scholarly journals 920 Long Term Outcomes After Resection of A 'Normal' Appendix

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F Hammett ◽  
S Ali ◽  
R Adair ◽  
M Peter ◽  
B Dobbins ◽  
...  
Keyword(s):  
Cost Effective ◽  
Normal Appendix ◽  
Suspected Appendicitis ◽  
Operative Outcomes ◽  
Primary Surgery ◽  
Cost Effective Method ◽  
Negative Appendicectomy ◽  
The Cost

Abstract Introduction Recent studies have suggested that there should be diagnostic confirmation of appendicitis prior to surgical resection to reduce the rate of negative (normal) appendicectomy. There are few long-term analyses of morbidity after negative appendicectomy. Method All appendicectomy specimens removed for suspected appendicitis from June 2010 to August 2015 at a single-centre surgical unit were identified. Patients with a histologically 'normal' appendix were analysed. Demographics, pre-operative and operative details and post-operative outcomes (Clavien-Dindo system) were recorded. Minimum follow-up was 5 years. Results There were 1977 patients. Most (1938 patients, 98%) had a laparoscopic procedure. There were 241 normal specimens (12.1%); none of these patients had pre-operative CT imaging. Thirty-two patients had at least one re-admission in the 5 years after surgery; 12 of these patients had multiple re-admissions (range, 2-5 re-admissions). 22 patients (69%) had a re-admission within 30 days after primary surgery. 4 patients (<1%) required further surgery and mortality was 0%. 6 patients (2%) had a Grade III complication, and none had a Grade IV complication. Conclusions There was low long-term morbidity after negative appendicectomy in this study. The cost of confirming a normal diagnosis by way of mandatory pre-operative CT does not represent a cost-effective method of management.

Pressure ulcer patients in long-term care. A follow-up study

2004 ◽  
Vol 14 (2) ◽  
pp. 91-103
Author(s):  
Mervi Lepistö ◽  
Sirkka Lauri ◽  
Elina Eriksson ◽  
Tero Vahlberg
Keyword(s):  
Long Term Care ◽  
Cost Effective ◽  
Nursing Workload ◽  
Main Diagnosis ◽  
Term Care ◽  
Bed Days ◽  
Type Of Institution ◽  
The Cost

Pressure ulcers (PU) may cause intolerable suffering to the patient. Not only do they affect patients but they also increase nursing workload. In Finnish studies, PU prevalence was 5.4–22% depending on the type of institution caring for the patient. The same level of prevalence is reported from other European countries. In 2000, it was reported that PUs, as the main diagnosis, were responsible for over 20000 bed days in Finnish long-term care hospitals, at a cost of approximately 3 million EUROs a year. In England, it was estimated that a 600-bed general hospital spends 600000 to 3 million GB£/year to care for PUs. Some US statistics estimate that nearly 2 million American patients acquire a PU during the course of their care, and the cost to treat one wound is from 2000 US$ to 70000 US$. Prevention is therefore not only beneficial for the patient but obviously cost-effective for the health care system.

scholarly journals Endodontic management of incisors with horizontal root fractures using H-file as endodontic implant – Two Case Reports.

2020 ◽  
Author(s):  
Vandana Kokane ◽  
Snehal Sonarkar ◽  
Mohit Gunwal ◽  
Noopur Kokane
Keyword(s):  
Simple Procedure ◽  
Case Reports ◽  
Cost Effective ◽  
Young Female ◽  
Accidental Injury ◽  
Cost Effective Method ◽  
Root Fractures ◽  
Long Term Prognosis

Accidental injury to anterior region with fractured and mobile teeth can be an awful experience to young female patient. Treating such patient requires knowledge judgment and skill of the operator. In the present case report multiple horizontal root fracture in cervical third region with mobile undetached crown was successfully stabilized by a very simple procedure using hedstrome endodontic file as an endodontic implant. In a two year follow-up period the tooth was completely asymptomatic clinically as well as radiographically. Immobilization of fractured root by endodontic instrument with MTA considered to be a simple ,reliable and cost effective method to save a tooth that would have been difficult to restore with good long term prognosis. Key-words: Incisors, Horizontal Root Fractures, H File

CAD Of Anticorrosive Protection Of Steel Structures

2019 ◽  
pp. 18-23
Keyword(s):  
Protective Coating ◽  
Computer Aided Design ◽  
Steel Structures ◽  
Cost Effective ◽  
Operating Conditions ◽  
Computational Tool ◽  
Protection Method ◽  
Cost Effective Method ◽  
The Cost ◽  
Aided Design

The choice of cost-effective method of anticorrosive protection of steel structures is an urgent and time consuming task, considering the significant number of protection ways, differing from each other in the complex of technological, physical, chemical and economic characteristics. To reduce the complexity of solving this problem, the author proposes a computational tool that can be considered as a subsystem of computer-aided design and used at the stage of variant and detailed design of steel structures. As a criterion of the effectiveness of the anti-corrosion protection method, the cost of the protective coating during the service life is accepted. The analysis of existing methods of steel protection against corrosion is performed, the possibility of their use for the protection of the most common steel structures is established, as well as the estimated period of effective operation of the coating. The developed computational tool makes it possible to choose the best method of protection of steel structures against corrosion, taking into account the operating conditions of the protected structure and the possibility of using a protective coating.

Extended Routine Follow-up of Primary Uncomplicated Hip and Knee Arthroplasty is not Necessary

2019 ◽  
Vol 13 (1) ◽  
pp. 266-271
Author(s):  
Georgina Kakra Wartemberg ◽  
Thomas Goff ◽  
Simon Jones ◽  
James Newman
Keyword(s):  
Aseptic Loosening ◽  
Revision Surgery ◽  
Revision Arthroplasty ◽  
Cost Effective ◽  
Face To Face ◽  
Primary Surgery ◽  
Effective System ◽  
Knee Revision Surgery ◽  
Knee Revision

Aims: To create a more effective system to identify patients in need of revision surgery. Background: There are over 160,000 total hip and knee replacements performed per year in England and Wales. Currently, most trusts review patients for up to 10 years or more. When we consider the cost of prolonged reviews, we cannot justify the expenditure within a limited budget. Study Design & Methods: We reviewed all patients' notes that underwent primary hip and knee revision surgery at our institution, noting age, gender, symptoms at presentation, referral source, details of the surgery, reason for revision and follow up history from primary surgery. Results: There were 145 revision arthroplasties (60 THR and 85 TKR) that met our inclusion criteria. Within the hip arthroplasty group, indications for revision included aseptic loosening (37), dislocation (10), and infection (3), periprosthetic fracture, acetabular liner wear and implant failure. All thirty-seven patients with aseptic loosening presented with pain. Twenty-five were referred from general practice with new symptoms. The remaining were clinic follow-ups. The most common reason for knee revision was aseptic loosening (37), followed by infection (21) and then progressive osteoarthritis (8). Most were referred from GP as a new referral or were clinic follow-ups. All patients were symptomatic. Conclusion: All the patients that underwent revision arthroplasty were symptomatic. Rather than yearly follow up, we recommend a cost-effective system. We are implementing a 'non face-to-face' system. Patients would be directly sent a questionnaire and x-ray form. The radiographs and forms will be reviewed by an experienced arthroplasty surgeon. The concerning cases will be seen urgently in a face-to-face clinic.

Is Acupuncture for Pain Relief in General Practice Cost-Effective?

1999 ◽  
Vol 17 (2) ◽  
pp. 97-100 ◽  
Author(s):  
Steven Lindall
Keyword(s):  
General Practice ◽  
Pain Relief ◽  
Acupuncture Treatment ◽  
Cost Effective ◽  
Total Saving ◽  
Hospital Outpatient ◽  
The Cost ◽  
Lost To Follow Up ◽  
Practice Cost

Sixty-five selected patients with pain, mainly of musculo-skeletal origin, were offered treatment by a qualified medical acupuncturist in his general practice surgery as an alternative to hospital outpatient referral. The patients assessed their own outcomes on a digital scale: there were 46 successful treatments and 14 failures, with 5 being lost to follow up. The cost of acupuncture treatment was compared to that of the referral that would have been made if acupuncture had not been offered. The acupuncture was found to have cost £10,943 against a minimum likely cost for hospital referrals of £26,783. A minimum total saving for all 60 patients of £13,916 was determined, giving an average saving per patient of £232. Additional hidden savings through avoiding further hospital procedures and expenditure on medication were not taken into account. It is concluded that acupuncture in selected patients and when used by an appropriately qualified practitioner appears to be a cost-effective therapy for use in general practice, reducing the need for more expensive hospital referrals.

Repair of Protruding Bilateral Cleft Lip and Palate With Staged Premaxilla Setback Osteotomy, Cheiloplasty, and Palatoplasty in Trisomy 17p Patient: A Review of Syndromic Clinical Characteristic

2021 ◽  
pp. 105566562110698
Author(s):  
Kristaninta Bangun ◽  
Jessica Halim ◽  
Vika Tania
Keyword(s):  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Surgical Techniques ◽  
Chromosome 17 ◽  
Long Term Effects ◽  
Surgical Strategies ◽  
Increased Risk ◽  
The Cost

Chromosome 17 duplication is correlated with an increased risk of developmental delay, birth defects, and intellectual disability. Here, we reported a female patient with trisomy 17 on the whole short arm with bilateral complete cleft lip and palate (BCLP). This study will review the surgical strategies to reconstruct the protruding premaxillary segment, cleft lip, and palate in trisomy 17p patient. The patient had heterozygous pathogenic duplication of chromosomal region chr17:526-18777088 on almost the entire short arm of chromosome 17. Beside the commonly found features of trisomy 17p, the patient also presented with BCLP with a prominent premaxillary portion. Premaxillary setback surgery was first performed concomitantly with cheiloplasty. The ostectomy was performed posterior to the vomero-premaxillary suture (VPS). The premaxilla was firmly adhered to the lateral segment and the viability of philtral flap was not compromised. Two-flap palatoplasty with modified intravelar veloplasty (IVV) was performed 4 months after. Successful positioning of the premaxilla segment, satisfactory lip aesthetics, and vital palatal flap was obtained from premaxillary setback, primary cheiloplasty, and subsequent palatoplasty in our trisomy 17p patient presenting with BLCP. Postoperative premaxillary stability and patency of the philtral and palatal flap were achieved. Longer follow-up is needed to evaluate the long-term effects of our surgical techniques on inhibition of midfacial growth. However, the benefits that the patient received from the surgery in improving feeding capacity and facial appearance early in life outweigh the cost of possible maxillary retrusion.

The Cost-Effectiveness of an RCT to Establish Whether 5 or 10 Years of Bisphosphonate Treatment Is the Better Duration for Women With a Prior Fracture

2009 ◽  
Vol 29 (6) ◽  
pp. 678-689 ◽  
Author(s):  
Matt D. Stevenson ◽  
Jeremy E. Oakley ◽  
Myfawny Lloyd Jones ◽  
Alan Brennan ◽  
Juliet E. Compston ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Fracture Prevention ◽  
Published Data ◽  
Bisphosphonate Treatment ◽  
Net Benefit ◽  
England And Wales ◽  
Term Efficacy ◽  
The Cost

Purpose. Five years of bisphosphonate treatment have proven efficacy in reducing fractures. Concerns exist that long-term bisphosphonate treatment may actually result in an increased number of fractures. This study evaluates, in the context of England and Wales, whether it is cost-effective to conduct a randomized controlled trial (RCT) and what sample size may be optimal to estimate the efficacy of bisphosphonates in fracture prevention beyond 5 years. Method. An osteoporosis model was constructed to evaluate the cost-effectiveness of extending bisphosphonate treatment from 5 years to 10 years. Two scenarios were run. The 1st uses long-term efficacy data from published literature, and the 2nd uses distributions elicited from clinical experts. Results of a proposed RCT were simulated. The expected value of sample information technique was applied to calculate the expected net benefit of sampling from conducting such an RCT at varying levels of participants per arm and to compare this with proposed trial costs. Results. Without further information, the better duration of bisphosphonate treatment was estimated to be 5 years using the published data but 10 years using the elicited expert opinions, although in both cases uncertainty was substantial. The net benefit of sampling was consistently high when between 2000 and 5000 participants per arm were recruited. Conclusions. An RCT to evaluate the long-term efficacy of bisphosphonates in fracture prevention appears to be cost-effective for informing decision making in England and Wales.

Method of Fuels and Lubricants Performance Properties Requirements Management

2021 ◽  
Vol 624 (2) ◽  
pp. 16-24
Author(s):  
Yu. M. Pimenov ◽  
◽  
A. V. Ulit’ko ◽  
V. A. Sereda ◽  
◽  
...  
Keyword(s):  
Cost Effective ◽  
Life Cycles ◽  
Requirements Management ◽  
Performance Properties ◽  
Operational Conditions ◽  
Quantitative Expression ◽  
Laboratory Bench ◽  
Motor Fuels ◽  
Cost Effective Method ◽  
The Cost

The cost-effective method of fuels and lubricants performance properties requirements management is proposed. Method ensures effectiveness enhancement of equipment and of fuels and lubricants life cycles; it includes requirements establishment (constructing of conceptual and empirical models of requirements), their quantitative expression through highly informative indicators of fuels and lubricants propensity for transformations, then approbation with the use of laboratory, bench and test stands tests, specification, assessment of realization in real world equipment operational conditions, effectiveness evaluation and modification of requirements. Some illustrations of application of the new method phases with regards to motor fuels and hydraulic fluid are provided.

Abstract 21: Telemedicine And The Barbershop Model Of Hypertension Care For Black Men

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Ciantel A Blyler ◽  
Mohamad Rashid ◽  
Norma B Moy ◽  
Kayslee A Kemp ◽  
Florian Rader
Keyword(s):  
Blood Pressure ◽  
Los Angeles ◽  
Black Men ◽  
Medication Management ◽  
Cost Effective ◽  
Serious Adverse Events ◽  
Blood Pressure Study ◽  
Collaborative Practice Agreement ◽  
The Cost

Background: The Los Angeles Barbershop Blood Pressure Study (LABBPS) demonstrated both efficacy and sustainability of a new model of hypertension (HTN) care for non-Hispanic black men that links health promotion by barbers to medication management by specialty-trained pharmacists. Barriers to scaling the model include logistical inefficiencies that contribute to the cost of the intervention. Most notable was the amount of time pharmacists spent traveling between barbershops. To address this, we tested whether telemedicine (remote follow-up) could be substituted for in-person visits after blood pressure (BP) control was achieved. Methods: We enrolled 10 black male patrons with systolic BP ≥ 140 mm Hg in this proof-of-concept study in which barbers promoted follow-up with pharmacists who initially met each patron in the barbershop where they prescribed BP medication under a collaborative practice agreement with the patrons’ physician. Medications were titrated during bimonthly in-person visits to achieve a BP goal of ≤130/80 mmHg. Once BP goal was reached, monthly visits were done by videoconference while barbers assisted with BP checks. Final BP and safety outcomes were assessed at 12 months. Results: After exclusion of one participant who declined adherence, 9 patients completed the intervention. Baseline BP of 155 + 14 / 83 + 11 mmHg decreased by 29 + 13 / 8.9 + 15 mmHg (p<.0001), with eight participants (89%) achieving systolic control and seven (78%) diastolic control at 12 months. These new data are statistically indistinguishable from our previous LABBPS data (p=0.8 for both change in systolic BP and diastolic BP). Overall HTN control (≤ 130/80) was 67% (6 of 9), numerically greater than the 63% observed in LABBPS (p=N.S.). As intended, the mean number of in-person pharmacist visits per patron fell from 11 in LABBPS to 6.6 visits over 12 months. No treatment-related serious adverse events occurred. Cohort retention was 90%. Conclusions: Telemedicine represents a viable substitute for in-person visits, both improving pharmacist efficiency and reducing cost while preserving intervention potency. These findings are crucial for future broad-scale implementation efforts and development of cost-effective barbershop HTN management programs for black men.

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