Homeopathic aggravation is a temporary worsening of existing symptoms following the administration of a correct homeopathic prescription. The aim of this study was to explore and compose criteria that may differentiate homeopathic aggravations from adverse effects.
A qualitative approach was employed using focus group interviews. 2 interviews, with 11 experienced homeopaths, were performed in Oslo, Norway. The practitioners have practiced classical homeopathy over a period of 10-32 years. Qualitative content analysis was used to analyze the text data. The codes were defined before and during the data analysis.
We found that aggravations were subtle and multifaceted events. Moreover, highly skilled homeopaths are required to identify and report aggravations. Adverse effect may be defined as an 'undesirable effect of a remedy'. This definition is pragmatic, flexible, and more in line with the holistic paradigm that the homeopaths represent. 8 criteria that distinguish aggravation from adverse effect were found. Highly sensitive persons hold a unique position regarding safety, as it is important to identify these patients in order to treat them correctly and avoid undesirable effects of the treatment.
This study rigorously explored homeopaths' views and experience on aggravation and adverse effects. The 8 criteria developed in this study may ensure patient safety and support therapists in identifying an 'undesirable effect of a remedy'.
Lifetime supplementation with vitamin K, vitamin D(3), and calcium is likely to reduce fractures and increase survival in postmenopausal women. It would be a cost-effective intervention at commonly used thresholds, but high uncertainty around the cost-effectiveness estimates persists. Further research on the effect of vitamin K on fractures is warranted.
Vitamin K might have a role in the primary prevention of fractures, but uncertainties about its effectiveness and cost-effectiveness persist.
We developed a state-transition probabilistic microsimulation model to quantify the cost-effectiveness of various interventions to prevent fractures in 50-year-old postmenopausal women without osteoporosis. We compared no supplementation, vitamin D(3) (800 IU/day) with calcium (1,200 mg/day), and vitamin K(2) (45 mg/day) with vitamin D(3) and calcium (at the same doses). An additional analysis explored replacing vitamin K(2) with vitamin K(1) (5 mg/day).
Adding vitamin K(2) to vitamin D(3) with calcium reduced the lifetime probability of at least one fracture by 25%, increased discounted survival by 0.7 quality-adjusted life-years (QALYs) (95% credible interval (CrI) 0.2; 1.3) and discounted costs by $8,956, yielding an incremental cost-effectiveness ratio (ICER) of $12,268/QALY. At a $50,000/QALY threshold, the probability of cost-effectiveness was 95% and the population expected value of perfect information (EVPI) was $28.9 billion. Adding vitamin K(1) to vitamin D and calcium reduced the lifetime probability of at least one fracture by 20%, increased discounted survival by 0.4 QALYs (95% CrI -1.9; 1.4) and discounted costs by $4,014, yielding an ICER of $9,557/QALY. At a $50,000/QALY threshold, the probability of cost-effectiveness was 80% while the EVPI was $414.9 billion. The efficacy of vitamin K was the most important parameter in sensitivity analyses.
Lifetime supplementation with vitamin K, vitamin D(3), and calcium is likely to reduce fractures and increase survival in postmenopausal women. Given high uncertainty around the cost-effectiveness estimates, further research on the efficacy of vitamin K on fractures is warranted.
To update the 1993 burden of illness of osteoporosis in Canada, administrative and community data were used to calculate the 2010 costs of osteoporosis at $2.3 billion in Canada or 1.3% of Canada's healthcare expenditures. Prevention of fractures in high-risk individuals is key to decrease the financial burden of osteoporosis.
Since the 1996 publication of the burden of osteoporosis in 1993 in Canada, the population has aged and the management of osteoporosis has changed. The study purpose was to estimate the current burden of illness due to osteoporosis in Canadians aged 50 and over.
Analyses were conducted using five national administrative databases from the Canadian Institute for Health Information for the fiscal-year ending March 31 2008 (FY 2007/2008). Gaps in national data were supplemented by provincial and community data extrapolated to national levels. Osteoporosis-related fractures were identified using a combination of most responsible diagnosis at discharge and intervention codes. Fractures associated with severe trauma codes were excluded. Costs, expressed in 2010 dollars, were calculated for osteoporosis-related hospitalizations, emergency care, same day surgeries, rehabilitation, continuing care, homecare, long-term care, prescription drugs, physician visits, and productivity losses. Sensitivity analyses were conducted to measure the impact on the results of key assumptions.
Osteoporosis-related fractures were responsible for 57,413 acute care admissions and 832,594 hospitalized days in FY 2007/2008. Acute care costs were estimated at $1.2 billion. When outpatient care, prescription drugs, and indirect costs were added, the overall yearly cost of osteoporosis was over $2.3 billion for the base case analysis and as much as $3.9 billion if a proportion of Canadians were assumed to be living in long-term care facilities due to osteoporosis.
Osteoporosis is a chronic disease that affects a large segment of the adult population and results in a substantial economic burden to the Canadian society.
The various benzodiazepines have essentially the same mechanism of action and differ from one another primarily through differences in pharmacokinetics. There is no pharmacological basis for using more than one benzodiazepine for the same patient. The purpose of the study was to examine the occurence of co-medication with different types of benzodiazepines in Norway.
Data were obtained from the Norwegian Prescription Database. Patients who received at least one benzodiazepine in 2008 were included (n = 299,185). The percentage of users who were co-medicated with at least two different benzodiazepines and the amounts prescribed were calculated and stratified by gender and age.
It is highly probably that 27,861 (14,6%) of patients who received at least two benzodiazepines in the course of 2008 used two different benzodiazepines simultaneously. 13,267 (6.9%) of the patients were prescribed at least two different benzodiazepines on the same prescription. A larger number of women were co-medicated with different benzodiazepines, but the proportion of comedication was higher in men than in women, and most frequent in the age group 18-49 years.
There is an extensive and unfortunate prescription practice whereby the same patient is prescribed different benzodiazepines that are used concurrently. Patients who use different benzodiazepines concurrently are mainly prescribed these by one and the same doctor.
The motor and non-motor symptoms of multiple sclerosis often result in a substantially reduced health-related quality of life. We surveyed patient satisfaction and own evaluation of the benefit of a period spent at a specialised rehabilitation centre.
All patients who spent a period at the Hakadal MS rehabilitation centre in 2010 were asked to complete a validated questionnaire designed to determine patient satisfaction with rehabilitation institutions.
Of a total of 339 patients, 277 (82%) returned the questionnaire. The great majority of respondents were satisfied with the knowledge, cooperation, care and engagement of those providing treatment, as well as with the advance information provided and the premises. They also found that they were consulted concerning their rehabilitation programme and that they were prepared for the period following their stay. More than 85% of the respondents stated that the stay would have major or very great importance for their general qualify of life and physical health. A similar score for mental health was given by 83%, mastery of day-to-day tasks by 77% and participation in social activities by 71%.
Patients who have had stays at the Hakadal MS rehabilitation centre are satisfied and feel that the stay will be of great importance to their level of functioning and mastery.
Comment In: Tidsskr Nor Laegeforen. 2012 Mar 6;132(5):50622398758
To investigate the occurrence and molecular mechanisms associated with carbapenemases in carbapenem-resistant Gram-negative isolates from Canadian cases.
Twenty hospital sites across Canada submitted isolates for a 1 year period starting 1 September 2009. All Enterobacteriaceae with MICs = 2 mg/L and Acinetobacter baumannii and Pseudomonas aeruginosa with MICs = 16 mg/L of carbapenems were submitted to the National Microbiology Laboratory (NML) where carbapenem MICs were confirmed by Etest and isolates were characterized by PCR for carbapenemase genes, antimicrobial susceptibilities, PFGE and plasmid isolation.
A total of 444 isolates (298 P. aeruginosa, 134 Enterobacteriaceae and 12 A. baumannii) were submitted to the NML of which 274 (61.7%; 206 P. aeruginosa, 59 Enterobacteriaceae and 9 A. baumannii) met the inclusion criteria as determined by Etest. Carbapenemase genes were identified in 30 isolates: bla(GES-5) (n = 3; P. aeruginosa), bla(KPC-3) (n = 7; Enterobacteriaceae), bla(NDM-1) (n = 2; Enterobacteriaceae), bla(VIM-2) and bla(VIM-4) (n = 8; P. aeruginosa) bla(SME-2) (n = 1; Enterobacteriaceae) and bla(OXA-23) (n = m9; A. baumannii). PFGE identified a cluster in each of Enterobacteriaceae, P. aeruginosa and A. baumannii corresponding to isolates harbouring carbapenemase genes. Three KPC plasmid patterns (IncN and FllA) were identified where indistinguishable plasmid patterns were identified in unrelated clinical isolates.
Carbapenemases were rare at the time of this study. Dissemination of carbapenemases was due to both dominant clones and common plasmid backbones.
Everyday challenges to "live well" with a rare disorder, anorectal anomaly, was the starting point to design a social-software environment, called RareICT, to help patients and family members in their everyday, additional un-paid work.
Persons with the rare disorder, family members and health providers were recruited to elaborate challenges to daily living given this condition.
An exploratory study was designed, and we set up a series of participatory design workshops to explore challenges to everyday living with a rare medical condition.
Anorectal anomaly has few visible outward signs, and is often surrounded with secrecies. Findings shed light on efforts to maintain physical functioning, psychosocial and emotional wellbeing. For an affected person to "live well" modifications to everyday routines, along with management work, support work and planning work are required. Accumulating practical strategies, everyday experiences and knowledge, along with virtual access to peers may augment such health maintenance work if integrity, accountability and trust, confidentiality and privacy are maintained.
A social-software environment was set up to offer co-evolving content and augment health-related decision-making at home. To evaluate the project will focus on interest in maintaining participation determined and how users benefit from services such as RareICT.
This article discusses the strategies and challenges of implementing interprofessional education interventions with students from different disciplines. It reviews two models of interprofessional education in academic prelicensure curricula including the extra-curricular and the crossbar models by considering ease of implementation, program reach and sustainability. It also introduces the interprofessional enhancement approach as an additional curriculum development strategy.
The Alberta Interprofessional Education for Collaborative Patient-Centred Practice project used the Interprofessional Enhancement Approach by integrating course content into existing placement courses for nursing, respiratory therapy, pharmacy, and physiotherapy students. The students conducted their regular discipline-specific placements at various clinical sites in southern Alberta, Canada that were supplemented by three interprofessional strategies: mentoring, workshops and online discussions. The intervention reached over sixty individuals including students, preceptors and faculty.
As compared to other approaches (extra-curricular and crossbar models), this approach shows that IP course content can be added to placement courses without restructuring complete curricula. This article intends to initiate further discussions about different IP education models in prelicensure education.