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Introduction: This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands. Methods: Nationwide health-insurance claims data were used to assess potentially inappropriate end-of-life care (≥2 emergency room visits; ≥2 hospital admissions; >14 days hospitalization; chemotherapy; ICU admission; hospital death) and healthcare-costs in all deceased adults in IPC regions pre- and post- implementation and in those receiving IPC compared to a 1:2 matched control group. Results: In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation (26.5% vs 27.9%; p < 0.05). Deceased adults who received IPC (n = 210) also received significantly less potentially inappropriate end-of-life care compared to a matched control group (14.8% vs 28.3%; p < 0.05). Mean hospital costs significantly decreased for deceased adults who received IPC (€2,817), while mean costs increased for general practitioner services (€311) and home care (€1,632). Discussion: These results highlight the importance of implementation of integrated palliative care and suitable payment. Further research in a larger sample is needed. Conclusion: This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC. [ABSTRACT FROM AUTHOR]

The article offers information about the lack of evidence and variation in recommendations for resuming work and daily life activities after knee arthroplasty, the use of activity restrictions in rehabilitation after total hip arthroplasty (THA). It highlights the rising demands of patients for return to activities following arthroplasty, the variability in guidelines among different hospitals and clinics, and the need for more evidence-based recommendations.

The analytical distinction between critical and problem-solving research is useful. At the onset of research, the latter takes the world as it is while the former questions it. Yet, in striving to integrate social and natural dimensions of sustainability such a distinction may surface as a methodological obstacle. We illustrate how combining critical with problem-solving approaches can help us imagine, understand, and enable transitions to sustainability. First, we trace the historical divide and potential complementarity between critical and problem-solving approaches in the natural and social sciences and how critical approaches in the social sciences are informed by critical theory. Inspired by Robert Cox, we then analyze a set of PhD theses in an interdisciplinary research program engaging in critical and problem-solving research, on and for sustainability. We do so based on Cox's terminology, especially the concepts of ideas, institutions, material capabilities, and frameworks for action, and then show how selected research narratives apply them. To conclude, we emphasize that integrated understandings of human-environmental dynamics are facilitated by multiscalar approaches, theoretical and methodological pluralism, and a combination of natural and social science theory, typical of the interdisciplinary research field of sustainability science. [ABSTRACT FROM AUTHOR]