Zoekresultaten

Cost Effectiveness and Budget Impact of the Boston University Approach to Psychiatric Rehabilitation for Increasing the Social Participation of Individuals With Severe Mental Illnesses

Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n=90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were e 12,886 in BPR and e 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to e190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.

MIG/MAG lassen en zijn varianten

Deze publicatie is tot stand gekomen in het kader van een updateproject, waarbij een groot aantal technische voorlichtingspublicaties worden aangepast aan de huidige stand der techniek. Hierbij heeft een nauwe samenwerking plaatsgevonden tussen de in de stuurgroep vermelde partijen. Deze publicatie "MIG/MAG lassen en zijn varianten" is een update van de publicatie "MIG/MAG lassen", welke is geschreven door de heer J.D. Roeters van Lennep en in 1986 is uitgegeven door het Nederlands Instituut voor Lastechniek. De geüpdate publicatie is, evenals de andere in dit updateproject vervaardigde en uitgegeven publicaties, gratis te downloaden vanaf de websites "www.verbinden-online.nl", "www.dunneplaat-online.nl" en via de websites van de deelnemende organisaties.

Varianten van honoursprogramma's

SME purchasing activity patterns delphi study

This survey is about recognizing patterns in the way Small and Medium Enterprises (SMEs) organize their procurement activities. The scope of the survey is limited to the key commodities of the SME.A key commodity is defined as the purchased product or service group which is essential for realizing the value proposition for the customers of the SME.Prior outcome of our research indicated the existence of four procurement oriented patterns in SMEs. 4 Procurement Oriented Patterns where part of the study: Pattern 1 Focal company: ICT turn-key designerValue proposition of the focal company: ICT Design and assembly of offices on a high quality level at a reasonable price. Operational excellence: standardization in commodities, low transaction costs internally and externallyPurchased key commodity: Standard ICT software and hardwarePattern 2 Focal company: Horse shoes manufacturerValue proposition of the focal company: Standard horse shoes assortment at reasonable prices in a competitive environmentPurchased key commodity: Standard quality iron, reliable deliveryPattern 3 Focal company: IT innovation driven companyValue proposition of the focal company: Developing innovative software made applicable for practical usage in devices at a reasonable pricePurchased key commodity: Delivering applicable solutions on the bases of regular soft- and hardware, to enable the companies’ innovative software function in practicePattern 4 Focal company: designer and manufacturer of trailersValue proposition of the focal company: Designing and manufacturing trailers tailor made for specific requirements of customersPurchased key commodity: Designing and manufacturing axles which align to the specific trailer wishes of the customer of the focal companyFINDINGS Pattern recognitionAbout 50 % of the respondents recognized the four presented patterns from own experience and/or read literature. Respondents also suggested pattern variants. It is concluded that this Delphi study strengthens the view that these patterns exist in SMEs. Further research may include further empirical testing of these patterns and their variants. Perceived strengths or weaknesses. Respondents mentioned a wide variety of strengths and weaknesses of the patterns. No clear conclusions can be drawn from this data. Adequacy of the pattern descriptions. One of the outcomes of this Delphi study is an improved conceptual framework for describing procurement activity patterns. This framework can be used for collecting SME data in future research, for example by modifying the existing survey questions which are used in the WIM research program to describe SME procurement activities. The improved model includes more variables and values than the initial model. Thus future research may lead to more detailed patterns descriptions. Missing patterns and pattern variantsApart from the suggested pattern variants, respondents do not miss patterns which are quite different from the four patterns suggested by the research team. Methodological remarksThe Delphi study method did not allow for fast feedback on panel member contributions and fast group think processes. For the future it is advised to consider other methods in similar cases, for example the World Cafe method.

Clinical reasoning in unimodal interventions in patients with non-specificneck pain in daily physiotherapy practice, a Delphi study

Background: Neck pain is the fourth major cause of disability worldwide but sufficient evidence regarding treatment is not available. This study is a first exploratory attempt to gain insight into and consensus on the clinical reasoning of experts in patients with non-specific neck pain. Objective: First, we aimed to inventory expert opinions regarding the indication for physiotherapy when, other than neck pain, no positive signs and symptoms and no positive diagnostic tests are present. Secondly, we aimed to determine which measurement instruments are being used and when they are used to support and objectify the clinical reasoning process. Finally, we wanted to establish consensus among experts regarding the use of unimodal interventions in patients with non-specific neck pain, i.e. their sequential linear clinical reasoning. Study design: A Delphi study.Methods:A Web-based Delphi study was conducted. Fifteen experts (teachers and researchers) participated. Results: Pain alone was deemed not be an indication for physiotherapy treatment. PROMs are mainly used for evaluative purposes and physical tests for diagnostic and evaluative purposes. Eighteen different variants of sequential linear clinical reasoning were investigated within our Delphi study. Only 6 out of 18 variants of sequential linear clinical reasoning reached more than 50% consensus. Conclusion: Pain alone is not an indication for physiotherapy. Insight has been obtained into which measurement instruments are used and when they are used. Consensus about sequential linear lines of clinical reasoning was poor.

Comprehensive analytical and clinical evaluation of a RNA extraction-free saliva-based molecular assay for SARS-CoV-2

Standard SARS-CoV-2 testing protocols using nasopharyngeal/throat (NP/T) swabs are invasive and require trained medical staff for reliable sampling. In addition, it has been shown that PCR is more sensitive as compared to antigen-based tests. Here we describe the analytical and clinical evaluation of our in-house RNA extraction-free saliva-based molecular assay for the detection of SARS-CoV-2. Analytical sensitivity of the test was equal to the sensitivity obtained in other Dutch diagnostic laboratories that process NP/T swabs. In this study, 955 individuals participated and provided NP/T swabs for routine molecular analysis (with RNA extraction) and saliva for comparison. Our RT-qPCR resulted in a sensitivity of 82,86% and a specificity of 98,94% compared to the gold standard. A false-negative ratio of 1,9% was found. The SARS-CoV-2 detection workflow described here enables easy, economical, and reliable saliva processing, useful for repeated testing of individuals.