scholarly journals Evaluation of Albumin Utilization in a Major Teaching Hospital in Iran Before and After Guideline Implementation

2021 ◽  
Author(s):  
Shahriyar Shahbazi Khamas ◽  
Iman Mirbagheri ◽  
Anoush Dehnadi-Moghaddam ◽  
Asieh Ashouri ◽  
Atefeh Jafari
Keyword(s):  
Teaching Hospital ◽  
Guideline Implementation ◽  
Hospital Costs ◽  
P Value ◽  
Second Phase ◽  
Inappropriate Use ◽  
Before And After ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
Two Phases

Background: Inappropriate use of drugs is one of the major issues in health care system. Rational drug utilization based on the appropriate guidelines has an important role in management of use of expensive medications. We aimed to evaluate albumin usage's appropriateness based on evidence-based indications before and after implementing albumin prescription guideline in a teaching hospital. Methods: This study was performed in two phases. During two-month periods, all the patients who were ordered to receive albumin were evaluated. The first phase was done in November and December of 2017, during which, based on physicians' comments, the guideline was finalized and then implemented. Phase two was performed in May and June 2018. Results: Albumin was prescribed appropriately in 33 patients (55%) in the first phase and 43 (70%) patients in the second phase. 299 vials in the first phase and 456 vials in the second phase were prescribed which 198 vials (66%) and 394 (86%) vials were used with appropriate indications, respectively. The number of vials consumed with inappropriate indication decreased significantly from 101 vials (34%) in the first phase to 62 vials (14%) in the second phase (P-value=0.01). The average cost of the inappropriate indication per patient decreased from $197.3 ± 131.6 in the first phase to $183.5 ± 126.8 in the second phase (P-value=0.52). Conclusion: This study showed implementing a DUE program and designing a guideline for rational prescribing of albumin and interventional methods can optimize treatment duration, significantly decrease inappropriate usage, and avoid unnecessary hospital costs.

scholarly journals Cost-effectiveness analysis of hernioplasties before and after the implementation of the ACERTO project

2020 ◽  
Vol 47 ◽  
Author(s):  
JOSÉ EDUARDO DE AGUILAR NASCIMENTO ◽  
ALBERTO BICUDO SALOMÃO ◽  
MARA REGINA ROSA RIBEIRO ◽  
ROBERTA FERREIRA DA SILVA ◽  
WESLEY SANTANA CORREA ARRUDA
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Hospital Costs ◽  
University Hospital ◽  
Outcome Variable ◽  
Second Phase ◽  
Site Infection ◽  
Cost Information ◽  
Before And After ◽  
Two Phases

ABSTRACT Objective: to compare hospital costs and clinical outcomes in inguinal and incisional hernioplasty before and after implementation of the ACERTO project in a university hospital. Methods: retrospective study of 492 patients undergoing either inguinal hernioplasty (n=315) or incisional hernioplasty (n=177). The investigation involved two phases: between January 2002 and December 2005, encompassing cases admitted before the implementation of the ACERTO protocol (PRE-ACERTO period), and the other phase, with cases operated between January 2006 and December 2011, after the implementation of the protocol (ACERTO period). The main outcome variable was the comparison of the mean hospital costs between the two periods. As secondary endpoints, we analyzed the length of stay, the surgical site infection rate and mortality. We used the cost method suggested by Public Sector Cost Information System. Results: surgical site infection was higher (p = 0.039) in the first phase of the study for both inguinal hernia operations (2 (1.6%) versus 0 (0%) cases) and incisional hernioplasty (5 (7.6%) versus 3 (2.7%) cases). The length of stay decreased one day after the implementation of the ACERTO protocol (p=0.005). There was a reduction in costs per patient from R$ 4,328.58 per patient in the first phase to R$ 2,885.72 in the second phase (66.7% reduction). Conclusion: there was a reduction in infectious morbidity, length of stay and hospital costs in hernioplasty after the implementation of the ACERTO protocol.

scholarly journals Biphasic pattern in the effect of severe measles infection; the difference between additive and multiplicative scale

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nhat Thanh Hoang Le ◽  
Nhan Thi Ho ◽  
Bryan Grenfell ◽  
Stephen Baker ◽  
Ronald B. Geskus
Keyword(s):  
Infectious Diseases ◽  
Hospital Admission ◽  
Measles Virus ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Second Phase ◽  
Before And After ◽  
The Difference ◽  
Two Phases ◽  
Additive Scale

Abstract Background Infection with measles virus (MeV) causes immunosuppression and increased susceptibility to other infectious diseases. Only few studies reported a duration of immunosuppression, with varying results. We investigated the effect of immunosuppression on the incidence of hospital admissions for infectious diseases in Vietnamese children. Methods We used retrospective data (2005 to 2015; N = 4419) from the two pediatric hospitals in Ho Chi Minh City, Vietnam. We compared the age-specific incidence of hospital admission for infectious diseases before and after hospitalization for measles. We fitted a Poisson regression model that included gender, current age, and time since measles to obtain a multiplicative effect measure. Estimates were transformed to the additive scale. Results We observed two phases in the incidence of hospital admission after measles. The first phase started with a fourfold increased rate of admissions during the first month after measles, dropping to a level quite comparable to children of the same age before measles. In the second phase, lasting until at least 6 years after measles, the admission rate decreased further, with values up to 20 times lower than in children of the same age before measles. However, on the additive scale the effect size in the second phase was much smaller than in the first phase. Conclusion The first phase highlights the public health benefits of measles vaccination by preventing measles and immune amnesia. The beneficial second phase is interesting, but its strength strongly depends on the scale. It suggests a complicated interaction between MeV infection and the host immunity.

WOAD

2012 ◽  
pp. 127-147
Author(s):  
Federico Cabitza ◽  
Carla Simone
Keyword(s):  
Teaching Hospital ◽  
Electronic Document ◽  
High Level Architecture ◽  
Formal Expression ◽  
Major Teaching Hospital ◽  
Major Teaching ◽  
High Level ◽  
Event Based ◽  
User Friendly

In this article, we present WOAD, a framework that was inspired and partly validated within a 2-year observational case study at a major teaching hospital. We present the WOAD framework by stating its main and motivating rationales, outlining its high-level architecture and then introducing its denotational language, LWOAD. We propose LWOAD to support users of an electronic document system in declaratively expressing, specifying and implementing content- and event-based mechanisms that fulfill coordinative requirements and make users aware of relevant conditions. Our focus addresses (a) the user-friendly and yet formal expression of local coordinative practices based on the work context; (b) the promotion of awareness of both these conventions and the context to enable actors to quickly respond; (c) the full deployment of coordination-oriented and context-aware functionalities into legacy electronic document systems. We give examples of LWOAD mechanisms taken from the case study and discuss their impact from the EUD perspective.

A prospective audit of total parenteral nutrition at a major teaching hospital

1995 ◽  
Vol 163 (5) ◽  
pp. 233-237 ◽  
Author(s):  
Lisa L Loannides‐Demos ◽  
Lisa Liolios ◽  
Duncan J Topliss ◽  
Allan J McLean
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Teaching Hospital ◽  
Prospective Audit ◽  
Major Teaching Hospital ◽  
Major Teaching

scholarly journals Involvement of NO in Antinociception of NSAIDS in Murine Formalin Hind Paw Assay

Drug Research ◽  
2020 ◽  
Vol 70 (04) ◽  
pp. 145-150 ◽  
Author(s):  
Viviana Noriega ◽  
Hugo F. Miranda ◽  
Juan Carlos Prieto ◽  
Ramón Sotomayor-Zárate ◽  
Fernando Sierralta
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Dose Response ◽  
Rank Order ◽  
Linear Regression Analysis ◽  
Second Phase ◽  
Response Curves ◽  
Before And After ◽  
Two Phases ◽  
Phase Phase

AbstractThere are different animal models to evaluate pain among them the formalin hind paw assay which is widely used since some of its events appear to be similar to the clinical pain of humans. The assay in which a dilute solution of formalin is injected into the dorsal hindpaw of a murine produces two ‘phases’ of pain behavior separated by a inactive period. The early phase (Phase I) is probably due to direct activation of nociceptors and the second phase (Phase II) is due to ongoing inflammatory input and central sensitization. Mice were used to determine the potency antinociceptive of piroxicam (1,3,10,and 30 mg/kg), parecoxib (0.3, 1,3,10 and 30 mg/kg), dexketoprofen (3,10,30 and 100 mg/kg) and ketoprofen (3,10,30 and 100 mg/kg). Dose-response for each NSAIDs were created before and after 5 mg/kg of L-NAME i.p. or 5 mg/kg i.p. of 7-nitroindazole. A least-squares linear regression analysis of the log dose–response curves allowed the calculation of the dose that produced 50% of antinociception (ED50) for each drug. The ED50 demonstrated the following rank order of potency, in the phase I: piroxicam > dexketoprofen > ketoprofen > parecoxib and in the phase II: piroxicam > ketoprofen > parecoxib > dexketoprofen. Pretreatment of the mice with L-NAME or 7-nitroindazol induced a significant increase of the analgesic power of the NSAIDs, with a significant reduction of the ED50. It is suggested that NO may be involved in both phases of the trial, which means that nitric oxide regulates the bioactivity of NSAIDs.

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