outcome, health-related quality of life and societal costs were comparable in both groups, whereas imaging costs were marginally lower in the reduced imaging group. Given this, adherence to a reduced imaging follow-up protocol for those with routine ankle fractures can be followed without sacrificing quality of care, and may result in reduced costs. Trial registration The trial was registered on 26-05-2014 in the Netherlands Trial Registry, with reference number NL4477 (www.trialregister.nl/trial/4477).

scholarly journals How do they cope with the situation when the caterpillars of beet armyworms, Spodoptera exigua, attack their host plant under different fertilization conditions?

2017 ◽  
Author(s):  
Sifang Wang ◽  
Tianbo Ding ◽  
Manlin Xu ◽  
Bin Zhang
Keyword(s):  
Ache Activity ◽  
Host Plants ◽  
Spodoptera Exigua ◽  
Economic Loss ◽  
Short Term ◽  
Significant Difference ◽  
Care Activity ◽  
Antioxidant Enzymes Activities ◽  
The Difference ◽  
And Control

Fertilizer with different ration of nitrogen (N) to phosphorus (P) could influence performance of plants including crops and vegetables. Spodoptera exigua is an important agriculture pest that has caused serious economic loss especially recent decades. In the present study, we explored that the response of host plants and S. exigua after S. exigua caterpillars damaged on the way of different level intensity and frequency under five fertilizer treatments with different ratio of N to P. The results indicated that fertilizer can significantly influence the interaction between host plants and caterpillars. Compensatory growth was detected under definite fertilizer with N : P = 3 : 1. Higher N proportion in fertilizer appears to contribute to maintain similar stem biomass in defoliated seedlings to control ones. Root biomass had almost no significant difference between defoliation and control, but it can not compensate under definite fertilizer. Higher proportion of N in fertilizer also contributed to enhance antioxidant enzymes activities: antioxidase catalase (CAT), superoxide dismutase (SOD), at low-level intensity caterpillars on host plants.However, when the herbivorous intensity was increasing, higher proportion of P in fertilizer seemed to play more important role on increase the activities of CAT and SOD. Higher phosphorus likely contributes to enhance acetylcholin esterase (AChE) activity at lower degree of defoliation, but higher nitrogen proportion could result in higher AChE activity at higher degree of defoliation. Higher content of nitrogen in definite range contributed to reduce the carboxylesterase (CarE) activity at high intensity within short-term defoliation. However, when defoliation intensity enhanced, the difference of CarE activity between fertilizer categories was small.

scholarly journals Effect of short-term peripheral myopic defocus on ocular biometrics using Fresnel “press-on” lenses in humans

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryo Kubota ◽  
Nabin R. Joshi ◽  
Inna Samandarova ◽  
Maksud Oliva ◽  
Arkady Selenow ◽  
...  
Keyword(s):  
Axial Length ◽  
Choroidal Thickness ◽  
Fresnel Lens ◽  
Short Term ◽  
Central Visual Field ◽  
Full Field ◽  
Before And After ◽  
The Difference ◽  
The Right ◽  
And Control

AbstractThis study assessed axial length and choroidal thickness changes following short-term peripheral myopic defocus in normal adult subjects. Twenty subjects underwent defocus sessions by viewing a full-field projected movie 4 m away for 4 h in the morning, while wearing spectacle lenses, corrected for distance vision in both eyes. The right eye, serving as the test eye, was peripherally defocused using a Fresnel lens overlay of + 3.50 D with a central clear aperture of 11.5 mm (correlating to a clear central visual field of approximately 23°), while the left eye served as the control (with no Fresnel lens overlay). A subset of 10 subjects from the same cohort also underwent additional defocus sessions with + 5.00 D of peripheral defocus. Axial length was measured and radial sub-foveal choroidal scans were obtained before and after the defocus sessions. The increase in axial length of the test eyes were significantly less than the control eyes under both peripheral defocus conditions (p < 0.05). The difference in mean change for choroidal thickness between test and control eyes was not significant for either dioptric condition. Our results demonstrated that short-term peripheral myopic defocus significantly inhibited axial elongation in adult humans, without significant changes in choroidal thickness.

Analysis of the horizontal structure of a measurement and control geodetic network based on entropy

2013 ◽  
Vol 62 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Maria Mrówczyńska
Keyword(s):  
Geodetic Network ◽  
The State ◽  
Observation System ◽  
Optimum Number ◽  
Optimum Structure ◽  
Horizontal Structure ◽  
The Difference ◽  
And Control ◽  
Measurement And Control ◽  
Horizontal Displacements

Abstract The paper attempts to determine an optimum structure of a directional measurement and control network intended for investigating horizontal displacements. For this purpose it uses the notion of entropy as a logarithmical measure of probability of the state of a particular observation system. An optimum number of observations results from the difference of the entropy of the vector of parameters ΔHX̂ (x)corresponding to one extra observation. An increment of entropy interpreted as an increment of the amount of information about the state of the system determines the adoption or rejection of another extra observation to be carried out.

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