Cost-effectiveness analysis of humanitarian relief interventions: visceral leishmaniasis treatment in the Sudan

Spending by aid agencies on emergencies has quadrupled over the last decade, to over US$ 6 billion. To date, cost-effectiveness has seldom been considered in the prioritization and evaluation of emergency interventions. The sheer volume of resources spent on humanitarian aid and the chronicity of many humanitarian interventions call for more attention to be paid to the issue of 'value for money'. In this paper we present data from a major humanitarian crisis, an epidemic of visceral leishmaniasis (VL) in war-torn Sudan. The special circumstances provided us, in retrospect, with unusually accurate data on excess mortality, costs of the intervention and its effects, thus allowing us to express cost-effectiveness as the cost per Disability Adjusted Life Year (DALY) averted. The cost-effectiveness ratio, of US$ 18.40 per DALY (uncertainty range between US$ 13.53 and US$ 27.63), places the treatment of VL in Sudan among health interventions considered 'very flood value for money' (interventions of less than US$ 25 per DALY). We discuss the usefulness of this analysis to the internal management of the VL programme, the procurement of funds for the programme, and more generally, to priority setting in humanitarian relief interventions. We feel that in evaluations of emergency interventions attempts could be made more often to perform cost-effectiveness analyses, including the use of DALYs, provided that the outcomes of these analyses are seen in the broad context of the emergency situation and its consequences on the affected population. This paper provides a first contribution to what is hoped to become an international database of cost-effectiveness studies of health outcome such as the DALY.

Tidal influence on behaviour of a coastal aquifer adjacent to a low-relief estuary

The tidal influence on groundwater hydrodynamics, salt-water intrusion and submarine groundwater discharge from coastal/estuarine aquifers is poorly quantified for systems with a mildly sloping beach, in contrast to the case where a vertical beach face is assumed. We investigated the effect of beach slope for a coastal aquifer adjacent to a low-relief estuary, where industrial waste was emplaced over the aquifer. The waste was suspected to discharge leachate towards the estuary. Field observations at various locations showed that tidally induced groundwater head fluctuations were skewed temporally. Frequency analysis suggested that the fluctuation amplitudes decreased exponentially and the phase-tags increased Linearly for the primary tidal signals as they propagated inland. Salinisation zones were observed in the bottom part of the estuary and near the beach surface. Flow and transport processes in a cross-section perpendicular to the estuary were simulated using SEAWAT-2000, which is capable of depicting density-dependent flow and multi-species transport. The simulations showed that the modelled water table fluctuations were in good agreement with the monitored data. Further simulations were conducted to gain insight into the effects of beach slope. In particular the limiting case of a vertical beach face was considered. The simulations showed that density difference and tidal forcing drive a more complex hydrodynamic pattern for the mildly sloping beach than the vertical beach, as well as a profound asymmetry in tidally induced water table fluctuations and enhanced salt-water intrusion. The simulation results also indicated that contaminant transport from the aquifer to the estuary was affected by the tide, where for the mildly sloping beach, the tide tended to intensify the vertical mass exchange in the vicinity of the shorelines, (c) 2005 Elsevier B.V. All rights reserved.

Pain Relief and Functional Recovery in Patients with Complex Regional Pain Syndrome after Motor Cortex Stimulation

In addition to pain and neurovegetative symptoms, patients with severe forms of complex regional pain syndrome (CRPS) develop a broad range of symptoms, including sensory disturbances, motor impairment and dystonic posturing. While most patients respond to medical therapy, some are considered refractory and become surgical candidates. To date, the most commonly used surgical procedure for CRPS has been spinal cord stimulation. This therapy often leads to important analgesic effects, but no sensory or motor improvements. We report on 2 patients with pain related to CRPS and severe functional deficits treated with motor cortex stimulation (MCS) who not only had significant analgesic effects, but also improvements in sensory and motor symptoms. In the long term (27 and 36 months after surgery), visual analog scale pain scores were improved by 60-70% as compared to baseline. There was also a significant increase in the range of motion in the joints of the affected limbs and an improvement in allodynia, hyperpathia and hypoesthesia. Positron emission tomography scan in both subjects revealed that MCS influenced regions involved in the circuitry of pain. Copyright (C) 2011 S. Karger AG, Basel

Is pain relief equally efficacious and free of side effects with repeated doses of oral sucrose in preterm neonates?

The aim of the present study was to examine the efficacy and potential side effects of repeated doses of oral sucrose for pain relief during procedures in NICU. Thirty-three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG = 17) and the control group (CG = 16). The responses of neonates to pain and distress were assessed during blood collection on four consecutive assessment (ass.) days. For the first assessment, the neonates did not receive any solution before the blood collection procedure. During the next three days, the SG received oral sucrose (25%; 0.5 ml/kg) and the CG received sterile water, 2 min before each minor acute painful procedure. The neonates were evaluated during blood collection each morning. The assessment was divided into five phases: Baseline (BL), Antisepsis (A), Puncture (P), Dressing (D), and Recovery (R). The neonates` facial activity (NFCS), behavioral state, and heart rate were evaluated. The data analysis used cut-off scores for painful and distressful responses. No side effects of using sucrose were detected. There were significantly fewer SG neonates with facial actions signaling pain than CG neonates in P (ass.2) and in A (ass.3). We found significantly fewer SG neonates in the awake state than CG neonates in P (ass.2 and ass.4). There were significantly fewer SG neonates crying during A (ass.2), P (ass.2 and ass.4), and D (ass.3). There was no statistical difference between-groups for physiological response. The efficacy of sucrose was maintained for pain relief in preterm neonates with no side effects. (C) 2007 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Determinants of nurses' intention to administer opioids for pain relief

A statewide cross-sectional survey was conducted in Australia to identify the determinants of registered nurses' intention to administer opioids to patients with pain. Attitudes, subjective norms and perceived control, the key determinants of the Theory of Planned Behavior, were found to independently predict nurses' intention to administer opioids to these patients. Perceived control was the strongest predictor. Nurses reported positive overall attitudes towards opioids and their use in pain management. However, many negative attitudes were identified; for example, administering the least amount of opioid and encouraging patients to have non-opioids rather than opioids for pain relief. The findings related to specific attitudes and normative pressures provide insight into registered nurses' management of pain for hospitalized patients and the direction for educational interventions to improve registered nurses' administration of opioids for pain management.

Optimization of a procedure for emergency cooling and pressure relief for reactors with exothermal processes

Passive trip system, reactor trip, runaway reaction, batch reactor

Saving and Re-building Lives: an Analysis of the Determinants of Disaster Relief

We analyse both theoretically and empirically, the factors that influence the amount of humanitarian aid which countries receive when they are struck by natural disasters. Our investigation particularly distinguishes between immediate disaster relief which helps the survival of victims and long term humanitarian aid given towards reconstruction and rehabilitation. The theoretical model is able to make predictions as well as explain some of the peculiarities in the empirical results. The empirical analysis, making use of some useful data sources, show that both short and long term humanitarian aid increase with number of people killed, financial loss and level of corruption, while GDP per capita has no effect. Number of people affected had no effect on short term aid, but significantly increased long term aid. Both types of aid increased if the natural disaster was an earthquake, tsunami or drought. In addition, short term aid increases in response to a flood while long term aid increases in response to storms.

Anaesthetics, Pain Relief and Critical Care Follow Up (PDF 797 KB)

In 2003/2004 the Department of Health, Social Services and Public Safety commissioned a value for money follow-up audit of Anaesthetics, Pain Relief and Critical Care (APRCC) services at twelve Trusts and covering fourteen hospital sites. The original study had reported in 1999/2000. Detailed follow-up reports, together with action plans have been agreed locally with Trusts. The objectives of the follow-up review were to: • Ascertain the progress made in implementing recommendations from the original study; • Provide data to compare performance across Trusts in areas such as: - Pre-operative assessments; - Organisation of post-operative pain relief; - Organisation of chronic pain services; - Levels of admissions to critical care units; - Occupancy in critical care units; and åÊ • Assess the extent of progress made by Trusts in the implementation of the Chief Medical Officer’s (CMO) recommendations from ‘Facing the Future –Building on the Lessons of Winter 1999/2000’. To enable comparisons across Trusts, data was collected for the financial year 2002/2003. In addition, relevant findings from the Audit Commission’s Acute Hospitals Portfolio have also been included. The Acute Hospital Portfolio is a collection of reviews that are undertaken at acute and specialist Trusts. They focus on key service areas and are reported along the key performance criteria of patient experience, efficiency and capacity. åÊ

Anaesthetics, Pain Relief and Critical Care Services in Northern Ireland - Regional Summary (May 2002)

Anaesthetics, Pain Relief and Critical Care Services in Northern Ireland - Regional Summary (May 2002) Pages 1 to 7 (PDF 276 KB)åÊ Pages 8 to 14 (PDF 392 KB)åÊ Pages 15 to 20 (PDF 265 KB)

Human milk for neonatal pain relief during ophthalmoscopy

Ophthalmoscopy performed for the early diagnosis of retinopathy of prematurity (ROP) is painful for preterm infants, thus necessitating interventions for minimizing pain. The present study aimed to establish the effectiveness of human milk, compared with sucrose, for pain relief in premature infants subjected to ophthalmoscopy for the early diagnosis of ROP. This investigation was a pilot, quasi-experimental study conducted with 14 premature infants admitted to the neonatal intensive care unit (NICU) of a university hospital. Comparison between the groups did not yield a statistically significant difference relative to the crying time, salivary cortisol, or heart rate (HR). Human milk appears to be as effective as sucrose in relieving acute pain associated with ophthalmoscopy. The study’s limitations included its small sample size and lack of randomization. Experimental investigations with greater sample power should be performed to reinforce the evidence found in the present study.