Quality of endoscopy reporting at index colonoscopy significantly impacts outcome of subsequent EMR in patients with > 20 mm colon polyps

Abstract Background and study aims Endoscopic mucosal resection (EMR) is safe and cost-effective in management of patients with colon polyps. However, very little is known about the actions of the referring endoscopist following identification of these lesions at index colonoscopy, and the impact of those actions on the outcome of subsequent referral for EMR. The aim of this study was to identify practices at index colonoscopy that lead to failure of subsequent EMR. Patients and methods Two hundred and eighty-nine consecutive patients with biopsy-proven non-malignant colon polyps (> 20 mm) referred for EMR were analyzed to identify practices that could be improved from the time of identifying the lesion at index colonoscopy until completion of therapy. Results EMR was abandoned at colonoscopy at the EMR center in 71 of 289 patients (24.6 %). Reasons for abandoning EMR included diagnosis of invasive carcinoma (n = 9; 12.7 %), tethered lesions (n = 21; 29.6 %) from prior endoscopic interventions, and overly large (n = 22; 31 %) and inaccessible lesions (n = 17; 24 %) for complete and safe resection whose details were not recorded in the referring endoscopy report, or polyposis syndromes (n = 2; 2.8 %) that were not recognized. Conclusions In our practice, one in four EMR attempts were abandoned as a result of inadequate diagnosis or management by the referring endoscopist, which could be improved by education on optical diagnosis of polyps, comprehensive documentation of the procedure and avoidance of interventions that preclude resection.

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OP56 Rehabilitation Of Memory In Brain Injury: A Cost-Utility Analysis

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318001034 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 20-21

Author(s):

Shaun Harris ◽

Deborah Fitzsimmons ◽

Roshan das Nair ◽

Lucy Bradshaw

Keyword(s):

Usual Care ◽

Cost Effective ◽

Cost Utility ◽

Sensitivity Analyses ◽

Base Case ◽

Utility Analysis ◽

Considerable Uncertainty ◽

Memory Rehabilitation ◽

The Impact

Introduction:People with traumatic brain injuries (TBIs) commonly report memory impairments which are persistent, debilitating, and reduce quality of life. As part of the Rehabilitation of Memory in Brain Injury trial, a cost-effectiveness analysis was undertaken to examine the comparative costs and effects of a group memory rehabilitation program for people with TBI.Methods:Individual-level cost and outcome data were collected. Patients were randomized to usual care (n=157) or usual care plus memory rehabilitation (n=171). The primary outcome for the economic analysis was the EuroQol-5D quality of life score at 12 months. A UK NHS costing perspective was used. Missing data was addressed by multiple imputation. One-way sensitivity analyses examined the impact of varying different parameters, and the impact of available cases, on base case findings whilst non-parametric bootstrapping examined joint uncertainty.Results:At 12 months, the intervention was GBP 26.89 (USD 35.76) (SE 249.15) cheaper than usual care; but this difference was statistically non-significant (p=0.914). At 12 months, a QALY loss of −0.007 was observed in the intervention group confidence interval (95% CI: −0.025–0.012) and a QALY gain seen in the usual care group 0.004 (95% CI: -0.017–0.025). This difference was not statistically significant (p=0.442). The base case analysis gave an ICER of GBP 2,445 (USD 3,252) reflecting that the intervention was less effective and less costly compared to usual care. Sensitivity analyses illustrated considerable uncertainty. When joint uncertainty was examined, the probability of the intervention being cost-effective at a willingness-to-pay threshold of GBP 20,000 per QALY gain was 29 percent and 24 percent at GBP 30,000.Conclusions:Our cost-utility analysis indicates that memory rehabilitation was cheaper but less effective than usual care but these findings must be interpreted in the light of small statistically non–significant differences and considerable uncertainty was evident. The ReMemBrIn intervention is unlikely to be considered cost-effective for people with TBI.

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The Impact of Heterogenous Ultra-dense Network Technologies on the Performance of 4G and 5GNetworks

International Journal of Innovative Technology and Exploring Engineering - Special Issue ◽

10.35940/ijitee.a8070.1110120 ◽

2020 ◽

Vol 10 (1) ◽

pp. 35-44

Keyword(s):

Cost Effective ◽

Cellular System ◽

Small Cells ◽

High Expectations ◽

Dense Networks ◽

High Data ◽

Data Rates ◽

Network Technologies ◽

The Impact

The flood of applications that demand massive data has imposed a challenge for 5G cellular network in order to deliver high data rates, a better quality of service, and low energy consumption. Heterogenous ultra- dense networks are one of the major technologies to address such challenges. HUDNs play a big role in a cellular system. They deliver cost-effective coverage with low transmit power and high capacty to face the risen data and the high expectations of the user's performance. In this paper, we introduce the impact of small cells on the cellular system and the technologies the small cells utilize to make the cellular system faces the subscriber's demands. First, we discuss the fundamentals of used technologies in small cells. Next, we studied the small cell management. Then, self-organizing networks are studied. After that, we have reviewed the small cell's power consumption, mobility, and handover. Finally, the real-world experience of mm-waves and MIMO in 5G small cells

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Specializing Nurses as An Indirect Education Program for Stoma Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16132272 ◽

2019 ◽

Vol 16 (13) ◽

pp. 2272

Author(s):

Manuel García-Goñi

Keyword(s):

Chronic Conditions ◽

Cost Effective ◽

Effectiveness Analysis ◽

Education Strategy ◽

Related Quality ◽

Health Related ◽

Low Incidence ◽

Specialist Nurses ◽

The Impact

Education programs are beneficial for patients with different chronic conditions. Prior studies have examined direct education, where information is transferred directly to patients. In contrast, in this program, information is transferred directly to nurses who become specialists and transfer education individually to patients. Hence, this paper evaluates the impact of having specialist nurses for stoma patients at hospitals, as those nurses provide healthcare to patients but also inform and educate patients about their condition and needs. The analysis uses an observational study with ostomized patients in Spain at hospitals with and without specialist nurses, and measures health service utilization and health-related quality of life (HRQL), besides performing a cost analysis and a cost-effectiveness analysis at both types of hospitals. The results show that patients with access to specialist nurses self-manage better, present lower adverse events and a better evolution of HRQL, and significantly demand more consultations with specialist nurses and less to A&E, primary care or specialists, resulting in important savings for the health system. Consequently, specializing or hiring nurses to provide indirect education to stoma patients is cost-effective and highly beneficial for patients. This type of indirect education strategy might be considered for specific conditions with low incidence or difficulties in identifying target patients or delivering information directly to them.

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A119 THE LOCATION-BASED RESECT AND DISCARD STRATEGY FOR DIMINUTIVE COLORECTAL POLYPS: A PROSPECTIVE CLINICAL STUDY

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.117 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 99-101

Author(s):

M Taghiakbari ◽

H Pohl ◽

R Djinbachian ◽

A N Barkun ◽

P Marques ◽

...

Keyword(s):

Task Force ◽

A Priori ◽

Cost Effective ◽

Colorectal Polyps ◽

Prospective Clinical Study ◽

Colon Polyps ◽

Optical Diagnosis ◽

Cost Effective Approach ◽

Surveillance Interval ◽

Task Force Guideline

Abstract Background Replacing histopathology evaluation of diminutive polyps with optical polyp diagnosis is considered a cost-effective approach. However, the widespread use of optical diagnosis is limited due to concerns about making incorrect optical diagnoses and the requirements of training, credentialing and auditing of performance. Aims This prospective study aimed to evaluate a simplified resect and discard strategy that is not operator dependent. Methods The study evaluated a resect and discard strategy that uses anatomical polyp location to classify colon polyps into non-neoplastic or low-risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and optical diagnosis, respectively. The primary outcome was ≥90% agreement with pathology in surveillance interval assignment. Results Overall, 1117 patients undergoing complete colonoscopy were included and 482 (43.1%) had at least one diminutive polyp. Surveillance interval agreement between the location-based resect and discard strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0% (95% CI = 0.96 - 0.98), surpassing the ≥90% benchmark. Optical diagnoses using NICE and Sano classifications reached 89.1% and 90.01% agreement, respectively (p <0.0001), and were inferior to the location-based strategy. The location-based resect and discard strategy allowed a 69.7% (95% CI = 0.67 - 0.72) reduction in pathology examinations compared with 55.3% (95% CI = 0.52 - 0.58) (NICE and Sano) and 41.9% (95% CI = 0.39 - 0.45) (WASP) with optical diagnosis. Conclusions The location-based resect and discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥90% quality benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided. Funding Agencies None

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Impact of index hopping and bias towards the reference allele on accuracy of genotype calls from low-coverage sequencing

10.1101/358085 ◽

2018 ◽

Cited By ~ 1

Author(s):

Roger Ros-Freixedes ◽

Battagin Mara ◽

Martin Johnsson ◽

Gregor Gorjanc ◽

Alan J Mileham ◽

...

Keyword(s):

Sequence Data ◽

Cost Effective ◽

Reference Allele ◽

High Coverage ◽

Sequencing Errors ◽

Percentage Points ◽

Low Coverage ◽

The Impact ◽

Genotype Concordance

AbstractBackgroundInherent sources of error and bias that affect the quality of the sequence data include index hopping and bias towards the reference allele. The impact of these artefacts is likely greater for low-coverage data than for high-coverage data because low-coverage data has scant information and standard tools for processing sequence data were designed for high-coverage data. With the proliferation of cost-effective low-coverage sequencing there is a need to understand the impact of these errors and bias on resulting genotype calls.ResultsWe used a dataset of 26 pigs sequenced both at 2x with multiplexing and at 30x without multiplexing to show that index hopping and bias towards the reference allele due to alignment had little impact on genotype calls. However, pruning of alternative haplotypes supported by a number of reads below a predefined threshold, a default and desired step for removing potential sequencing errors in high-coverage data, introduced an unexpected bias towards the reference allele when applied to low-coverage data. This bias reduced best-guess genotype concordance of low-coverage sequence data by 19.0 absolute percentage points.ConclusionsWe propose a simple pipeline to correct this bias and we recommend that users of low-coverage sequencing be wary of unexpected biases produced by tools designed for high-coverage sequencing.

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Comparing COVID-19 vaccines for their characteristics, efficacy and effectiveness against SARS-CoV-2 and variants of concern

10.31219/osf.io/z4x7t ◽

2021 ◽

Author(s):

Fiolet ◽

Yousra Kherabi ◽

Conor MacDonald ◽

Jade Ghosn ◽

Nathan Peiffer-Smadja

Keyword(s):

South Africa ◽

Herd Immunity ◽

Real Life ◽

Cost Effective ◽

Phase Iii ◽

Real Life Data ◽

National Drug ◽

Phase Iii Trials ◽

The Impact

Vaccines are critical cost-effective tools to control the COVID-19 pandemic. However, the emergence of more transmissible SARS-CoV-2 variants may threaten the potential herd immunity sought from mass vaccination campaigns.The objective of this study was to provide an up-to-date comparative analysis of the characteristics, adverse events, efficacy, effectiveness and impact of the variants of concern (Alpha, Beta, Gamma and Delta) for fourteen currently authorized COVID-19 vaccines (BNT16b2, mRNA-1273, AZD1222, Ad26.COV2.S, Sputnik V, NVX-CoV2373, Ad5-nCoV, CoronaVac, BBIBP-CorV, COVAXIN, Wuhan Sinopharm vaccine, QazCovid-In, Abdala and ZF200) and two vaccines (CVnCoV and NVX-CoV2373) currently in rolling review in several national drug agencies.Overall, all COVID-19 vaccines had a high efficacy against the traditional strain and the variants of SARS-CoV-2, and were well tolerated. BNT162b2, mRNA-1273 and Sputnik V had the highest efficacy (>90%) after two doses at preventing symptomatic cases in phase III trials. Efficacy was ranging from 10.4% for AZD1222 in South Africa to 50% for NVX-CoV2373 in South Africa and 50 % for CoronaVac in Brazil, where the 501YV.2 and P1 variants were dominant. Seroneutralization studies showed a negligible reduction in neutralization activity against Alpha for most of vaccines, whereas the impact was modest for Delta. Beta and Gamma exhibited a greater reduction in neutralizing activity for mRNA vaccines, Sputnik V and CoronaVac. Regarding observational real-life data, most studies concerned the Pfizer and Moderna vaccines. Full immunization with mRNA vaccines effectively prevents SARS-CoV-2 infection against Alpha and Beta. All vaccines appeared to be safe and effective tools to prevent symptomatic and severe COVID-19, hospitalization and death against all variants of concern, but the quality of evidence greatly varied depending on the vaccines considered. There are remaining questions regarding specific populations excluded from trials, the duration of immunity and heterologous vaccination. Serious adverse event and particularly anaphylaxis (2.5-4.7 cases per million doses among adults) and myocarditis (3.5 cases per million) for mRNA vaccines ; thrombosis with thrombocytopenia syndrome for Janssen vaccine (3 cases per million) and AstraZeneca vaccine (2 cases per million) and Guillain-Barre syndrome (7.8 cases per million) for Janssen vaccine are very rare. COVID-19 vaccine benefits outweigh risks, despite rare serious adverse effect.

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The Impact of Ultra-widefield Retinal Imaging on Practice Efficiency

US Ophthalmic Review ◽

10.17925/usor.2017.10.01.27 ◽

2017 ◽

Vol 10 (01) ◽

pp. 27 ◽

Cited By ~ 1

Author(s):

Paul E Tornambe ◽

Keyword(s):

Quality Care ◽

Retinal Imaging ◽

Cost Effective ◽

The United States ◽

Care Plans ◽

Healthcare Environment ◽

Practice Efficiency ◽

Government Reimbursement ◽

The Impact

I n the current cost- and resource-constrained healthcare environment in the United States, characterized by declining government reimbursement and increased utilization scrutiny by managed care plans, providers are challenged to continue delivering quality care to more patients while also more effectively managing practice economics. Employing technology to improve practice efficiency is one of the most promising solutions to this dilemma. We have demonstrated that the integration of ultra-widefield (UWF) retinal imaging in our practice is cost-effective. It has allowed us to increase the number of patient encounters while simultaneously raising the quality of care, and increasing patient satisfaction.

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Bloody Good! The Impact of eLearning on Medical and Nursing Practice

International Journal of Advanced Corporate Learning (iJAC) ◽

10.3991/ijac.v10i2.7349 ◽

2017 ◽

Vol 10 (2) ◽

pp. 75 ◽

Cited By ~ 1

Author(s):

David Peterson ◽

Tracey Clark ◽

Richard Sprod ◽

Trudi Verrall ◽

Louise English ◽

...

Keyword(s):

Best Practice ◽

Positive Impact ◽

Improve Patient Safety ◽

Cost Effective ◽

Transfusion Practice ◽

Medical Procedure ◽

Reliable Knowledge ◽

The Impact ◽

Improve Patient

Blood transfusion is a commonly-performed medical procedure that improves and saves the lives of patients. However, this procedure also has significant risks, is sometimes used inappropriately and has substantial costs associated with the collection, testing, processing and distribution of blood and blood products.BloodSafe eLearning Australia (BEA) (<a href="/index.php/i-jac/author/saveSubmit/www.bloodsafelearning.org.au">www.bloodsafelearning.org.au</a>) is an education program for Australian doctors, nurses and midwives, designed to improve the safety and quality of clinical transfusion practice. Courses are interactive and include case studies, videos, and best-practice tips. Successful completion of a multiple-choice assessment provides learners with a certificate of completion. To date there are more than 400,000 registered learners, from more than 1500 organisations, who have completed more than 765,000 courses.Stakeholder feedback shows that the program: provides credible, consistent education across Australia; is cost effective; reduces duplication; is ‘best-practice’ elearning that is readily accessible; allows institutions to focus on practical aspects of transfusion education; results in change to clinical practice; and supports the broader implementation of a blood management strategy in Australia.User evaluation shows that the courses have a positive impact, with 89% of respondents stating they had gained additional knowledge of transfusion practice, processes and/or policy and more than 87% reporting they will make, or have made, changes to their work practices which will improve patient safety and outcomes.The BloodSafe eLearning Australia program provides education to a large number of health professionals across Australia. Evaluation demonstrates that these courses provide users with a consistent and reliable knowledge base that translates into changes to practice and improved patient outcomes.

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A patient-initiated DMARD self-monitoring service for people with rheumatoid or psoriatic arthritis: a cost-effectiveness analysis

Rheumatology ◽

10.1093/rheumatology/keaa309 ◽

2020 ◽

Vol 60 (1) ◽

pp. 277-287 ◽

Cited By ~ 1

Author(s):

Hayley McBain ◽

Chris Flood ◽

Michael Shipley ◽

Abigail Olaleye ◽

Samantha Moore ◽

...

Keyword(s):

Quality Of Life ◽

Cost Effectiveness ◽

Usual Care ◽

Short Form ◽

Cost Effective ◽

Self Monitoring ◽

The Cost ◽

Monitoring Service ◽

The Impact

Abstract Objective To determine whether a patient-initiated DMARD self-monitoring service for people on MTX is a cost-effective model of care for patients with RA or PsA. Methods An economic evaluation was undertaken alongside a randomized controlled trial involving 100 patients. Outcome measures were quality of life and ESR assessed at baseline and post-intervention. Costs were calculated for healthcare usage using a United Kingdom National Health Service economic perspective. Sensitivity analysis was performed to explore the impact of nurse-led telephone helplines. Uncertainty around the cost-effectiveness ratios was estimated by bootstrapping and analysing the cost-effectiveness planes. Results Fifty-two patients received the intervention and 48 usual care. The difference in mean cost per case indicated that the intervention was £263 more expensive (P < 0.001; 95% CI: £149.14, £375.86) when the helpline costs were accounted for and £94 cheaper (P = 0.08; 95% CI: –£199.26, £10.41) when these costs were absorbed by the usual service. There were, however, statistically significant savings for the patient (P = 0.02; 95% CI: −£28.98, £3.00). When costs and effectiveness measures of ESR and quality of life measured, using the Short Form-12v1, were combined this did not show the patient-initiated service to be cost-effective at a statistically significant level. Conclusion This patient-initiated service led to reductions in primary and secondary healthcare services that translated into reduced costs, in comparison with usual care, but were not cost-effective. Further work is needed to establish how nurse-led telephone triage services are integrated into rheumatology services and the associated costs of setting up and delivering them. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, ISRCTN21613721

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