Reduction in neonatal mortality by simple interventions

1989 ◽  
Vol 21 (S10) ◽  
pp. 127-136 ◽  
Author(s):  
S. R. Daga
Keyword(s):  
Neonatal Intensive Care ◽  
Newborn Infants ◽  
Extremely Low Birth Weight ◽  
Daily Cost ◽  
Average Hospital ◽  
Low Birth Weight Babies ◽  
Definition Of ◽  
The Cost ◽  
Care Costs ◽  
Average Daily Cost

Newborn infants are among those which generate the highest health care costs. For instance, the cost of hospital care until discharge was assessed at US $ 14,200 (Boyle et al., 1983) for babies weighing 1000–1499g at birth. The average hospital stay for a baby weighing less than 1500g at birth in 1981 was 100 days at an average daily cost of US$ 898 (Stahlman, 1984). Achievements in neonatal survival, especially of extremely low birth weight babies, have necessitated frequent revision of the definition of viability. However, modern neonatal intensive care cannot be regarded as appropriate for developing countries as it cannot be made accessible to all at an affordable cost.

scholarly journals Influence of Government Price Regulation on the Price, Volume and Spending of Antibiotics in China: A Controlled Interrupted Time Series Study

2020 ◽  
Author(s):  
Haishaerjiang Wushouer ◽  
Zhenhuan Luo ◽  
Xiaodong Guan ◽  
Luwen Shi
Keyword(s):  
Time Series ◽  
Interrupted Time Series ◽  
Price Regulation ◽  
Chinese Government ◽  
Positive Trend ◽  
Daily Cost ◽  
Average Hospital ◽  
Intervention Point ◽  
The Impact ◽  
Average Daily Cost

Background: Chinese government established maximum retail prices for antibiotics listed in China’s National Reimbursement List in February 2013. This study aimed to analyze the impact of pharmaceutical price regulation on the price, volume and spending of antibiotics in China. Methods: An interrupted time series design with comparison series was used to examine impacts of the policy changes on average daily cost, monthly hospital purchase volume and spending of the 11 price-regulated antibiotics and 40 priceunregulated antibiotics in 699 hospitals. One intervention point was applied to assess the impact of policy. Results: After government price regulation, compared to price-unregulated antibiotics, the average daily cost of the price-regulated group declined rapidly (β=-5.68, P<.001). The average hospital monthly purchase spending of priceregulated antibiotics also decreased rapidly (β=-0.49, P<.010) and a positive trend change (β=0.04, P<.001) in average hospital spending of price-unregulated antibiotics was found. Conclusion: Government regulation can reduce the prices and spending of price-regulated antibiotics. To control increasing expenditure, besides price caps regulation, factors determining drug utilization also need to be considered in policy designing.

scholarly journals Should Echocardiographic Evaluation Be Performed Routinely in the First 72 Hours in Extremely Low Birth Weight Babies?

2021 ◽  
pp. 1-6
Author(s):  
Ruya Çolak ◽  
Senem Alkan Ozdemir ◽  
Ezgi Yangin Ergon ◽  
Ferit Kulali ◽  
Oguz Han Kalkanli ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Intensive Care ◽  
Ductus Arteriosus ◽  
Clinical Signs ◽  
Extremely Low Birth Weight ◽  
Average Birth Weight ◽  
Mortality And Morbidity ◽  
Echocardiographic Evaluation ◽  
Low Birth Weight Babies

Objective: Hemodynamically significant patent ductus arteriosus(hsPDA) is resulting in severe mortality and morbidity in infants with extremely low birth weight(ELBW). In our study, we aimed to evaluate the necessity of performing routine echocardiography(ECHO) in the first 72hours in ELBW infants.Study Design:This study was planned retrospectively and observationally.Between June2016 and December2018,36 patients diagnosed with hemodynamically significant PDA(hsPDA) who were hospitalized in the neonatal intensive care unit(NICU),with ≤28Gw or ≤1000g were included in this study.These babies were routinely performed ECHO for PDA between 24-72hours,although they were asymptomatic in the period from June2016 to December2017(n:23).Between January2018 and December2018, patients without PDA symptoms were expected to complete 72hours for routine PDA screening (n:13).The patients were divided into 2 groups as early ECHO group(EEG)(n=23) and late ECHO group (LEG)(n=13).In the presence of at least one of the clinical signs of systemic hypoperfusion and/or pulmonary hyperperfusion, symptomatic PDA was accepted and closure treatment was  applied with ibuprofen(n: 23) or paracetamol(n: 5).While the two groups were compared in terms of demographic features,ECHO findings,and the state of taking closure therapy,patients receiving closure therapy were compared in terms of mortality and premature morbidity.Results:The average birth weight of 36 patients was 855.9(± 241.5)g, and the average week of birth was 26.4(± 2.1)Gw.It was observed that the two groups were similar in terms of demographic characteristics.Although the findings of ECHO and treatment rates were similar between the two groups,it was observed that the EEG had earlier closure treatment(p = 0.03). In patients receiving closure treatment, performing early(n:17)and late(n:11) echocardiography showed no statistical difference in the long-term results.Conclusion:Performing early ECHO without symptoms in infants with ELBW may provoke the clinician to give PDA closure treatment earlier. In infants with ELBW,unnecessary closure treatment can be prevented by closely monitoring the symptoms of PDA and performing ECHO when necessary.

Application and Evaluation of SPD Based Logistics Management Model for Medical Consumables in Clinical Nursing Departments

2020 ◽  
Author(s):  
Chai YANG ◽  
Wei GU ◽  
Tongzhu LIU
Keyword(s):  
Delphi Method ◽  
Turnover Rate ◽  
Operating Costs ◽  
Daily Cost ◽  
Management Efficiency ◽  
Clinical Nursing ◽  
Inventory Turnover ◽  
Time Required ◽  
The Cost ◽  
Average Daily Cost

Background: Supply, processing, and distribution (SPD) model is sparingly used in hospitals in China. We evaluated its effects on the management efficiency, quality control, and operating costs of medical consumables (MCs) in the clinical nursing surroundings in a single Chinese hospital-Anhui Provincial Hospital from 2014 to 2015. Methods: Amount-based packages (ABP) and procedure-based packages (PBP) models were created. They were introduced the use of quick response (QR) code scanning for using in clinical nursing departments (CNDs). Questionnaires were prepared by referring to previous literature and using Delphi method repeatedly, further discussed and formalized. Partial results of the formal questionnaire were analyzed using SPSS. Results: Frequency of MCs claims reduced without any requirements of MCs in 70% of CNDs. Average time spent on the inventory per week decreased and the time required to procure MCs reduced. Moreover, the average satisfaction score with MCs management increased, reaching 100%. Average space occupied by MCs decreased significantly, reducing by 1.2444m3. Overall, 100% of the respondents concluded that the management of MCs improved effectively and the inventory turnover rate had accelerated. The cost of MCs decreased by 15% with more than 10% increase in in-hospital amount, and the average daily cost of MCs also showed decrease. Conclusion: SPD can improve the efficiency of MCs management in CNDs, reducing medical risks and disputes, saving hospital operating costs, and decreasing capital occupation.

345 A Novel Study Exploring the Hidden Cost of Insufficient Investment in Computer Technology in a District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Rogers ◽  
R Ramasubbu ◽  
B Ramasubbu
Keyword(s):  
Computer Technology ◽  
Capital Investment ◽  
District General Hospital ◽  
Daily Cost ◽  
Hidden Cost ◽  
Computer Based ◽  
Cost Of Time ◽  
The Cost ◽  
Computer Unit ◽  
Average Daily Cost

Abstract Introduction The NHS’ move towards increasing digitisation is limited by inadequate resourcing. It is estimated 70% of a junior doctor’s time is spent completing computer-based administrative work. Aging and insufficient equipment leads to inefficiency. The objective of this study is to investigate the hidden cost of insufficient and poorly performing computer technology. Method Surveys were disseminated to doctors and data was collected regarding designation, ward, salary and estimated ‘minutes-waiting’ for computers to become free (CF) and to load (CL). Results 33 surveys were completed. The hospital-wide average CF and CL were 25 minutes and 31.06 minutes respectively, with a corresponding average daily cost per doctor of £10.16 (CF) and £12.63 (CL), totalling £22.79/doctor/day. In the highest-expense ward, CF (31.66 minutes) and CL (38.33 minutes) equated to £30.28/doctor/day. Following acquisition of new hardware and re-audit, CL was significantly reduced to 20.4 minutes (p = 0.0142). Conclusions This study highlights the hidden cost of insufficient, poorly performing hardware. Every day the total cost of time-wasted greatly surpasses the cost of a single computer unit, illustrating the false economy of reduced capital investment in computer technology.

Response to “Neonatal Viability in the 1990s: Held Hostage by Technology” by Jonathan Muraskas et al. and “Giving ‘Moral Distress’ a Voice: Ethical Concerns among Neonatal Intensive Care Unit Personnel” by Pam Hefferman and Steve Heilig (CQ Vol 8, No 2)

1999 ◽  
Vol 8 (4) ◽  
pp. 524-526 ◽  
Author(s):  
Thomas J. Simpson
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Moral Distress ◽  
Extremely Low Birth Weight ◽  
High Tech ◽  
Premature Newborns ◽  
Ethical Concerns ◽  
Life Saving ◽  
Intensive Care Nursery ◽  
The Cost

Muraskas et al. and Hefferman and Heilig present the painfully elusive ethical questions regarding decisionmaking in the care of the extremely low birth weight (ELBW) infants in the intensive care nursery. At what gestation or size do we resuscitate? Can we stop resuscitation after we have started? How much money is too much to spend? Is the distress of the parents of the ELBW infant, the anguish of their caregivers, and the moral and ethical uncertainty of the approach to these infants too much to pay? Who speaks for the neonate: the parent, nurse, attorney, or physician? Ideally these questions should have been answered 30 years ago when modern neonatology embarked on a journey from where it could not return. A new breed of physician, called “neonatologist,” seduced by the high-tech lure and the promise of saving lives previously unsavable pioneered a lucrative and life-saving technological revolution in the care of premature newborns. This rapid advancement in neonatology occurred a few years after the death of a premature infant named Patrick Kennedy in 1963. While the country mourned, medical scientists vowed that this would not happen again. First continuous positive airway pressure, then mechanical ventilation, changed medical care of premature newborns forever. It began an era of euphoria and excitement. Neonatologists raced to push to the edge of newborn viability. What was the youngest salvageable gestational age? What was the smallest that could be saved? Yes, we dreamed, and still do dream of artificial placentas. Ethical questions took a back seat in the search for the edge because the waters were uncharted and the tough questions could not be answered without experience. What was to be the cost in dollars and in anguish to save the Patrick Kennedys of the world? Triumphs led to grave concerns as we approached the edge. However, no advancement in neonatology has ever changed the ultimate questions.

The Neonatal Consequences and Neonatal Cost of Reducing the Number of Embryos Transferred following IVF

1997 ◽  
Vol 42 (3) ◽  
pp. 76-78 ◽  
Author(s):  
X-H. Liao ◽  
L. de Caestecker ◽  
J. Gemmell ◽  
A. Lees ◽  
G. McIlwaine ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Clinical Audit ◽  
Multiple Pregnancy ◽  
Clinical Pregnancy ◽  
The West ◽  
Hospital Records ◽  
Low Birth Weight Babies ◽  
Audit Project ◽  
The Cost

This clinical audit project examined the effects of change of policy between 1990 and 1993 transferring an average two (maximum three for particular cases) embryos to women undergoing IVF in the West of Scotland programme. All women who achieved clinical pregnancy in 1990 (92 women) and 1993 (93 women) as a result of the IVF programme were included in the study. The hospital records of women via the programme were analysed. The results of the study showed that there was a significant reduction in the rate of multiple pregnancy, preterm birth and low birth weight babies in the 1993 group (new policy). The cost of neonatal intensive care in 1993 for babies born following IVF was about nine times lower than that in 1990 (old policy). This study concluded that a policy of transferring two embryos (or three for particular cases) to women in an IVF programme, had improved the perinatal outcome and reduced the cost of the neonatal service for those babies.

GSS 2011 Linked with TIFF: Exploring the Cost of Child Care in Canada and the Use of the Child Care Tax Benefit

2019 ◽  
Vol 12 (1) ◽  
pp. 81-103
Author(s):  
Leanne Findlay ◽  
Dafna Kohen
Keyword(s):  
Child Care ◽  
General Social Survey ◽  
Cost Of Care ◽  
Indigenous Identity ◽  
Social Survey ◽  
The Cost ◽  
Care Costs ◽  
Compare And Contrast ◽  
Employment Characteristics ◽  
Different Sources

Affordability of child care is fundamental to parents’, in particular, women’s decision to work. However, information on the cost of care in Canada is limited. The purpose of the current study was to examine the feasibility of using linked survey and administrative data to compare and contrast parent-reported child care costs based on two different sources of data. The linked file brings together data from the 2011 General Social Survey (GSS) and the annual tax files (TIFF) for the corresponding year (2010). Descriptive analyses were conducted to examine the socio-demographic and employment characteristics of respondents who reported using child care, and child care costs were compared. In 2011, parents who reported currently paying for child care (GSS) spent almost $6700 per year ($7,500 for children age 5 and under). According to the tax files, individuals claimed just over $3900 per year ($4,700). Approximately one in four individuals who reported child care costs on the GSS did not report any amount on their tax file; about four in ten who claimed child care on the tax file did not report any cost on the survey. Multivariate analyses suggested that individuals with a lower education, lower income, with Indigenous identity, and who were self-employed were less likely to make a tax claim despite reporting child care expenses on the GSS. Further examination of child care costs by province and by type of care are necessary, as is research to determine the most accurate way to measure and report child care costs.

The cost implication of primary prevention in the HOPE 3 trial

2019 ◽  
Vol 5 (3) ◽  
pp. 266-271
Author(s):  
Andre Lamy ◽  
Eva Lonn ◽  
Wesley Tong ◽  
Balakumar Swaminathan ◽  
Hyejung Jung ◽  
...  
Keyword(s):  
Developing Countries ◽  
Primary Prevention ◽  
Cost Saving ◽  
Developed Countries ◽  
Sensitivity Analyses ◽  
Clinical Trial Registration ◽  
Pressure Lowering ◽  
The Cost ◽  
Care Costs ◽  
Country Specific

Abstract Aims The Heart Outcomes Prevention Evaluation-3 (HOPE-3) found that rosuvastatin alone or with candesartan and hydrochlorothiazide (HCT) (in a subgroup with hypertension) significantly lowered cardiovascular events compared with placebo in 12 705 individuals from 21 countries at intermediate risk and without cardiovascular disease. We assessed the costs implications of implementation in primary prevention in countries at different economic levels. Methods and results Hospitalizations, procedures, study and non-study medications were documented. We applied country-specific costs to the healthcare resources consumed for each patient. We calculated the average cost per patient in US dollars for the duration of the study (5.6 years). Sensitivity analyses were also performed with cheapest equivalent substitutes. The combination of rosuvastatin with candesartan/HCT reduced total costs and was a cost-saving strategy in United States, Canada, Europe, and Australia. In contrast, the treatments were more expensive in developing countries even when cheapest equivalent substitutes were used. After adjustment for gross domestic product (GDP), the costs of cheapest equivalent substitutes in proportion to the health care costs were higher in developing countries in comparison to developed countries. Conclusion Rosuvastatin and candesartan/HCT in primary prevention is a cost-saving approach in developed countries, but not in developing countries as both drugs and their cheapest equivalent substitutes are relatively more expensive despite adjustment by GDP. Reductions in costs of these drugs in developing countries are essential to make statins and blood pressure lowering drugs affordable and ensure their use. Clinical trial registration HOPE-3 ClinicalTrials.gov number, NCT00468923.

Constructing Images of Deviance: A Look at State Intervention into the Problem of Wife-Battery

1983 ◽  
Vol 31 (1_suppl) ◽  
pp. 60-76
Author(s):  
Patricia A. Morgan
Keyword(s):  
Social Problem ◽  
State Intervention ◽  
The United States ◽  
The State ◽  
Structural Position ◽  
Wife Battering ◽  
The Social ◽  
Class Context ◽  
Definition Of ◽  
The Cost

Patricia Morgan's paper describes what happens when the state intervenes in the social problem of wife-battering. Her analysis refers to the United States, but there are clear implications for other countries, including Britain. The author argues that the state, through its social problem apparatus, manages the image of the problem by a process of bureaucratization, professionalization and individualization. This serves to narrow the definition of the problem, and to depoliticize it by removing it from its class context and viewing it in terms of individual pathology rather than structure. Thus refuges were initially run by small feminist collectives which had a dual objective of providing a service and promoting among the women an understanding of their structural position in society. The need for funds forced the groups to turn to the state for financial aid. This was given, but at the cost to the refuges of losing their political aims. Many refuges became larger, much more service-orientated and more diversified in providing therapy for the batterers and dealing with other problems such as alcoholism and drug abuse. This transformed not only the refuges but also the image of the problem of wife-battering.

scholarly journals Neonatal Hypoglycaemia: A Never-Ending Story?

Neonatology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Nestor E. Vain ◽  
Florencia Chiarelli
Keyword(s):  
At Risk ◽  
Neonatal Period ◽  
Newborn Infants ◽  
Neonatal Hypoglycaemia ◽  
Rational Decision Making ◽  
Weak Evidence ◽  
Universal Approach ◽  
Definition Of ◽  
Therapeutic Alternatives ◽  
Current Guidelines

Neonatal hypoglycaemia is a common metabolic disorder presenting in the first days of life and one potentially preventable cause of brain injury. However, a universal approach to diagnosis and management is still lacking. The rapid decrease in blood glucose (BG) after birth triggers homeostatic mechanisms. Most episodes of hypoglycaemia are asymptomatic, and symptoms, when they occur, are nonspecific. Therefore, neonatologists are presented with the challenge of identifying infants at risk who might benefit from a rapid and effective therapy while sparing others unnecessary sampling and overtreatment. There is much controversy regarding the definition of hypoglycaemia, and one level does not fit all infants since postnatal age and clinical situations trigger different accepted thresholds for therapy. The concentration and duration of BG which cause neurological damage are unclear. Recognizing which newborn infants are at risk of hypoglycaemia and establishing protocols for treatment are essential to avoid possible deleterious effects on neurodevelopment. Early breastfeeding may reduce the risk of hypoglycaemia, but in some cases, the amount of breast milk available immediately after birth is insufficient or non-existent. In these situations, other therapeutic alternatives such as oral dextrose gel may lower the risk for NICU admissions. Current guidelines continue to be based on expert opinion and weak evidence. However, malpractice litigation related to neurodevelopmental disorders is frequent in children who suffered hypoglycaemia in the neonatal period even if they had other important factors contributing to the poor outcome. This review is aimed to help the practicing paediatricians and neonatologists to comprehend neonatal hypoglycaemia from physiology to therapy, hoping it will result in a rational decision-making process in an area not sufficiently supported by evidence.

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