Multimorbidity is very common in primary care and in a system with strong gatekeeping is associated with high health care utilization and cost across the health care system. Interventions to address quality and cost associated with multimorbidity must focus on primary as well as secondary care.
The dermal scratch provides a well-tolerated, standardized, and reproducible wound model for investigating the healing response to dermal injury of different depths. There is a threshold depth of dermal injury at which scarring develops.
Dementia is a costly condition and one that differs from other conditions in the significant cost burden placed on informal caregivers. The aim of this analysis was to estimate the economic and social costs of dementia in Ireland in 2010. With an estimate of 41,470 people with dementia, the total baseline annual cost was found to be over €1.69 billion, 48% of which was attributable to the opportunity cost of informal care provided by family and friends and 43% to residential care. Due to the impact of demographic ageing in the coming decades and the expected increase in the number of people with dementia, family caregivers and the general health and social care system will come under increasing pressure to provide adequate levels of care. Without a significant increase in the amount of resources devoted to dementia, it is unclear how the system will cope in the future.
Chronic obstructive pulmonary disease is a common, preventable and treatable disease. Exercise training programmes (ETPs) improve symptoms, health-related quality of life (HRQoL) and exercise capacity, but the optimal setting is unknown. In this review, we compared the effects of ETPs in different settings on HRQoL and exercise capacity. We searched (5 July 2016) the Cochrane Airways Group Specialised Register, ClinicalTrials.gov and World Health Organization trials portal. We selected studies, extracted data and assessed risk of bias with two independent reviewers. We calculated mean differences (MD) with 95% CI. We assessed the quality of evidence using Grades of Recommendation, Assessment, Development and Evaluation. Ten trials (934 participants) were included. Hospital (outpatient) and home-based ETPs (seven trials) were equally effective at improving HRQoL on the Chronic Respiratory Questionnaire (CRQ) (dyspnoea: MD −0.09, 95% CI: −0.28 to 0.10; fatigue: MD −0.00, 95% CI: −0.18 to 0.17; emotional: MD 0.10, 95% CI: −0.24 to 0.45; and mastery: MD −0.02, 95% CI: −0.28 to 0.25; moderate quality) and on the St George's Respiratory Questionnaire (SGRQ) (MD −0.82, 95% CI: −7.47 to 5.83, low quality). Hospital (outpatient) and community-based ETPs (three trials) were equally effective at improving HRQoL (CRQ dyspnoea: MD 0.29, 95% CI: −0.05 to 0.62, moderate quality; fatigue: MD −0.02, 95% CI: −1.09 to 1.05, low quality; emotional: MD 0.10, 95% CI: −0.40 to 0.59, moderate quality; and mastery: MD −0.08, 95% CI: −0.45 to 0.28, moderate quality). There was no difference in exercise capacity. There was low to moderate evidence that outpatient and home-based ETPs are equally effective.
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