Associations of Healthcare Utilization and Costs with Increasing Pain and Treatment Intensity Levels in Osteoarthritis Patients: an 18-Year Retrospective Study

BackgroundOsteoarthritis (OA) is a complex disease, and prior studies have documented the health and economic burdens of patients with OA compared to those without OA. Our goal was to use two strategies to further stratify OA patients based on both pain and treatment intensity to examine healthcare utilization and costs using electronic records from 2001-2018 at a large integrated health system. Methods Adult patients with ≥1 pain numerical rating score (NRS) and diagnosis of OA were included. Pain episodes of ≥90 days were defined as mild (0-3), moderate (4-6) or severe (7-10) based on initial NRS. Patients were initially classified as mild and moved to moderate-severe OA if any of eight treatment-based criteria were met. Outpatient visits (OP), emergency department visits (ED), inpatient days, and healthcare costs (both all-cause and OA-specific) were compared among pain levels and OA severity levels as frequencies and per-member-per-year rates, using generalized linear regression models adjusting for age, sex and body mass index, with contrasts of p<0.05 considered significant. ResultsWe identified 127,656 patients, 92,576 with pain scores. Moderate and severe pain were associated with significantly higher rates of OA-related utilization and costs, and all-cause ED visits and pharmacy costs. Moderate-severe OA patients had significantly higher OA-related utilization and costs, and all-cause OP, ED and pharmacy costs. ConclusionsPain and treatment intensity were both strongly associated with OA-related resource utilization but not consistently with all-cause utilization. With better understanding of how OA patients intensify services, thus increasing costs, we can deploy targeted preventative strategies aimed at halting progression into more costly phases of the disease.

Penggunaan Lembar Kerja Digital untuk Mengembangkan Keterampilan Komunikasi Mahasiswa pada Mata kuliah Telaah Kurikulum Fisika

This study aims to develop students' communication skills in the Physics Curriculum Study course through the use of Digital Worksheets. The subjects of this study were 23 students of class 5B. The student came from the Physics Education Study Program, University of Mataram, who attended the Physics Curriculum Study course in the odd semester of the 2021/2022 academic year. The research instrument used was a student communication skill observation sheet with three indicators. Observations were made online at the Learning Management System (LMS) equipped with Digital Worksheets on the Discussion Forum menu. Observations were made every meeting, namely 14 times using a 4-scale rating score. The increase in score from the first meeting to the last meeting was calculated using N-gain. The average score of student communication skills is 79.5 which is in good criteria. The improvement of students' communication skills based on the calculation of N-gain is 72.7 which is in the high category. Thus, the use of Digital Worksheets can develop students' communication skills in the Physics Curriculum Study course.

Seeding development potential and prospects of NASA 29 hybrid corn in North Sulawesi Province

North Sulawesi is one of the areas with great potential in supporting the production and productivity of hybrid maize seeds. The land available for the cultivation of hybrid maize seeds is very wide, the requirements for agro-climatic are simple, the technology is readily available, so that the prospect of profits for the cultivator is quite large. Most of the maize farmers in North Sulawesi tend to use hybrid seeds. This is because the yield obtained is very high, however, the availability of hybrid seeds is very limited, even if available, the price is quite expensive. Farmers are currently still dependent on seed assistance from the Government. Production of seeds through breeder farmers as a solution in order to increase corn production. NASA 29 variety is a new superior variety derived from male parents G102612 and Mal 03 as female parents. The results of the interview showed that 86% of the 25 respondents of maize farmers gave an average rating score of 3.8. This shows that they really like the characteristics of the plant. The production data for NASA 29 seed candidates is 3.6 tons / ha. These results indicate that the prospect of hybrid maize seeding business is profitable for breeder farmers.

COMPARISON OF PAIN RELIEF EFFICACY OF PLATELET-RICH PLASMA VERSUS CORTICOSTEROIDS IN KNEE OSTEOARTHRITIS

Objective: To compare the pain relief efficacy of platelet rich plasma injection with corticosteroid injection in knee osteoarthritis using numeric rating scale. Study Design: Quasi experimental study. Place and Duration of Study: Department of Anesthesia and Pain Management, Combined Military Hospital Peshawar, from Jan 2018 to Dec 2019. Methodology: Total of 310 patients who underwent knee injection for osteoarthritis were included in this study. Patients were divided into two groups; group A and group B comprising of 155 patients each. Patients in group ‘A’ received intra articular corticosteroid injection while patients in group ‘B’ received intra articular platelet rich plasma injection for knee osteoarthritis. Pain assessment via numerical rating score was done at the start of the treatment and at 6 months. Results: In group A female to male ratio was 2.69:1 while in group B the female to male ratio was 2.78:1. Mean age of ‘group A’ was 58.52 ± 11.87 years and that of ‘group B’ was 58.79 ± 11.15 years. Numerical rating score pre-treatment in ‘group A’ vs ‘group B’ was 8.35 ± 1.17 vs 8.42 ± 1.14. While numeric rating scale post treatment in ‘group A’ vs ‘group B’ was 5.74 ± 1.37 vs 4.06 ± 1.19, respectively with p-value of 0.001, which is statistically significant. Conclusion: Patients who received intra-articular platelet rich plasma had significantly more pain relief as compared to patients who received intra-articular steroid on numerical rating score.

Genotype-Phenotype Correlations in PMM2-CDG

PMM2-CDG is a rare disease, causing hypoglycosylation of multiple proteins, hence preventing full functionality. So far, no direct genotype–phenotype correlations have been identified. We carried out a retrospective cohort study on 26 PMM2-CDG patients. We collected the identified genotype, as well as continuous variables indicating the disease severity (based on Nijmegen Pediatric CDG Rating Score or NPCRS) and dichotomous variables reflecting the patients’ phenotype. The phenotypic effects of patients’ genotype were studied using non-parametric and Chi-Square tests. Seventeen different pathogenic variants have been studied. Variants with zero enzyme activity had no significant impact on the Nijmegen score. Pathogenic variants involving the stabilization/folding domain have a significantly lower total NPCRS (p = 0.017): presence of the p.Cys241Ser mutation had a significantly lower subscore 1,3 and NPCRS (p = 0.04) and thus result in a less severe phenotype. On the other hand, variants involving the dimerization domain, p.Pro113Leu and p.Phe119Leu, resulted in a significantly higher NPCRS score (p = 0.002), which indicates a worse clinical course. These concepts give a better insight in the phenotypic prognosis of PMM2-CDG, according to their molecular base.

Spacious Environments Make Us Tolerant—The Role of Emotion and Metaphor

The physical environment plays an important role in moral cognition. Previous research has demonstrated that the physical environment affects individual moral judgment. Investigators have argued that the environment influences moral judgment through emotion and cognition, such as during metaphor processing. Following the intensification of urbanization and increases in population size, the phenomenon of a narrow environment has become more common. However, the relation between environmental spaciousness and moral judgment has not been thoroughly examined. We examined the effect of environmental spaciousness (spaciousness vs. narrowness) on moral judgments in Experiment 1 and Experiment 2. Results showed that participants report a higher rating score of moral judgment in more spacious environments compared with narrow environments. We further explored the roles of emotion and metaphor in the relation between environmental spaciousness and moral judgments. We found support for a partial mediation effect of emotion in the relationship between environmental spaciousness and moral judgment. The results also supported an association between the concept of spaciousness and tolerant cognition. Spacious environments may elicit positive emotions and more tolerant cognition, which in turn influences moral judgment. These results provide new evidence for the influence of the environment on moral judgments, and more attention may be warranted to incorporate this relationship in environmental design.

EVALUATION OF EFFICIENCY AND THE DEGREE OF DEPENDENCE OF HEALTH INSTITUTION PERFORMANCE INDICATORS ON THE LEVEL OF ADMINISTRATIVE COMPETENCE OF THE MANAGER

Aim. The aim of the study was to develop proposals for improving the administrative competencies in managers of health institutions. Material and methods. The main data for the study were obtained by questioning a group of managers of health institutions, namely state autonomous health care institutions of the Republic of Tatarstan. In total the questionnaire survey covered 31 health institutions. A total of 73 persons, including 31 heads of health institutions of the Republic of Tatarstan and 42 specialists from among the heads of departments and deputy chief physicians, who are the members of reserve of management personnel, participated in the questionnaire survey. Results and discussion. According to the data obtained, the group of heads of health institutions with the highest rating score differed from the representatives of health institutions with fewer rating scores by higher values of anticipatory statefulness. Among the heads of health institutions with the highest rating score, a higher level of overall anticipation competence was revealed, which allows us to conclude about the application of the algorithm of psychological tests for determining the level of anticipation competence to predict the effectiveness of the head when considering candidates for the appointment to the position of the head of a health institution. Conclusion. The developed algorithm of using the parameters of psychological tests to assess and predict the effectiveness of the respondent can be applied in the practice of the Ministry of Health, as a tool for human resource activities

Peripheral administration of selective GlyT2 inhibitor, oleoyl-D-lysine, is analgesic in neuropathic but not acute or inflammatory pain models in mice

Background and Purpose: Changes to spinal glycinergic signalling are a feature of pain chronification. Normalising those changes by inhibiting glycine transporter-2 (GlyT2) is a promising treatment strategy. However, existing GlyT2 inhibitors e.g. ORG25543 are limited by narrow therapeutic windows and severe dose-limiting side effects such as convulsions, and are therefore poor candidates for clinical development. Experimental Approach: Analgesic and side-effect properties of intraperitoneally administered oleoyl-D-lysine, a lipid-based GlyT2 inhibitor, were characterised in mice. Analgesia was assessed in models of chronic neuropathic and inflammatory pain via the von Frey test, and acute nociception via hotplate. Side effects were scored via numerical rating scale, convulsions score, the Rotarod test and whole-body plethysmography for respiratory depression. Key Results: Oleoyl-D-lysine produced significant analgesia/anti-allodynia in the model for chronic neuropathic pain but not for chronic inflammatory or acute pain. No side effects were seen at the peak analgesic dose, 30 mg kg-1. Mild side effects were observed at the highest dose, 100 mg kg-1, in the numerical rating score, but no convulsions. These results contrasted markedly with ORG25543, which produced significant analgesia only at the lethal or near-lethal dose of 50 mg kg-1. At this dose, ORG25543 caused severe side effects on the numerical rating score, severe convulsions, and Rotarod impairment. Oleoyl-D-lysine (30 mg kg-1) did not cause any respiratory depression, a problematic side effect of opiates. Conclusions and Implications: Oleoyl-D-lysine safely and effectively reverses neuropathic pain in mice. GlyT2 inhibitors may be better suited to treating pain of neuropathic origin over other pain aetiologies.

Impact of Technology on School Leadership at Jakar Higher Secondary School, Bumthang

Technology is indispensable in today's era and we have to think about how we can utilize it to create and impart effective leadership and learning in the schools. The essence of technology is strongly felt in education than ever before. The school leader who harnesses technology advances in every aspect and becomes a technology leader. Technology advancement is professional growth and it affects school leadership. The purpose of this action research was to find out the impact of technology on school leadership. The pre-test and post-test were carried out and data were analyzed accordingly. The questionnaire was categorized into three aspects such as communication, student learning, and administrative and managerial. The pre-test and post-test data showed a change in responses and the rating score on the questionnaire indicated the effectiveness of intervention strategies and the impact of technology on school leadership. The findings also show a significant positive correlation between technology and school leadership. It was found out that technology has a greater impact on school leadership, student learning and also amplifies communication skills.

Exploring the Effect on 5 Senses in Children under Nitrous Oxide Sedation

BACKGROUND Sensation and perception are two separate processes that are very closely related. Sensation is the input about the outside world obtained by our sensory receptors while perception is the difficult system by which the brain selects, organizes and interprets these sensations. Effects of nitrous oxide on the sensation and perception has not been unturned although role in physiological, anxiolytic, behavioural, psychomotor and analgesic parameters have been examined in both children and adults. The human senses have long been unnoticed, despite their responsiveness being of great importance. The purpose of this study was to evaluate the effectiveness of nitrous oxide inhalation sedation on 5 senses i.e. sight, hearing, touch, smell and taste at different titrations of nitrous oxide and oxygen. METHODS 7 to 12 years old children with Frankl’s behaviour rating score of 2, 3 and 4 with no prior dental experience and requiring dental treatment under nitrous oxide sedation who were systemically healthy were included in the study. The 5 senses (i.e. hearing, touch, smell, taste and vision) were evaluated with different materials at 4 different titration levels to evaluate the effect of nitrous oxide on the 5 senses T0: 100 % oxygen, T1: 30 % nitrous oxide, T2: 50 % nitrous oxide, T3: 100 % oxygen. RESULTS The results of the present study depicted that there is significant difference in the perception of various senses at different concentrations of nitrous oxide and also when compared to baseline values. It was observed that the patient regained the normal perception in 5 minutes after 100 % oxygen post-operatively. CONCLUSIONS Nitrous oxide is found to depress/relax one’s senses too. KEY WORDS Vision, Smell, Taste, Touch, Sound, Perception, Consciousness, Nitrous Oxide Sedation, Oxygen, Behaviour