DEEP Study: Modeling Outcomes and Costs of Persistent Orofacial Pain

Persistent orofacial pain (POFP) affects patients’ daily lives and can lead to significant costs for them and/or the health service provider. This partial economic evaluation examined costs and utilities experienced by individuals with POFP over a 24-mo period and used these data to populate the life course Markov model used to estimate costs and quality-adjusted life years (QALYs) from pain onset over an individual’s life course while receiving usual health care. A total of 202 people receiving care for POFP were followed for 24 mo. Data were collected every 6 mo on pain-related disability (Graded Chronic Pain Scale dichotomized to low [0–IIa] or high [IIb–IV] pain-related disability states), health service utilization, and health-related quality of life measured by QALYs derived from the EQ-5D-5L. Unbalanced regressions were used to demonstrate how costs and QALYs varied according to participant characteristics with the results used to parameterize a Markov model. This probabilistic Markov model was used to estimate the outcomes for a cohort of POFP patients from age 25 y until death as determined by age- and sex-specific mortality rates. Across all time points, complete data were available from 129 participants. A high pain-related disability state led to significantly increased health care cost (£221; 95% confidence interval [CI], 87–355; P < 0.01) and a significant decrease in quality of life (mean difference, –0.08; 95% CI, –0.11 to −0.05; P < 0.0001) over a 24-mo period. The Markov model estimated that the average cost was £27,317 (95% CI, 26,558–28,046) and the average lifetime QALYs were 17.54 (95% CI, 17.38–17.71). The modeling suggests that a cohort of POFP patients from age 25 y would only accrue 18 QALYs per person before death. POFP therefore exerts a considerable impact on health, and it is likely more effective care (pathways) could realize substantial gains in terms of both treatment outcomes and health care utilization. Knowledge of Transfer Statement: Despite a substantial number of consultations, individuals experiencing the care pathways in this study continued to have far from perfect health over their life course. The modeling suggests they would only experience 18 y in “perfect health.” There is considerable scope to improve current care/outcomes and patient experience.

STUDIES ON EXPERIMENTAL MODELS USED FOR NUTRITIONAL AND BIOLOGICAL RESEARCH: A TECHNIQUE OF PERMANENT INSTALLATION OF RUMEN CANNULAE IN THE NIGERIAN CATTLE

The procedure found suitable for cannulating the rumen of some indigenous breeds of cattle in Nigeria for nutritional analysis and bioassays has been described. The viability of the technique relative to others suggested for exotic ruminants, is reviewed. The anatomical location for a successful implantation in order to reduce complications to the barest minimum has been suggested. The maintenance of the implanted cannula for the purpose of keeping the modified experimental model in perfect health is discussed.

AN ANALYSIS OF THE EFFECT OF THE BODY VIBRATIONS ON THE HUMAN PERFORMANCES

In this paper, we wanted to check if classical music can improve the intellectual and practical skills of those who work in very difficult conditions. For this, we exposed 44 male students, aged 21-24, with normal BMI (19-24), in perfect health, to four types of stressors, when there is classical music as a sic sound background and when we have no music. The stressors used were vibration, excessive temperature, and humidity as well as very strong light. Two pieces of music were chosen as background: "Eine Kleine Nachtmusik" (Mozart) and "Minuetto" (Boccherini). These 2 musical works were chosen because they are cheerful, optimistic, written in an alert rhythm, easily recognizable even if the audience is not music lovers. Students’ performance was measured using 3 tests: the Purdue Pegboard Test, the Stroop Color and Word Test and also Comparing of Names Test. The results show that neither Mozart's music nor Boccherini's music led to an improvement in student performances; on the contrary, better results were obtained when it was silence.

Comparative Effectiveness of Endovascular Thrombectomy in Elderly Stroke Patients

Background and Purpose— Strokes in patients aged ≥80 years are common, and advanced age is associated with relatively poor poststroke functional outcome. The current guidelines do not recommend an upper age limit for endovascular thrombectomy (EVT). The purpose of this study is to evaluate the effectiveness of EVT in acute stroke because of large vessel occlusion for elderly patients >age 80 years. Methods— A Markov decision analytic model was constructed from a societal perspective to evaluate health outcomes in terms of quality-adjusted life years (QALYs) after EVT for acute ischemic stroke because of large vessel occlusion in patients above age 80 years. Age-specific input parameters were obtained from the most recent/comprehensive literature. Good outcome was defined as a modified Rankin Scale score ≤2. Probabilistic, 1-way, and 2-way sensitivity analyses were performed for both healthy patients and patients with disability at baseline. Results— Base case calculation showed in functionally independent patients at baseline, intravenous thrombolysis (IVT) with tPA (tissue-type plasminogen activator) only to be the better strategy with 3.76 QALYs compared to 2.93 QALYs for patients undergoing EVT. The difference in outcome is 0.83 QALY (equivalent to 303 days of life in perfect health). For patients with baseline disability, IVT only yields a utility of 1.92 QALYs and EVT yields a utility of 1.65 QALYs. The difference is 0.27 QALYs (equivalent to 99 days of life in perfect health). Multiple sensitivity analyses showed that the effectiveness of EVT is significantly determined by the morbidity and mortality after both IVT and EVT strategies, respectively. Conclusions— Our study demonstrates the impact of relevant factors on the effectiveness of EVT in patients above 80 years of age. Morbidity and mortality after both IVT and EVT strategies significantly influence the outcomes in both healthy and disabled patients at baseline. Better identification of patients not benefiting from IVT would optimize the selective use of EVT thereby improving its effectiveness.

Psychosocial Effects of a Holistic Ayurvedic Approach to Well-being in Health and Wellness Courses

Background As individuals are increasingly attending health and wellness courses outside of the conventional medical system, there is a need to obtain objective data on the effects of those programs on well-being. Methods In total, 154 men and women (mean age 54.7 years; range 25–83) participated in 3 different holistic wellness programs based on Ayurvedic Medicine principles (Seduction of Spirit, Journey into Healing, and Perfect Health) or a vacation control group. Psychosocial outcomes included spirituality (Delaney Spirituality Scale), mindful awareness (Mindful Attention Awareness Scale), psychological flexibility (Acceptance and Action Questionnaire), mood (Center for Epidemiology Studies-Depression), and anxiety (Patient-Reported Outcomes Measurement System Anxiety Scale). Results Participants in the Seduction of Spirit ( P < .004), Journey into Healing ( P < .05), and Perfect Health ( P < .004) courses showed significant increases in spirituality as compared to vacation controls. Participants in Seduction of Spirit ( P < .007) also showed significant increases in mindfulness as compared to vacation controls. Participants in the Seduction of Spirit ( P < .001) and Journey into Healing ( P < .05) courses showed significant decreases in depressed mood as compared to those in the Perfect Health and vacation control groups. All study participants showed similar increases in psychological flexibility ( P < .01) and decreases in anxiety ( P < .01). Conclusion Participation in wellness courses that incorporate a mind–body–spirit approach to health improves multiple domains of psychosocial well-being, which persists even after course participation.

Marshmallow sun roast & O Canada

Marshmallow sun roastLocation: Grouse Mountain, BCHypothermia, trauma, concussion and death. All these are acceptable risks many of us are willing to take to enjoy our favorite winter outdoor activities. Medicine is not just about keeping people in perfect health, but to enable us to do what we love. After all, “life is not measured by the number of breaths we take, but by the moments that take our breath away”._____O CanadaIt’s a lot easier to sit back and relax when it’s the only logical option available. Some say laughter is the best medicine, and I believe it’s best delivered in nature with good company.