scholarly journals One-Stop Surgery: An Innovation to Limit Hospital Visits in Children

2021 ◽  
Author(s):  
Kelly M.A. Dreuning ◽  
Joep P.M. Derikx ◽  
Ayoub Ouali ◽  
Liedewij M.J. Janssen ◽  
Maurits W. van Tulder ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Cost Effectiveness ◽  
Intervention Group ◽  
Family Satisfaction ◽  
Secondary Outcome ◽  
Productivity Cost ◽  
Inguinal Hernia Surgery ◽  
One Stop ◽  
Hospital Visits

Abstract Introduction One-stop surgery (OSS) allows for same-day outpatient clinic visit, preoperative assessment, and surgical repair. This study aims to determine the efficiency, (cost-)effectiveness, and family satisfaction of one-stop inguinal hernia surgery compared with usual care. Material and Methods Children (≥ 3 months) with inguinal hernia and American Society of Anesthesiologists (ASA) grades I–II, scheduled for OSS (intervention) or regular treatment (control) between March 1, 2017, and December 1, 2018, were eligible for inclusion. Exclusion criteria consisted of age less than 3 months and ASA grades III–IV. The primary outcome measure was treatment efficiency (i.e., total number of hospital visits and waiting time [days] between referral and surgery). Secondary outcome measures were the effectiveness in terms of complication and recurrence rate, and parent-reported satisfaction and cost-effectiveness using the Dutch Pediatric Quality of Life Healthcare Satisfaction and Institute for Medical Technology Assessment Productivity Cost Questionnaire. Results Ninety-one (intervention: 54; control: 37) patients (56% boys) were included. Median (interquartile range) number of hospital visits was lower in the intervention group (1 vs 3; p < 0.001). All but one of the OSS patients (98%) were discharged home on the day of surgery. Postoperative complication (1.9% vs 2.7%; p = 0.787) and recurrence rates (0% vs 2.7%; p = 0.407) did not differ between the intervention and control patients. “General satisfaction,” “satisfaction with communication,” and “inclusion of family” were higher after OSS, while satisfaction about “information,” “technical skills,” and “emotional needs” were similar. Median (range) follow-up was 28 (15–36) months. Conclusions Pediatric one-stop inguinal hernia repair seems to be an effective treatment strategy that limits the number of hospital visits and provides enhanced family satisfaction without compromising the quality of care.

scholarly journals Acceptability and Feasibility of a Mindfulness Intervention Delivered via Videoconferencing for People With Parkinson’s

2021 ◽  
pp. 089198872098890
Author(s):  
Angeliki Bogosian ◽  
Catherine S. Hurt ◽  
John V. Hindle ◽  
Lance M. McCracken ◽  
Debora A. Vasconcelos e Sa ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Qualitative Interviews ◽  
Quality Adjusted Life Year ◽  
Secondary Outcome ◽  
Structured Interviews ◽  
Potential Cost ◽  
Mindfulness Intervention ◽  
Related Quality

Mindfulness-based group therapy is a rapidly growing psychological approach that can potentially help people adjust to chronic illness and manage unpleasant symptoms. Emerging evidence suggests that mindfulness-based interventions may benefit people with Parkinson’s. The objective of the paper is to examine the appropriateness, feasibility, and potential cost-effectiveness of an online mindfulness intervention, designed to reduce anxiety and depression for people with Parkinson’s. We conducted a feasibility randomized control trial and qualitative interviews. Anxiety, depression, pain, insomnia, fatigue, impact on daily activities and health-related quality of life were measured at baseline, 4, 8, and 20 weeks. Semi-structured interviews were conducted at the end of the intervention. Participants were randomized to the Skype delivered mindfulness group (n = 30) or wait-list (n = 30). Participants in the mindfulness group were also given a mindfulness manual and a CD with mindfulness meditations. The intervention did not show any significant effects in the primary or secondary outcome measures. However, there was a significant increase in the quality of life measure. The incremental cost-effectiveness ratio was estimated to be £27,107 per Quality-Adjusted Life Year gained. Also, the qualitative study showed that mindfulness is a suitable and acceptable intervention. It appears feasible to run a trial delivering mindfulness through Skype, and people with Parkinson’s found the sessions acceptable and helpful.

scholarly journals The Role of Pedometer Based Walking Exercise To Quadriceps Muscle, Quality of Life, Benefit, and Cost in Stable COPD Patient

2020 ◽  
Vol 40 (3) ◽  
pp. 163-172
Author(s):  
Jatu Aviani ◽  
Suradi Suradi ◽  
Ana Rima
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Muscle Strength ◽  
Intervention Group ◽  
Quadriceps Muscle ◽  
Muscle Quality ◽  
Control Group ◽  
Quadriceps Muscle Strength ◽  
Walking Exercise

Backgrounds: Quadriceps muscle dysfunction in chronic obstructive pulmonary disease (COPD) is caused by systemic or local inflammation, hypoxia, hypercapnia, corticosteroid use, nutritional depletion, anabolic/catabolic hormone imbalances, oxidative stress, genetic susceptibility, and decreased daily activity. Decreased quadriceps muscle strength reduces exercise capacity, physical activity, increases shortness of breath, and decreases quality of life. Exercise trainng of walking increases the quadriceps muscle strength and overcomes deconditioning. The purpose of this study was to analyze effect of pedometer-based exercise on quadriceps muscle strength, quality of life, benefits, and cost on patients with stable COPD. Methods: A clinical study with quasi-experimental pre-post test control group design using consecutive sampling was performed in patients with stable COPD at Dr. Moewardi Hospital from September to November 2018. Subjects were divided into intervention group which were given pedometer based walking exercise for six weeks and control group with standard rehabilitation. Quadriceps muscle strength, SGRQ score, LCADL score, and cost effectiveness were measured before and after exercise. Results: Twenty-seven of stable COPD patients were included in this study. The intervention groups showed increased quadriceps muscle strength (2,58+0,49), decreased SGRQ scores (23,39+6,60), decreased LCDAL scores (-5,69+2,18), and cost effectiveness compared to control group (P

scholarly journals Extended Duration Regional Analgesia for Total Knee Arthroplasty: A Randomised Controlled Trial Comparing Five Days to Three Days of Continuous Adductor Canal Ropivacaine Infusion

2018 ◽  
Vol 46 (3) ◽  
pp. 326-331 ◽  
Author(s):  
S. C. Sargant ◽  
M. J. Lennon ◽  
R. J. Khan ◽  
D. Fick ◽  
H. Robertson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Rating Scale ◽  
Intervention Group ◽  
Numeric Rating Scale ◽  
Secondary Outcome ◽  
Quality Of Recovery ◽  
Adductor Canal ◽  
Total Knee ◽  
Numeric Rating

There is a growing body of evidence in favour of continuous adductor canal block (CACB) for total knee arthroplasty. However, there are no studies describing the optimal duration of the infusion. At our institution the usual practice was to stop the infusion on day three. Our hypothesis was that extending the infusion to five days would improve analgesia and quality of recovery. A prospective, non-blinded, randomised trial was undertaken. Patients received a continuous infusion of 0.2% ropivacaine via an adductor canal catheter for either three or five days. Primary outcome was pain while walking during the 24-hour period up to day five (numeric rating scale from 0 to 10). The minimum clinically important difference was set at 1.5 on the numeric rating scale. Secondary outcome measures included quality of recovery, mobility, pain while walking on postoperative day six, Oxford Knee Scores, and complications. Eighty-six patients were recruited with 43 randomised to each group. Seventy-eight were analysed. Median pain scores reported on day five were significantly better in the intervention group (1 versus 3, P=0.003). Furthermore, quality of recovery (QOR-15) scores were significantly better in the intervention group (133.6 versus 123.4, P=0.017). No statistically significant difference between groups was identified for other secondary outcome measures. CACB prolonged to five days provides superior analgesia and a higher quality of recovery on postoperative days four and five compared to a three-day infusion. This benefit did not extend beyond the period of infusion.

scholarly journals (Cost-)effectiveness of lower extremity nerve decompression surgery in subjects with diabetes: the DeCompression (DECO) trial—study protocol for a randomised controlled trial

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e035644
Author(s):  
Willem D Rinkel ◽  
Tirzah M Fakkel ◽  
Manuel Castro Cabezas ◽  
Erwin Birnie ◽  
J Henk Coert
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Lower Extremity ◽  
Controlled Trial ◽  
Surgical Care ◽  
Life Questionnaire ◽  
Productivity Cost ◽  
Nerve Decompression

IntroductionThe peripheral nerves of patients with diabetes are often pathologically swollen, which results in entrapment at places of anatomical narrowing. This results in nerve dysfunction. Surgical treatment of compression neuropathies in the lower extremities (lower extremity nerve decompression (LEND)) results in relief of symptoms and gain in peripheral nerve function, which may lead to less sensory loss (short term) and less associated detrimental effects including foot ulceration and amputations, and lower costs (long term). The aim of the DeCompression trial is to evaluate the effectiveness and (cost-)effectiveness of surgical decompression of compressed lower extremity nerves (LEND surgery) compared with patients treated with conventional (non-surgical) care.Methods and analysisA stratified randomised (1 to 1) controlled trial comparing LEND surgery (intervention) with conventional non-surgical care (control strategy) in subjects with diabetes with problems of neuropathy due to compression neuropathies in the lower extremity. Randomisation is stratified for participating hospital (n=11) and gender. Patients and controls have the same follow-up at 1.5, 3, 6, 9, 12, 18, 24 and 48 months. Participants (n=344) will be recruited in 12 months and enrolled in all affiliated hospitals in which they receive both the intervention or conventional non-surgical care and follow-up. Outcome assessors are blinded to group assignment. Primary outcome: disease-specific quality of life (Norfolk Quality of Life Questionnaire—Diabetic Neuropathy). Secondary outcomes: health-related quality of life (EuroQoL 5-dimension 5-level (EQ-5D5L), 36-item Short Form (SF-36)), plantar sensation (Rotterdam Diabetic Foot Test Battery), incidence of ulcerations/amputations, resource use and productivity loss (Medical Cost Questionnaire, Productivity Cost Questionnaire) during follow-up. The incremental cost-effectiveness ratio will be estimated on the basis of the collected empirical data and a cost-utility model.Ethics and disseminationEthics approval has been granted by the Medical Research Ethics Committee of Utrecht University Medical Center (reference: NL68312.041.19v5, protocol number: 19-335/M). Dissemination of results will be via journal articles and presentations at national and international conferences.Trial registration numberNetherlandsTrial Registry NL7664.

scholarly journals THE EFFECTS OF THE NAMASTE CARE FAMILY PROGRAM ON QUALITY OF LIFE OF PEOPLE WITH ADVANCED DEMENTIA

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S824-S824
Author(s):  
Jenny T van der Steen ◽  
Karlijn J Joling ◽  
Anneke L Francke ◽  
Wilco P Achterberg ◽  
Hanneke J A Smaling
Keyword(s):  
Quality Of Life ◽  
Nursing Homes ◽  
Family Caregivers ◽  
Family Caregiver ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Advanced Dementia ◽  
Family Program ◽  
Care Family

Abstract People with advanced dementia often die in nursing homes. Family caregivers frequently feel that their loved one’s quality of life and dying is suboptimal. The daily Namaste Care Family program -derived from the US Namaste Care program- involves family caregivers and integrates personalized care with meaningful activities for people with advanced dementia. A cluster-randomized controlled trial (December 2016 - December 2018) examined effects of the Namaste Care Family program on resident and family caregiver outcomes. Ten Dutch nursing homes implemented Namaste Care Family for 117 residents, while nine nursing homes provided usual care for 114 residents in the study. Nursing staff assessed quality of life over the last week with the Quality of Life in Late-Stage Dementia (QUALID, the primary resident outcome measure). Research assistants observed discomfort during the sessions with the Discomfort Scale-Dementia of Alzheimer Type (DS-DAT). Assessments were at baseline and after 1, 3, 6, and 12 months. We found a significant difference in QUALID score at 12 months favoring quality of life in the intervention group. Further, the intervention group showed less signs of discomfort at 3, 6, and 12 months compared with the control group. The Namaste Care Family program can improve quality of life of people with advanced dementia in the long run. These study findings support sustained implementation of the daily program in nursing homes. Further analyses of effects on the other outcomes will include blinded DS-DAT assessments, more secondary outcome measures and family caregiver outcomes.

scholarly journals Preventive Efficacy and Safety of Yiqi-Wenjing-Fang Granules on Oxaliplatin-Induced Peripheral Neuropathy: A Protocol for a Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Zhancheng Gu ◽  
Guoli Wei ◽  
Liangjun Zhu ◽  
Lingjun Zhu ◽  
Jing Hu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Peripheral Neuropathy ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Group I ◽  
Preventive Efficacy

Background. Oxaliplatin-induced peripheral neuropathy (OIPN) is one of the most common side effects of oxaliplatin, which can cause reduction and cessation of oxaliplatin-based chemotherapy and significantly affect patients’ quality of life. However, no drug has got recognition to prevent or treat OIPN. Yiqi-Wenjing-Fang (YWF) is a joint name of Chinese medicine prescriptions with similar effects of tonifying qi and warming meridians, represented by Huangqi Guizhi Wuwu decoction (HGWD) and Danggui Sini decoction (DSD), both from “Treatise on Cold Pathogenic and Miscellaneous Diseases.” YWF granules, including HGWD granules and DSD granules, have been, respectively, demonstrated to be effective in preventing OIPN in previous small-sample observations. The purpose of this study is to enlarge the sample size for further evaluation of the preventive efficacy and safety of YWF granules on OIPN. Methods and Analysis. This study is a randomized, double-blind, placebo-controlled, and multicenter clinical trial. 360 postoperative patients with stage IIa-IIIc colorectal cancer will be randomly assigned into placebo-control group, intervention group I, and intervention group II, taking the mimetic granules of YWF as placebo, HGWD granules and DSD granules, respectively. All subjects will receive oxaliplatin-based chemotherapy regimen at the same time. EORTC QLQ-CIPN20 will be used to assess the degree of OIPN as the primary outcome measure. The grades of OIPN, quality of life, chemotherapeutic efficacy, and the number of completed chemotherapy cycles are selected as the secondary outcome measures. Discussion. Based on the condition of no recognized effective drugs in preventing OIPN, evidence-based medical study will be conducted for seeking a breakthrough in the field of Chinese herb medicine. This protocol could provide reliable and systemic research basis about the efficacy of YWF granules and the differentiation of two classical prescriptions of YWF on preventing OIPN objectively. Trial Registration. This study was registered at ClinicalTrials.gov on 26 December 2020 (ID: https://clinicaltrials.gov/ct2/show/NCT04690283).

scholarly journals Decreased costs and retained QoL due to the ‘PACE Steps to Success’ intervention in LTCFs: cost-effectiveness analysis of a randomized controlled trial

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Anne B. Wichmann ◽  
◽  
Eddy M. M. Adang ◽  
Kris C. P. Vissers ◽  
Katarzyna Szczerbińska ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cost Effectiveness ◽  
Intervention Group ◽  
Cost Savings ◽  
Daily Routine ◽  
Significant Cost ◽  
Term Care ◽  
Care Programme ◽  
The Cost

Abstract Background The number of residents in long-term care facilities (LTCFs) in need of palliative care is growing in the Western world. Therefore, it is foreseen that significantly higher percentages of budgets will be spent on palliative care. However, cost-effectiveness analyses of palliative care interventions in these settings are lacking. Therefore, the objective of this paper was to assess the cost-effectiveness of the ‘PACE Steps to Success’ intervention. PACE (Palliative Care for Older People) is a 1-year palliative care programme aiming at integrating general palliative care into day-to-day routines in LTCFs, throughout seven EU countries. Methods A cluster RCT was conducted. LTCFs were randomly assigned to intervention or usual care. LTCFs reported deaths of residents, about whom questionnaires were filled in retrospectively about resource use and quality of the last month of life. A health care perspective was adopted. Direct medical costs, QALYs based on the EQ-5D-5L and costs per quality increase measured with the QOD-LTC were outcome measures. Results Although outcomes on the EQ-5D-5L remained the same, a significant increase on the QOD-LTC (3.19 points, p value 0.00) and significant cost-savings were achieved in the intervention group (€983.28, p value 0.020). The cost reduction mainly resulted from decreased hospitalization-related costs (€919.51, p value 0.018). Conclusions Costs decreased and QoL was retained due to the PACE Steps to Success intervention. Significant cost savings and improvement in quality of end of life (care) as measured with the QOD-LTC were achieved. A clinically relevant difference of almost 3 nights shorter hospitalizations in favour of the intervention group was found. This indicates that timely palliative care in the LTCF setting can prevent lengthy hospitalizations while retaining QoL. In line with earlier findings, we conclude that integrating general palliative care into daily routine in LTCFs can be cost-effective. Trial registration ISRCTN14741671.

scholarly journals Cost-effectiveness of an early intervention service for people with psychosis

2010 ◽  
Vol 196 (5) ◽  
pp. 377-382 ◽  
Author(s):  
Paul McCrone ◽  
Tom K. J. Craig ◽  
Paddy Power ◽  
Philippa A. Garety
Keyword(s):  
Quality Of Life ◽  
Early Intervention ◽  
Cost Effectiveness ◽  
Standard Care ◽  
Intervention Group ◽  
Cost Effective ◽  
Care Group ◽  
Early Intervention Service ◽  
Intervention Service

BackgroundThere is concern that delaying treatment for psychosis may have a negative impact on its long-term course. A number of countries have developed early intervention teams but there is limited evidence regarding their cost-effectiveness.AimsTo compare the costs and cost-effectiveness of an early intervention service in London with standard care.MethodIndividuals in their first episode of psychosis (or those who had previously discontinued treatment) were recruited to the study. Clinical variables and costs were measured at baseline and then at 6- and 18-month follow-up. Information on quality of life and vocational outcomes were combined with costs to assess cost-effectiveness.ResultsA total of 144 people were randomised. Total mean costs were £11 685 in the early intervention group and £14 062 in the standard care group, with the difference not being significant (95% CI –£8128 to £3326). When costs were combined with improved vocational and quality of life outcomes it was shown that early intervention would have a very high likelihood of being cost-effective.ConclusionsEarly intervention did not increase costs and was highly likely to be cost-effective when compared with standard care.

scholarly journals DAMPAK IMPLEMENTASI MODEL PRAKTIK KEPERAWATAN PROFESIONAL TERHADAP MUTU ASUHAN KEPERAWATAN DI RUMAH SAKIT

2014 ◽  
Vol 7 (2) ◽  
pp. 41-47
Author(s):  
Ratna Sitorus
Keyword(s):  
Nursing Care ◽  
Care Delivery ◽  
Intervention Group ◽  
Family Satisfaction ◽  
Control Group ◽  
Chi Square ◽  
Post Test ◽  
The Impact ◽  
Quality Of Nursing

AbstrakPeningkatkan mutu asuhan keperawatan di rumah sakit memerlukan restructuring, reengineering, dan redesigning sistem pemberian asuhan keperawatan melalui implementasi Model Praktik Keperawatan Profesional (MPKP). Tujuan penelitian ini ialah untuk menilai dampak implementasi MPKP terhadap mutu asuhan keperawatan di rumah sakit. Disain penelitian adalah kuasi eksperimen dalam bentuk pre and post test with control group. Uji statistik yang digunakan adalah uji Chi-square dan uji t. Hasil penelitian menunjukkan bahwa pada kelompok intervensi (MPKP) terdapat peningkatan kepuasan klien dan keluarga (OR=114,24) yang lebih besar dibandingkan dengan peningkatan kepuasan klien dan keluarga pada kelompok kontrol (OR=3,78). Demikian juga terdapat peningkatan kepatuhan perawat terhadap standar yang lebih tinggi pada kelompok intervensi (OR=235,5) dibandingkan dengan kelompok kontrol (OR=0). Lama hari rawat lebih pendek pada kelompok intervensi. Angka infeksi nosokomial juga lebih rendah pada kelompok intervensi dibandingkan dengan kelompok kontrol. Penelitian ini menyimpulkan bahwa implementasi MPKP dapat meningkatkan mutu asuhan keperawatan di rumah sakit. Berdasarkan hasil tersebut, untuk memicu implementasi MPKP di berbagai rumah sakit, disarankan agar implementasi MPKP menjadi salah satu kriteria penilaian pada akreditasi rumah sakit khususnya pelayanan keperawatan AbstractIn order to improve the quality of nursing care in the hospital, nursing care delivery system need restructuring, reengineering, and redesigning through the implementation of Professional Nursing Practice Model (PNPM). The study was aimed to evaluate the impact of the PNPM on the quality of nursing care in the hospital. The design used was quasi experiment in pre and post test with control group. The statistic used are Chi-square and t-test. The result showed that in the intervention group, the improvement of client/family satisfaction with nursing care (OR = 114,28) was higher than the improvement in the control group (OR = 3,78). It was founded there was an improvement of the compliance of nurses to the standard was higher in the intervention group (OR = 235,5) compare to control group (OR = 0). The length of stay shorter in the intervention group, and also the nosocomial infection rate is lower in the intervention group compare to control group. The study concluded that the implementation of the PNPM could improve the quality of nursing care in the hospital. Based on this result, in order to challenge the implementation of PNPM in the hospital it was suggested that the implementation of PNPM becomes an evaluation criteria for hospital accreditation specifically for nursing service.

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