Cost-effectiveness analysis of pancreatin minimicrospheres in patients with pancreatic exocrine insufficiency due to chronic pancreatitis.

OBJECTIVE: Chronic pancreatitis (CP) is the most common cause of pancreatic exocrine insufficiency (PEI). Management of PEI due to CP is achieved through lifelong treatment with pancreatic enzyme replacement therapy (PERT). To the authors' knowledge, no cost-effectiveness analysis on the benefit of PERT in CP patients with PEI has been performed to date. The objective of this analysis was to examine the cost-effectiveness of Creon (pancreatin minimicrospheres [MMS]), one of the main PERTs available in Poland, in treating patients with CP-related PEI. METHODS: The cost-effectiveness of pancreatin MMS in the treatment of patients with CP-related PEI vs no PERT treatment was estimated using a decision analysis based on clinical data from relevant studies. The model horizon was 20 years. Main outcomes included the percentage of patients with controlled PEI, survival, total medical costs, number of quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER). All costs were analysed from the Polish payer perspective. RESULTS: The model included clinical data from 176 patients treated in five pancreatin MMS randomized trials. Treatment with pancreatin MMS resulted in a considerably higher proportion of patients with controlled PEI compared to those not treated with any PERT. Over a horizon of 20 years, the total treatment cost and the ICER for pancreatin MMS was €8223 and €6312 per QALY, respectively. LIMITATIONS: Important limitations include the lack of long-term and comparative clinical data available. The use of 'no PERT treatment' as a comparator against pancreatin MMS treatment may not accurately reflect current practice in Poland. CONCLUSIONS: Treatment of CP-related PEI with pancreatin MMS is cost-effective from a Polish payer perspective, with an ICER below the accepted 'willingness to pay' threshold of 3-times gross domestic product (GDP) per capita. These results are likely to apply to other European countries.

Impact of alcohol education and training on general practitioners' diagnostic and management skills: findings from a World Health Organization collaborative study.

OBJECTIVE: The potential of general practitioners (GPs) to reduce the prevalence of alcohol-related problems via alcohol intervention contrasts sharply with actual practice. One explanation for GPs' limited involvement in alcohol intervention is that they have had inadequate training or continuing medical education (CME) on alcohol-related issues. This study examined GPs' experience of alcohol-related CME and its possible relationship with attitudes and practice behavior regarding alcohol-related problems. METHOD: A questionnaire-based survey was returned by 2,139 GPs from 13 countries across Western and Eastern Europe. North America and Australasia. Diagnostic and management skills were assessed by responses to standardized case vignettes. RESULTS: The survey response rate was 54%. Approximately one third of GPs (32%) reported receiving no alcohol-related CME, while 8% could not remember whether or not they had received any such training or education. Of the remaining GPs (n = 1,217), 23% reported less than 4 hours (low levels) and 37% reported 4 or more hours (high levels) of alcohol-related CME. GPs who reported higher levels of alcohol-related CME were more likely to obtain information about alcohol, were more prepared to counsel problem drinkers and managed more patients for alcohol issues than did colleagues reporting lower levels of CME. Those with greater CME experience were also more confident about their ability to alleviate alcohol-related problems and reported more appropriate management strategies than did GPs with less CME experience. CONCLUSIONS: Greater exposure to alcohol-related CME appears to result in better diagnosis and more appropriate management of alcohol-related problems by GPs. Whether this is directly due to the CME itself or because GPs with greater interest in alcohol issues seek out such experience cannot be ascertained from the current study and requires further investigation.

Gifts bestowed, gifts withheld. Assessing psychological theory with a Kochian attitude.

Sigmund Koch, along with several members of his generation, insisted on a critical and self-critical stance toward psychological theory. Blending critique and possibility, Koch and others focused on the intricate links between theory and practice, morals and values, and the actual, although usually unacknowledged, choices open to theorists. An examination of "theory biographies" heightens appreciation of the legacy of such analyses as well as the positive promise of a Kochian perspective on psychological studies.

Analysis of cationic nutrients from foods by ion chromatography.

This paper describes the feasibility of combining two relatively new technologies to generate data on the cationic nutrient content of foods. Single-column ion chromatography was used to monitor several analytes following the use of a microwave digestion scheme aimed at rapid, multiple sample digestion. The result is a more streamline and productive approach to multi-sample preparation and multi-analyte determination when investigating the cation content of foods. Linearity and limits of detection for the chromatographic procedure were established. Sample size as well as digestion acid type and amount were investigated during the microwave process. The method was applied to a variety of food matrices to evaluate its scope. Results generated with this method compare favorably to those from atomic absorption. Finally, capillary ion electrophoresis (Waters' trade name: Capillary Ion Analysis), a subset of capillary electrophoresis which has been optimized for ion analysis, was applied to the sample digests to investigate the usefulness of this technology to the analysis of mono-/divalent cations from foods.

Liquid chromatographic determination of zoalene in medicated feeds.

A rapid, reliable separation and quantitation of zoalene (3,5-dinitro-o-toluamide) from feeds is accomplished by using reverse phase liquid chromatography (LC) and ultraviolet detection. An extraction technique which is similar to the present AOAC official colorimetric method is used before chromatographic analysis. This extraction is followed by an activated alumina cleanup and LC to separate zoalene from feed matrix. The methodology was applied to a variety of spiked feed matrices, and yielded good recoveries. Liquid chromatographic results were shown to correlate with colorimetric determinations.