Development and validation of a new instrument to evaluate the ease of use of patient-controlled analgesic modalities for postoperative patients

Abstract

Objective: To describe the development and psychometric evaluation of a questionnaire assessing the ease of use that patients associate with patient-controlled analgesia (PCA) modalities.

Methods: Qualitative interviews were conducted with patients who had experience with intravenous (IV) PCA for postoperative pain management to generate items relevant to the ease of using PCA modalities. The content validity of the resulting questionnaire was examined through follow-up patient interviews, and an expert panel reviewed the questionnaire. Cognitive debriefing interviews were conducted with patients to determine the clarity and content of the instructions, items, and response scales, and the ease of completing the instrument. Psychometric evaluation was performed with patients who had undergone surgery and received IV PCA for postoperative pain management. Item and scale quality and the internal consistency reliability of the questionnaire were assessed. Construct validity was evaluated by examining the relationship between subscales of the questionnaire with patient-reported outcome measures. Known-groups validity was determined by assessing the instrument's ability to differentiate between patients with versus without an IV PCA problem. A potential limitation of this study was the exclusive sampling of patients who had experience with IV PCA.

Results: The Patient Ease-of-Care (EOC) Questionnaire included 23 items in the following subscales: Confidence with Device, Comfort with Device, Movement, Dosing Confidence, Pain Control, Knowledge/Understanding, and Satisfaction. Coefficient alpha reliability estimates were ≥0.66 for Overall EOC (includes all subscales except Satisfaction) and all EOC subscales. Construct validity was supported by the moderate relationship between the Pain Control subscale and measures of pain severity and pain interference; additional evidence of construct validity was provided by correlations of the Confidence with Device subscale, the Satisfaction subscale, and Overall EOC with measures of pain severity, pain interference, and satisfaction. Significant mean score differences were reported between participants with and without IV PCA problems for Overall EOC and for the Comfort with Device, Confidence with Device, Movement, Pain Control, and Satisfaction subscales indicating known-groups validity.

Conclusions: Results provide evidence for the reliability and validity of the Patient EOC Questionnaire as a measure of the ease of use that patients associate with PCA systems and may be useful for evaluating emerging PCA modalities.     

纤维蛋白胶粘合法联合神经生长因子治疗周围神经损伤的临床疗效

目的探讨纤维蛋白胶(FG)粘合法联合神经生长因子(NGF)治疗周围神经损伤的临床疗效。方法选取我院2006年8月至2013年10月就诊的124例腓总神经损伤患者,随机均分为两组,对照组患者单纯使用缝合法,试验组患者在缝合法的基础上配合使用FG粘合法联合NGF治疗,随访6个月以上,分析两组患者的运动功能和患肢感觉疗效。结果试验组患者总有效率明显优于对照组,差异有统计学异议(P<0.05)。结论周围神经损伤的修复与再生过程中使用FG粘合法联合NGF治疗,可有效改善患者症状,安全性高,不良反应较少。     

Real-world cost of treatment for multiple sclerosis patients initiating and receiving infused disease-modifying therapies per recommended label in the United States

Abstract

Aims: The study evaluated the real-world cost of treatment in multiple sclerosis (MS) patients initiating infused disease-modifying-therapies (DMT) in the United States.

Materials and Methods: This retrospective cohort study using administrative claims data included adult patients with MS initiating index infusion DMT (ocrelizumab (OCR), natalizumab (NTZ) or alemtuzumab (ATZ)) from April 2017–September 2018 with 6-months pre/12-months post-index continuous enrollment. The primary cohort included patients who had prescribed annual dosing visits indicated by the approved product label (PL): 3 OCR, 5 ATZ, and 12–13 NTZ infusion visits within the first year of initiation. Annual treatment cost was the sum of all costs on index DMT infusion visit dates. Costs were summarized for a primary and secondary cohort of patients receiving additional doses than prescribed in PL (>3 OCR, >5 ATZ, and >13 NTZ infusion visits); and an overall cohort of patients who met minimum required annual dose (≥3 OCR, ≥5 ATZ, and ≥12 NTZ), further stratified by insurance type.

Results: For patients in the primary cohort (123 OCR, 18 ATZ, and 48 NTZ), mean (standard-deviation) annual cost of treatment with OCR, ATZ, and NTZ cohorts was $72,066 ($34,480), $121,053 ($51,097) and $93,777 ($38,815), respectively. Among patients initiating OCR and NTZ, 15 and 6% respectively, had additional infusion visits leading to greater costs. Mean annual costs of index infusion DMT treatment in the overall cohort (162 patients treated with OCR, 18 with ATZ, 56 with NTZ) were $80,582, $121,053, and $93,807, respectively. The mean costs for commercial enrollees were higher than those for MAPD enrollees.

Limitations: Small sample size, limited population generalizability, and cost-reduction for ATZ beyond the second year need to be accounted for.

Conclusions: Real-world infusion DMT treatment costs for commercially insured patients were higher than perceived expenditures based on wholesale acquisition cost and administration costs via a physician-fee schedule. Consideration of real-world costs in cost-effectiveness and treatment/coverage decisions is needed.     

贸易成本、要素流动与区域经济差异

本世纪以来,中国交通基础设施不断优化、物流业的迅猛发展以及国内市场化的不断加深对中国区域间要素流动、产业转移及区域经济差异的影响,成为具有重要理论与现实意义的问题。本文通过构建包含贸易成本的两地区-两部门新经济地理模型来研究这一问题,并在合理的参数条件下进行数值模拟。研究发现贸易成本的降低阻碍了劳动力、资本与可贸易产业从发达地区向欠发达地区的流动和转移,加大了地区间经济差异,从而为"迁移谜题"提供了新的解释角度。根据理论研究的结果,本文提出相关的政策建议。     

我国的地方经济:制度特征与发展不平衡

区域性是地理学的独特视角,反映在国民经济的研究中就是对区域经济和“地方”的关注。我国的地方经济和地方政府在历史进程和社会经济发展的各个阶段上都占有十分重要的地位,改革开放的成功在很大程度上也得益于地方经济。针对多年来对地方政府和地方经济的不断指责,文章认为有必要从理论上阐述我国地方经济存在和发展的规律,其中,有我国地方政权的历史基础、地方经济的制度基础和在我国形成强势政府与强势经济的制度条件。发展不平衡是地方经济研究的又一个重点领域,但是与其他学科不同的是,地理学更多地要从地理条件方面去解释差异。地方经济发展的差异在很大程度上取决于区域开发的地理成本,恶劣的自然地理条件、偏僻的经济地理位置都会导致地区开发成本的高昂并影响地方经济的发育。文章主要讨论了地理环境和地理位置所导致的区域差异。     

居民递增型阶梯水价政策有效性研究

城市水价改革的基本目标是实现水资源节约、企业成本回收和保障社会公平。运用2004_2011年中国36个大中城市相关数据实证分析现行递增型阶梯水价政策的实施效果,发现阶梯水价政策在一定程度上有助于促进水资源节约,但对实现成本补偿目标的作用非常有限,且恶化了不同收入家庭之间的相对公平。现有阶梯水价政策只能部分实现城市供水价格改革目标,有必要进一步推进市场化水价机制改革。     

Evolutionary dynamics of social tolerance in the economic interaction model with local social cost functions

The evolutionary dynamics of social tolerance in a society with local social cost functions have been discussed. We show that, very different from the global function case studied previously, dynamics of social tolerance in a society with local social cost functions is integrable in phase space. The exact solution of the evolutionary dynamics in phase space is obtained, and the evolutionary trajectories are discussed by using the Kolmogorov–Arnold–Moser theorem. We show that the property of steady states is closely related to the group populations. We also discuss the necessary condition of the full tolerance steady state, and it is demonstrated that both global and local social cost functions have the same necessary condition of achieving full tolerance.     

现代企业战略调整的成本与效益——从核心能力跃迁和持续竞争优势动态演化的视角

本文以企业核心能力与持续竞争优势为根本出发点,以战略调整的成本效益分析为主线,按照环境、管理认知的动态性——创新——组织内部核心能力跃迂——竞争优势的动态演化——战略调整的成本效益分析——行为——市场绩效的逻辑思维链进行理论阐释,并分析我国企业由“制度适应”向“市场博弈”的过渡期,即企业从对政策制度的被动适应过渡到由市场机制配置资本资源达到最优化或帕累托改进的过程,企业相机抉择地进行战略调整的成本效益分析,在较大程度上取决于企业由“制度适应”向“市场博弈”过渡的动态环境和动态管理认知中的效率。     

市场均衡就业区间与区间内两种特殊的就业失衡

现代市场经济运行中的社会均衡就业量并不只是一个孤立的点,而是一个区间。该区间具有较为复杂的性质与结构,其内部一般还存在两种特殊的、长期以来一直未引起人们注意的就业失衡－－区间内就业不足和区间内过量就业。从理论上阐明“市场均衡就业区间”的形成机理,并对其内部特殊的就业失衡进行必要的分析,将有助于我们深化对现代市场经济条件下社会就业规律的认识,同时,对在总量波动背景下进一步完善就业管理、实现充分就业,也将起到重要的理论指导作用。