Treatment of peripheral neuropathic pain: a simulation model.

OBJECTIVE: To describe the use of a generalizable stochastic-simulation model of the treatment of neuropathic pain associated with peripheral neuropathies. METHODS: We developed a model to simulate treatment outcomes in a hypothetical cohort of patients with peripheral neuropathies. Each patient was randomly assigned an average pretreatment daily pain score (on a 0-10 scale), based on an assumed distribution of mean pretreatment pain scores in the cohort. Patients were randomly assigned daily pain scores, based on their pretreatment average and an assumed distribution of daily pain scores around this mean. Treatment outcomes were then simulated using the expected mean change (vs. baseline) in pain scores. Model outcomes include the expected increase in days with no or mild pain (score < or = 3), days with > or = 30% and > or = 50% reductions in pain intensity, and days with 2- and 3-point absolute reductions in pain intensity. To illustrate its use, the model was estimated over a 12-week period using data from a recent clinical trial of a new antiepileptic (pregabalin). RESULTS: Treatment over 12 weeks (84 days) was projected to result in 26 (+/-0.4) (mean [+/-SE]) additional (vs. no treatment) days with no or mild pain, 33 (+/-0.5) days with a > or = 30% reduction in pain intensity, 28 (+/-0.4) days with > or = 50% reduction in pain intensity, and 34 (+/-0.5) and 30 (+/-0.5) days with > or = 2-point and > or = 3-point absolute reductions in pain intensity. CONCLUSIONS: When combined with data on health-state utilities and treatment costs, this new analytical tool can provide a foundation for formal cost-effectiveness evaluations of interventions for painful peripheral neuropathies.     

Connection Versus Disconnection: Examining Culturally Competent Care in the Neonatal Intensive Care Unit

Culturally competent health care is of critical importance; however, it is presented as a frequent challenge in health care settings. This study explored cross-cultural care from the health care provider perspective within two tertiary level Neonatal Intensive Care Units (NICUs). Fifty eight inter-professional health care providers (HCP) participated in focus groups. Participants identified perceived care-related experiences of newly immigrated parents whose infant received care in the NICU as well as health care provider perspectives on delivering that care. Results identified core processes of “connection” and “disconnection,” which appeared to have a substantial bearing on NICU experience and interaction. Connection comprised congruity, synergy, and “fit,” and resulted in an enhanced relationship between the family and HCP. Disconnection, in contrast, entailed a lack of “fit” and in some cases, misunderstanding and/or conflict between the family and a member or members of the health care team. Connection and disconnection occurred at various junctures of NICU care. These junctures reflected interaction between the family and HCP at the bedside and/or at the level of the unit, hospital, or community at large. Implications for practice, policy, and research are discussed.