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Objective: To determine work participation, social roles, and empowerment of QFS patients ≥10-year after infection. Methods: QFS patients ≥10-year after acute infection, who were of working age, participated in a cross-sectional survey study. Work participation, fulfilment of social roles, and empowerment outcomes were studied for the total population, as well as for subgroups based on employment type and current work status. Associations between empowerment, work and social roles were examined. Results: 291 participants were included. Of the 250 participants who had paid work before Q-fever, 80.4% stopped working or worked less hours due to QFS. For each social role, more than half of the participants (56.6–87.8%) spent less time on the role compared to before Q-fever. The median empowerment score was 41.0 (IQR: 37.0–44.0) out of 60. A higher empowerment score was significantly associated with lower odds of performing all social roles less due to QFS (OR = 0.871–0.933; p<0.001–0.026), except for parenting and informal care provision (p = 0.070–0.460). No associations were found between empowerment and current work status. Conclusion: Work participation and fulfilment of social roles is generally low in QFS patients. Many of the participants stopped working or are working less hours due to QFS, and most spent less time on social roles compared to before Q-fever. Minor variation was seen in total empowerment scores of participants; however, these slight differences were associated with the fulfilment of social roles, but not work participation. This new insight should be further explored in future studies. [ABSTRACT FROM AUTHOR]

Maryse C Cnossen,1 Thomas A van Essen,2,3 Iris E Ceyisakar,1 Suzanne Polinder,1 Teuntje M Andriessen,4 Joukje van der Naalt,5 Iain Haitsma,6 Janneke Horn,7 Gaby Franschman,8 Pieter E Vos,9 Wilco C Peul,2,3 David K Menon,10 Andrew IR Maas,11 Ewout W Steyerberg,1,12 Hester F Lingsma1 1Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; 2Neurosurgical Cooperative Holland, Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands; 3Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands; 4Department of Psychology, RIVAS Healthcare Group, Gorinchem, the Netherlands; 5Department of Neurology, University Medical Center Groningen, Groningen, the Netherlands; 6Department of Neurosurgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; 7Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; 8Department of Anesthesiology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands; 9Department of Neurology, Slingeland Hospital, Doetinchem, the Netherlands; 10Division of Anaesthesia, University of Cambridge/Addenbrooke’s Hospital, Cambridge, UK; 11Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium; 12Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands Introduction: Observational studies of interventions are at risk for confounding by indication. The objective of the current study was to define the circumstances for the validity of methods to adjust for confounding by indication in observational studies. Patients and methods: We performed post hoc analyses of data prospectively collected from three European and North American traumatic brain injury studies including 1,725 patients. The effects of three interventions (intracranial pressure [ICP] monitoring, intracranial operation and primary referral) were estimated in a proportional odds regression model with the Glasgow Outcome Scale as ordinal outcome variable. Three analytical methods were compared: classical covariate adjustment, propensity score matching and instrumental variable (IV) analysis in which the percentage exposed to an intervention in each hospital was added as an independent variable, together with a random intercept for each hospital. In addition, a simulation study was performed in which the effect of a hypothetical beneficial intervention (OR 1.65) was simulated for scenarios with and without unmeasured confounders. Results: For all three interventions, covariate adjustment and propensity score matching resulted in negative estimates of the treatment effect (OR ranging from 0.80 to 0.92), whereas the IV approach indicated that both ICP monitoring and intracranial operation might be beneficial (OR per 10% change 1.17, 95% CI 1.01–1.42 and 1.42, 95% CI 0.95–1.97). In our simulation study, we found that covariate adjustment and propensity score matching resulted in an invalid estimate of the treatment effect in case of unmeasured confounders (OR ranging from 0.90 to 1.03). The IV approach provided an estimate in the similar direction as the simulated effect (OR per 10% change 1.04–1.05) but was statistically inefficient. Conclusion: The effect estimation of interventions in observational studies strongly depends on the analytical method used. When unobserved confounding and practice variation are expected in observational multicenter studies, IV analysis should be considered. Keywords: confounding, observational studies, traumatic brain injury, instrumental variable analysis, comparative effectiveness research

Background: The population of elderly patients with burn injuries is growing. Insight into long-term mortality rates of elderly after burn injury and predictors affecting outcome is limited. This study aimed to provide this information. Methods: A multicentre observational retrospective cohort study was conducted in all three Dutch burn centres. Patients aged ≥65 years, admitted with burn injuries between 2009 and 2018, were included. Data were retrieved from electronic patient records and the Dutch Burn Repository R3. Mortality rates and standardized mortality ratios (SMRs) were calculated. Multivariable logistic regression was used to assess predictors for in-hospital mortality and mortality after discharge at 1 year and five-year. Survival analysis was used to assess predictors of five-year mortality. Results: In total, 682/771 admitted patients were discharged. One-year and five-year mortality rates were 8.1 and 23.4%. The SMRs were 1.9(95%CI 1.5–2.5) and 1.4(95%CI 1.2–1.6), respectively. The SMRs were highest in patients aged 75–80 years at 1 year (SMRs 2.7, 95%CI 1.82–3.87) and five-year in patients aged 65–74 years (SMRs 10.1, 95%CI 7.7–13.0). Independent predictors for mortality at 1 year after discharge were higher age (OR 1.1, 95%CI 1.0–1.1), severe comorbidity, (ASA-score ≥ 3) (OR 4.8, 95%CI 2.3–9.7), and a non-home discharge location (OR 2.0, 95%CI 1.1–3.8). The relative risk of dying up to five-year was increased by age (HR 1.1, 95%CI 1.0–1.1), severe comorbidity (HR 2.3, 95%CI 1.6–3.5), and non-home discharge location (HR 2.1, 95%CI 1.4–3.2). Conclusion: Long-term mortality until five-year after burn injury was higher than the age and sex-matched general Dutch population, and predicted by higher age, severe comorbidity, and a non-home discharge destination. Next to pre-injury characteristics, potential long-lasting systemic consequences on biological mechanisms following burn injuries probably play a role in increased mortality. Decreased health status makes patients more prone to burn injuries, leading to early death. [ABSTRACT FROM AUTHOR]

In population pharmacokinetic (PK) models, interindividual variability is explained by implementation of covariates in the model. The widely used forward stepwise selection method is sensitive to bias, which may lead to an incorrect inclusion of covariates. Alternatives, such as the full fixed effects model, reduce this bias but are dependent on the chosen implementation of each covariate. As the correct functional forms are unknown, this may still lead to an inaccurate selection of covariates. Machine learning (ML) techniques can potentially be used to learn the optimal functional forms for implementing covariates directly from data. A recent study suggested that using ML resulted in an improved selection of influential covariates. However, how do we select the appropriate functional form for including these covariates? In this work, we use SHapley Additive exPlanations (SHAP) to infer the relationship between covariates and PK parameters from ML models. As a case‐study, we use data from 119 patients with hemophilia A receiving clotting factor VIII concentrate peri‐operatively. We fit both a random forest and a XGBoost model to predict empirical Bayes estimated clearance and central volume from a base nonlinear mixed effects model. Next, we show that SHAP reveals covariate relationships which match previous findings. In addition, we can reveal subtle effects arising from combinations of covariates difficult to obtain using other methods of covariate analysis. We conclude that the proposed method can be used to extend ML‐based covariate selection, and holds potential as a complete full model alternative to classical covariate analyses. [ABSTRACT FROM AUTHOR]

Nonlinear mixed effect (NLME) models are the gold standard for the analysis of patient response following drug exposure. However, these types of models are complex and time‐consuming to develop. There is great interest in the adoption of machine‐learning methods, but most implementations cannot be reliably extrapolated to treatment strategies outside of the training data. In order to solve this problem, we propose the deep compartment model (DCM), a combination of neural networks and ordinary differential equations. Using simulated datasets of different sizes, we show that our model remains accurate when training on small data sets. Furthermore, using a real‐world data set of patients with hemophilia A receiving factor VIII concentrate while undergoing surgery, we show that our model more accurately predicts a priori drug concentrations compared to a previous NLME model. In addition, we show that our model correctly describes the changing drug concentration over time. By adopting pharmacokinetic principles, the DCM allows for simulation of different treatment strategies and enables therapeutic drug monitoring. [ABSTRACT FROM AUTHOR]

Objective To develop a standardized method for calculating years lived with disability (YLD) after injury. Methods The method developed consists of obtaining data on injury cases seen in emergency departments as well as injury-related hospital admissions, using the EUROCOST system to link the injury cases to disability information and employing empirical data to describe functional outcomes in injured patients. Findings Overall, 87 weights and proportions for 27 injury diagnoses involving lifelong consequences were included in the method. Almost all of the injuries investigated (96-100%) could be assigned to EUROCOST categories. The mean number of YLD per case of injury varied with the country studied. Use of the novel method resulted in estimated burdens of injury that were 3 to 8 times higher, in terms of YLD, than the corresponding estimates produced using the conventional methods employed in global burden of disease studies, which employ disability-adjusted life years. Conclusion The novel method for calculating YLD after injury can be applied in different settings, overcomes some limitations of the method used to calculate the global burden of disease, and allows more accurate estimates of the population burden of injury. Objectif Mettre au point une methode normalisee de calcul des annees vecues avec une incapacite (AVl) apres une blessure. Methodes La methode developpee consiste a obtenir les donnees relatives aux blessures des services d'urgence, ainsi que celles relatives aux hospitalisations liees a des blessures, en utilisant le systeme EUROCOST pour relier les cas de blessures a l'information relative a l'invalidite, et en utilisant des donnees empiriques pour decrire les resultats fonctionnels chez les patients blesses. Resultats Au total, 87 poids et proportions pour 27 diagnostics de blessures impliquant des sequelles a vie ont ete inclus dans la methode. Presque toutes les blessures etudiees (96 a 100%) pouvaient etre attribuees aux categories EUROCOST. Le nombre moyen d'AVI par cas de blessure variait selon le pays etudie. L'utilisation de la nouvelle methode a entraine des charges estimees des blessures 3 a 8 fois superieures en termes d'AVI que les estimations correspondantes resultant des methodes classiques utilisees dans les etudes de charge globale de la morbidite, employant les annees vecues ajustees a l'incapacite. Conclusion La nouvelle methode de calcul d'AMI apres une blessure peut etre appliquee dans des contextes differents, surmonte certaines des limites de la methode utilisee pour calculer la charge globale de la morbidite et permet d'effectuer des estimations plus precises de la charge des blessures de la population. Objetivo Desarrollar un metodo estandarizado para calcular las atlas vividos con una discapacidad (YLD, par sus siglas en ingles) despues de un traumatismo. Metodos El metodo desarrollado consiste en la obtencion de datos acerca de las casos de traumatismos vistos en las servicios de urgencias y en hospitalizaciones relacionadas con traumatismos par media del sistema EUROCOST para relacionar las casos de traumatismos con la informacion sobre la discapacidad y utilizar las datos empfricos para describir las resultados funcionales en pacientes con traumatismos. Resultados En total, se incluyeron en el metodo 87 pesos y proporciones de 27 diagnosticos par traumatismo con consecuencias para toda la vida. La mayoria de las traumatismos investigados (96-100%) pudo asignarse a una de las categorias de EUROCQST. EI numero media de YLD par traumatismo vario en cada pais estudiado. EI usa del metodo novedoso dio coma resultado cargas estimadas de traumatismo que fueron de 3 a 8 veces mas altas, desde el punto de vista de los YLD, que las calculos correspondientes obtenidos a traves de las metodos convencionales empleados en las estudios mundiales sobre la carga de traumatismos, que utilizan las anos de vida ajustados par discapacidad. Conclusion EI metodo novedoso para calcular Ios YLD despues de un traumatismo puede aplicarse en entornos distintos, supera algunas de las limitaciones del metodo empleado para calcular la carga global de morbilidad y permite realizar estimaciones mas exactas de la poblacion con traumatismos., Introduction The setting of priority in health care, surveillance and interventions is based increasingly on the results of studies on the burdens of disease and injury. (1,2) The burden of [...]

Background: Isolation precautions are recommended when caring for patients identified with highly resistant micro-organisms (HRMOs). However, the direct costs of patients in isolation are largely unknown.Aim: To obtain detailed information on the daily direct costs associated with isolating patients identified with HRMOs.Methods: This study was performed from November until December 2017 on a 12-bed surgical ward. This ward contained solely isolation rooms with anterooms. The daily direct costs of isolation were based on three cost items: (1) additional personal protective equipment (PPE), measured by counting the consumption of empty packaging materials; (2) cleaning and disinfection of the isolation room, based on the costs of an outsourced cleaning company; and (3) additional workload for healthcare workers, based on literature and multiplied by the average gross hourly salary of nurses. A distinction was made between the costs for strict isolation, contact-plus isolation, and contact isolation.Findings: During the study period, 26 patients were nursed in isolation because of HRMO carriage. Time for donning and doffing of PPE was 31 min per day. The average daily direct costs of isolation were the least expensive for contact isolation (gown, gloves), €28/$31, and the most expensive for strict isolation (surgical mask, gloves, gown, cap), €41/$47.Conclusion: Using a novel, easy method to estimate consumption of PPE, we conclude that the daily direct costs of isolating a patient differ per type of isolation. Insight into the direct costs of isolation is of utmost importance when developing or updating infection prevention policies. [ABSTRACT FROM AUTHOR]

Purpose: Writing an Advance Directive (AD) is often seen as a part of Advance Care Planning (ACP). ADs may include specific preferences regarding future care and treatment and information that provides a context for healthcare professionals and relatives in case they have to make decisions for the patient. The aim of this study was to get insight into the content of ADs as completed by patients with advanced cancer who participated in ACP conversations.Methods: A mixed methods study involving content analysis and descriptive statistics was used to describe the content of completed My Preferences forms, an AD used in the intervention arm of the ACTION trial, testing the effectiveness of the ACTION Respecting Choices ACP intervention.Results: In total, 33% of 442 patients who received the ACTION RC ACP intervention completed a My Preferences form. Document completion varied per country: 10.4% (United Kingdom), 20.6% (Denmark), 29.2% (Belgium), 41.7% (the Netherlands), 61.3% (Italy) and 63.9% (Slovenia). Content analysis showed that 'maintaining normal life' and 'experiencing meaningful relationships' were important for patients to live well. Fears and worries mainly concerned disease progression, pain or becoming dependent. Patients hoped for prolongation of life and to be looked after by healthcare professionals. Most patients preferred to be resuscitated and 44% of the patients expressed maximizing comfort as their goal of future care. Most patients preferred 'home' as final place of care.Conclusions: My Preferences forms provide some insights into patients' perspectives and preferences. However, understanding the reasoning behind preferences requires conversations with patients. [ABSTRACT FROM AUTHOR]

Background: Although mortality rates following major trauma are continuing to decline, a growing number of patients are experiencing long‐term disability. The aim of this study was to identify factors associated with health status in the first year following trauma and develop prediction models based on a defined trauma population. Methods: The Brabant Injury Outcome Surveillance (BIOS) study was a multicentre prospective observational cohort study. Adult patients with traumatic injury were included from August 2015 to November 2016 if admitted to one of the hospitals of the Noord‐Brabant region in the Netherlands. Outcome measures were EuroQol Five Dimensions 5D‐3L (EQ‐5D™ utility and visual analogue scale (VAS)) and Health Utilities Index (HUI) 2 and 3 scores 1 week and 1, 3, 6 and 12 months after injury. Prediction models were developed using linear mixed models, with patient characteristics, preinjury health status, injury severity and frailty as possible predictors. Predictors that were significant (P < 0·050) for one of the outcome measures were included in all models. Performance was assessed using explained variance (R2). Results: In total, 4883 patients participated in the BIOS study (50·0 per cent of the total), of whom 3366 completed the preinjury questionnaires. Preinjury health status and frailty were the strongest predictors of health status during follow‐up. Age, sex, educational level, severe head or face injury, severe torso injury, injury severity, Functional Capacity Index score, co‐morbidity and duration of hospital stay were also relevant in the multivariable models predicting health status. R2 ranged from 35 per cent for EQ‐VAS to 48 per cent for HUI 3. Conclusion: The most important predictors of health status in the first year after trauma in this population appeared to be preinjury health status and frailty. This study developed promising models for health status in the clinical trauma population. Preinjury frailty and health status, age, sex, educational level, severe head/face or torso injury, injury severity, functional capacity index, co‐morbidity and duration of stay in hospital were predictors of health status during follow‐up. The EuroQol visual analogue scale and Health Utility Index Mark 3 were identified as the best outcome measures. The models need further evaluation by external validation. Pre‐trauma health status and frailty important [ABSTRACT FROM AUTHOR]

Introduction Patients', parents' and providers' preferences with regard to medical innovations may have a major impact on their implementation. Aim To evaluate barriers and facilitators for individualized pharmacokinetic (PK)-guided dosing of prophylaxis in haemophilia patients, parents of young patients, and treating professionals by discrete choice experiment (DCE) questionnaire. Patients/Methods The study population consisted of patients with haemophilia currently or previously on prophylactic treatment with factor concentrate ( n = 114), parents of patients aged 12-18 years ( n = 19) and haemophilia professionals ( n = 91). DCE data analysis was performed, taking preference heterogeneity into account. Results Overall, patients and parents, and especially professionals were inclined to opt for PK-guided dosing of prophylaxis. In addition, if bleeding was consequently reduced, more frequent infusions were acceptable. However, daily dosing remained an important barrier for all involved. 'Reduction of costs for society' was a facilitator for implementation in all groups. Conclusions To achieve implementation of individualized PK-guided dosing of prophylaxis in haemophilia, reduction of bleeding risk and reduction of costs for society should be actively discussed as they are motivating for implementation; daily dosing is still reported to be a barrier for all groups. The knowledge of these preferences will enlarge support for this innovation, and aid in the drafting of implementable guidelines and information brochures for patients, parents and professionals. [ABSTRACT FROM AUTHOR]

BackgroundThe health care costs for reproductive care have substantially increased with the use of in vitro fertilization (IVF) treatment. The mobile health (mHealth) coaching program Smarter Pregnancy is an effective intervention to improve nutrition and lifestyle behaviors and pregnancy rates in (sub)fertile couples, including those who undergo IVF treatment. Therefore, we hypothesize that this mHealth program can also reduce health care costs associated with IVF treatment. ObjectiveThis study aimed to evaluate the cost-effectiveness of the mHealth coaching program Smarter Pregnancy and compare it to usual care in women of subfertile couples who start their first IVF cycle. MethodsThis model-based cost-effectiveness analysis was performed on data from couples undergoing IVF treatment at the Erasmus MC, University Medical Center Rotterdam. A decision tree model was used to assess the incremental cost-effectiveness ratio (ICER) of ongoing pregnancies and costs of use of the mHealth program as compared to usual care. A probabilistic sensitivity analysis was performed to consider the uncertainty surrounding the point estimates of the input parameters. ResultsBased on our model including 793 subfertile women undergoing IVF treatment, use of the mHealth program resulted in 86 additional pregnancies and saved €270,000 compared to usual care after two IVF cycles, with an ICER of –€3050 (95% CI –3960 to –540) per additional pregnancy. The largest cost saving was caused by the avoided IVF treatment costs. Sensitivity analyses showed that the mHealth program needs to increase the ongoing pregnancy rate by at least 51% after two IVF cycles for cost saving. ConclusionsThe mHealth coaching program Smarter Pregnancy is potentially cost saving for subfertile couples preceding their first IVF treatment. Implementation of this mHealth program in routine preconception care for subfertile couples should be seriously considered, given the relatively low costs and promising cost-effectiveness estimates.

Between January 2004 and February 2006, 109 patients after intentionally curative surgery for oesophageal or gastric cardia cancer were randomised to standard follow-up of surgeons at the outpatient clinic (standard follow-up; n=55) or by regular home visits of a specialist nurse (nurse-led follow-up; n=54). Longitudinal data on generic (EuroQuol-5D, European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30) and disease-specific quality of life (EORTC QLQ-OES18), patient satisfaction and costs were collected at baseline and at 6 weeks and 4, 7 and 13 months afterwards. We found largely similar quality-of-life scores in the two follow-up groups over time. At 4 and 7 months, slightly more improvement on the EQ-VAS was noted in the nurse-led compared with the standard follow-up group (P=0.13 and 0.12, respectively). Small differences were also found in patient satisfaction between the two groups (P=0.14), with spouses being more satisfied with nurse-led follow-up (P=0.03). No differences were found in most medical outcomes. However, body weight of patients of the standard follow-up group deteriorated slightly (P=0.04), whereas body weight of patients of the nurse-led follow-up group remained stable. Medical costs were lower in the nurse-led follow-up group (\[euro]2600 vs \[euro]3800), however, due to the large variation between patients, this was not statistically significant (P=0.11). A cost effectiveness acceptability curve showed that the probability of being cost effective for costs per one point gain in general quality-of-life exceeded 90 and 75% after 4 and 13 months of follow-up, respectively. Nurse-led follow-up at home does not adversely affect quality of life or satisfaction of patients compared with standard follow-up by clinicians at the outpatient clinic. This type of care is very likely to be more cost effective than physician-led follow-up.British Journal of Cancer (2009) 100, 70–76. doi:10.1038/sj.bjc.6604811 www.bjcancer.com Published online 9 December 2008 [ABSTRACT FROM AUTHOR]

Background: Disability weights are necessary to estimate the disability component (years lived with disability, YLDs) of disability-adjusted life years. The original global burden of disease approach to deriving disability weights ignores temporary consequences of injury. Objectives: To develop and apply novel empirical disability weights to improve estimates of the non-fatal burden of injury. Methods: A set of 45 disability weights was derived for both permanent and temporary consequences of injury, using the annual profile approach. A population panel (n = 143) provided the values. The novel set of disability weights was then linked to epidemiological surveillance data on the incidence of injury in The Netherlands to calculate YLD resulting from permanent and temporary consequences of injury. Results: The empirical disability weights for injury consequences varied from minor (corneal abrasion, 0.004) to very severe (quadriplegia, 0.719) health loss. Increasing disability weights by level of severity were found, as illustrated by concussion (0.02), versus moderate brain injury (0.193), versus severe brain injury (0.540). Application of these new disability weights showed a 36% increase in YLD as the result of unintentional injury. Conclusions: YLD calculations based on global burden of disease disability weights underestimate the size of the injury problem by ignoring temporary health consequences. Application of novel empirical disability weights, derived using the annual profile approach, may improve calculations on the burden of non-fatal injury. [ABSTRACT FROM AUTHOR]

The primary objective was to describe the methodological challenges and devise solutions to compare injury incidence across countries. The research design was a mixed methods study, consisting of a consultation with an expert group and comparison of injury surveillance systems and data from ten European countries. A subset of fractures, selected radiologically verifiable fractures and a method of checking the national representativeness of sample emergency department data were devised and are proposed for further development.These methodological considerations and developments will be further refined and tested and should prove useful tools for those who need to compare injury incidence data across countries. [ABSTRACT FROM AUTHOR]

Self-expanding metal stent placement and single-dose brachytherapy are commonly used for the palliation of oesophageal obstruction due to inoperable oesophagogastric cancer. We randomised 209 patients to the placement of an Ultraflex stent (n=108) or single-dose brachytherapy (12?Gy, n=101). Cost comparisons included comprehensive data of hospital costs, diagnostic interventions and extramural care. We acquired detailed information on health care consumption from a case record form and from monthly home visits by a specialised nurse. The initial costs of stent placement were higher than the costs of brachytherapy (\[euro]1500 vs \[euro]570; P<0.001). Total medical costs were, however, similar (stent \[euro]11?195 vs brachytherapy \[euro]10?078, P>0.20). Total hospital stay during follow-up was 11.5 days after stent placement vs 12.4 days after brachytherapy, which was responsible for the high intramural costs in both treatment groups (stent \[euro]6512 vs brachytherapy \[euro]7982, P>0.20). Costs for medical procedures during follow-up were higher after stent placement (stent \[euro]249 vs brachytherapy \[euro]168, P=0.002), while the costs of extramural care were similar (\[euro]1278 vs \[euro]1046, P>0.20). In conclusion, there are only small differences between the total medical costs of both palliative treatment modalities, despite the fact that the initial costs of stent placement are much higher than those of brachytherapy. Therefore, cost considerations should not play an important role in decision making on the appropriate palliative treatment strategy for patients with malignant dysphagia.British Journal of Cancer (2004) 90, 2067-2072. doi:10.1038/sj.bjc.6601815 www.bjcancer.com Published online 4 May 2004 [ABSTRACT FROM AUTHOR]

Background: Intoxications with alcohol and drugs are common in the Emergency Department. This study aimed to describe the occurrence and characteristics of intoxications (alcohol, Drugs of Abuse (DOA), pharmaceutical and chemical) presented to the Emergency Department and the health care costs of these intoxications. Methods: This was a retrospective medical record study of all patients (≥ 16 years) who presented to the Emergency Department of an inner-city academic hospital in the Netherlands due to single or multiple intoxication(s) as the primary or secondary reason in the year 2016. An intoxication was reported as present if the attending physician described the intoxication in the patient's medical record. Results: A total of 783 patients were included, accounting for 3.2% of the adult Emergency Department population (age ≥ 16 year). In 30% more than one substance was used. Intoxications with alcohol, Drugs of Abuse and pharmaceuticals was reported in respectively 62%, 29% and 21% of the intoxicated patients. The mean costs per patient presenting with an intoxication to the Emergency Department was € 1,490. The mean costs per patient were highest for pharmaceutical intoxications (€ 2,980), followed by Drugs of Abuse (€ 1,140) and alcohol (€ 1,070). Conclusions: Intoxications among patients aged 16 years and older are frequently seen at the Emergency Department and are frequently caused by multiple substances. Alcohol is the most common intoxication. Substantial healthcare costs are involved. Therefore, this study suggests that further research into hazardous alcohol consumption and DOA abuse is warranted. [ABSTRACT FROM AUTHOR]

To describe the two year recovery pattern of Health Status (HS) and psychological outcome for different categories of trauma patients and to identify risk factors for decreased short, mid and long term health status. Data was collected on patient characteristics, comorbidities, HS (EuroQol-5D-3L (EQ5D), the Health Utilities Index (HUI) 2 and 3), psychological outcome (Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale (IES)). Female gender, more comorbidities and longer hospital stay were associated with higher risk of decreased HS during all terms, while the effect of severity and type of injury faded out over time. [Extracted from the article]

(I) to determine prognostic factors for poor health status (HS) and recovery patterns after injury and (II) to identify high risk groups for poor HS during the first two years after injury in the clinical trauma population. Although patients showed to be recovered after six months for the dimensions anxiety/depression and cognition, the EQ-5D-3L dimensions mobility, pain/discomfort and usual activities still improved 2 years after injury. Lower pre-injury health status, frailty and longer LOS were important prognostic factors for both decreased health status and reporting problems in its' dimensions during the first two years after trauma. [Extracted from the article]

Introduction: Health-related quality of life (HRQL) is an important outcome in burn care and research. An advantage of a generic HRQL instrument, like the EQ-5D, is that it enables comparison of outcomes with other conditions and the general population. However, the downside is that it does not include burn specific domains, like scar issues or itching. Adding extra items to a generic instrument might overcome this issue. This study explored the potential and added value of extending the EQ-5D-5L with a burn-specific item, using a itching item as an example.Methods: The EQ-5D-5L and the Patient and Observer Scar Assessment Scale (POSAS) was completed by adult patients 5-7 years after injury. A separate POSAS itching item was used to study the added value of an itching item for the EQ-5D-5L. The EQ-5D-5L + Itching was created by adding the POSAS itching item to the EQ-5D-5L. Five psychometric properties were compared between EQ-5D-5L and EQ-5D-5L + Itching: distribution (e.g. ceiling), informativity cf. Shannon's indices, convergent validity, dimension dependency, and explanatory power respectively.Results: A total of 243 patients were included, of whom 49% reported any itching on the POSAS. Adding an itching item to the EQ-5D-5L decreased the ceiling effect, and resulted in increased absolute informativity (H' = 4.76 vs. H' = 3.64) and relative informativity (J' = 0.34 vs. J' = 0.31). The extra itching item decreased the convergent validity (Spearman's rank correlation coefficient = -0.51 vs. -0.59). Mutual dependency of dimensions existed, showing that all other items were dominant over the itching item. Adding the itching item to the standard EQ-5D-5L barely improved explanatory power (49.3% vs. 49.0%).Conclusions: PThe present study showed adding a burn-specific item to the EQ-5D-5L is possible and has potential. However, 5 to 7 years after injury, adding an itching item to the EQ-5D-5L provides little additional information; the gain in terms of added value is relatively small. Apart from instances where itching information is specifically needed, a strong case is not present for adding an itching item to the EQ-5D-5L for long-term (>5 yr after burns) HRQL assessment in burn patients. In early time periods after burn, the added value might be greater and we recommend exploring this potential in future studies, ideally on multiple timepoints after burn. [ABSTRACT FROM AUTHOR]