scholarly journals TP8.2.28 Can surgical advanced care practitioners provide a cost effective local anaesthetic minor procedures service? Results from a 5-year retrospective study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adnan Taib ◽  
Christa Hammill ◽  
Aleyamma Abraham ◽  
Paula Garstang ◽  
Bilal Fakim ◽  
...  
Keyword(s):  
Local Anaesthetic ◽  
Operating Time ◽  
Cost Effective ◽  
Financial Benefit ◽  
Consultant Surgeon ◽  
Staffing Levels ◽  
Surgical Workforce ◽  
Lesion Type ◽  
A Minor ◽  
The Cost

Abstract Aims Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists. Methods This was a retrospective cohort study including all patients who had a minor ‘lumps and bumps’ procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected. The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding. Results A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n = 907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (£21.72) more on average than those on SACP lists (£56.55 vs £34.83 median respectively, p < 0.001) due to excess staff for these cases. Conclusion A dedicated and independent SACP ‘lumps and bumps’ list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.

scholarly journals Thyroidectomy under Local Anaesthesia; Experience from a Tertiary Hospital in Kumasi, Ghana

2020 ◽  
Vol 2 (2) ◽  
pp. 01-07
Author(s):  
Anna Konney ◽  
Mawutor Dzogbefia ◽  
Philip Oppong Peprah ◽  
Derrick Gyimah ◽  
Isaac Barnor
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Operating Time ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Tertiary Referral Hospital ◽  
Thyroid Lobectomy ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
The Cost

Objectives: Improvement in anaesthesia has allowed thyroidectomies to be performed mainly under general anaesthesia. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia. The objective of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia in a tertiary referral hospital in Ghana. Materials and Methods: A retrospective study was conducted on all patients who had thyroidectomy under local anaesthesia from 1st January 2017 to 31st May 2018 in KATH. Data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness of the procedure. Data was analysed using Stata version 16.0software. Results: A total of 105 thyroidectomies were done in the study period out of which 16 were done under local anaesthesia. All 16 patients (16 females, 100%) and majority 11 (68.75%) were aged between 30 and 50 years. 11 (68.75) had grade IB goitres. The most frequently performed surgery was thyroid lobectomy 12 (75%) and in 75% of cases the surgery was completed between 60 and 90 minutes. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. The cost of treatment was averagely 30% less compared to same surgery under general anaesthesia. No complications were recorded in the post-operative period. Conclusions: Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia result in good surgical outcomes. The procedure is safe and cost-effective and should be performed by experienced surgeons for the best outcomes.

scholarly journals Intraoperative Margin Assessment by Frozen Section Enables Cost-Effective, Safe, One-Step Breast Conservation

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 2s-2s ◽  
Author(s):  
Gaurav Agarwal ◽  
S. Chaitra ◽  
M. Sabaretnam ◽  
Anjali Mishra ◽  
Vinita Agrawal ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Frozen Section ◽  
False Negative ◽  
Operating Time ◽  
Breast Conservation ◽  
Cost Effective ◽  
Single Stage ◽  
Margin Assessment ◽  
One Step ◽  
The Cost

Purpose Acceptance of breast conservation surgery (BCS) is low among Indian women, as many perceive mastectomy to be a superior cost-effective surgical option. Obtaining uninfiltrated margins is vital during BCS. The need for reoperation to re-excise infiltrated surgical margins adds to the cost of treatment, which further reduces the acceptability of BCS. Intraoperative frozen-section (FS) histology assessment of margins provides an opportunity to carry out a single-stage, safe BCS; however, the utility of FS margin assessment remains unproven because of its perceived low accuracy, added costs, and longer operating time. In this retrospective analysis, we studied the accuracy of FS for margin assessment, its ability to help avoid reoperations, and the cost effectiveness of one-step BCS using FS compared with margin assessment using postoperative paraffin section (PS) histopathology. Methods Patients who underwent BCS during 2011 to 2015 with a minimum 1-year follow-up were included. All patients underwent intraoperative FS and postoperative PS margin assessment. All infiltrated margins were re-excised. Repeatedly infiltrated re-excised margins or extensive ductal carcinoma in situ necessitated mastectomy in few patients. We evaluated the accuracy of FS in the detection of margin infiltration, thereby allowing single-stage, safe BCS. The cost effectiveness of two strategies for the management of infiltrated margins, namely intraoperative FS and single-stage margin excision/mastectomy and postoperative PS and reoperation (two-step) surgery, were compared. The cost per saved reoperation with the use of intraoperative FS was calculated using actual hospital costs and various—lower and higher—cost assumptions. Results On the basis of intraoperative FS margin assessment, 18 (12.5%) of 144 patients required margin(s) re-excision and another nine patients (6.2%) needed mastectomy. Twenty-six patients (18%) were thus spared reoperation with the use of FS. Two patients (1.4%) with uninfiltrated margins on FS—false-negative FS—needed reoperation for infiltrated margins that were detected on PS. Considering the costs (144 FS and two reoperations) and savings (26 avoided reoperations), use of FS was 1.15 times more cost effective than PS for achieving uninfiltrated margins. Cost incurred per saved reoperation by FS was INR 5,438 (approximately $81 USD). Sensitivity analysis using various cost assumptions revealed similar results. Conclusion Use of FS can facilitate single-step, oncologically safe BCS by avoiding reoperation in those patients with infiltrated margins and is cost effective compared with postoperative margin assessment using PS alone. FS can thus help in improving the acceptability of BCS, even in those patients with relatively large tumors for whom the possible need and cost of reoperation are major deterrents against BCS. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.

Cost-effectiveness of Misoprostol in Sweden

1992 ◽  
Vol 8 (02) ◽  
pp. 234-244 ◽  
Author(s):  
Bengt Jönsson ◽  
Ulf Haglund
Keyword(s):  
Abdominal Pain ◽  
Cost Effectiveness ◽  
Indirect Costs ◽  
Cost Effective ◽  
Care Hospital ◽  
Osteoarthritis Patient ◽  
High Age ◽  
A Minor ◽  
The Cost ◽  
Minor Extent

AbstractBased on an American multicenter study, an economic evaluation of prophylactic misoprostol was undertaken in Sweden. The study included 420 patients with osteoarthritis and nonsteroidal anti-inflammatory drug (NSAID)-associated abdominal pain, but no gastric ulcer at inclusion. The frequency of ulcer development with and without prophylactic misoprostol was assessed at 21.7% and 5.6%, respectively, for a 3-month period. All costs for drugs, ambulatory care, hospital care, loss of production, as well as other factors such as dosage and compliance, were transferred to Swedish conditions. It was concluded that in patients with osteoarthritis and NSAID-induced abdominal pain, prophylaxis with misoprostol is cost-effective in Sweden, which is similar to what is found for other countries. A prerequisite for this result is a frequency of ulcer development of 15%. A patient compliance to prophylactic treatment of more than 60% is also presupposed (79% was observed in the above study). Due to the high age of the osteoarthritis patient population, the cost-effectiveness is influenced to only a minor extent by whether indirect costs are included in the calculation.

scholarly journals Thyroidectomy under Local Anaesthesia; Experience from a Tertiary Hospital in Kumasi, Ghana

2020 ◽  
Vol 2 (2) ◽  
pp. 1-09
Author(s):  
Anna Konney
Keyword(s):  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Operating Time ◽  
Cost Effective ◽  
Tertiary Hospital ◽  
Tertiary Referral Hospital ◽  
Thyroid Lobectomy ◽  
Cervical Plexus Block ◽  
Plexus Block ◽  
The Cost

Objectives: Improvement in anaesthesia has allowed thyroidectomies to be performed mainly under general anaesthesia. There is however a growing interest in performing thyroid surgery under local or regional anaesthesia. The objective of this study was to analyse and share our experience with safety of thyroidectomy under regional cervical plexus block/ local anaesthesia in a tertiary referral hospital in Ghana. Materials and Methods: A retrospective study was conducted on all patients who had thyroidectomy under local anaesthesia from 1st January 2017 to 31st May 2018 in KATH. Data collected were demography, grade of goitre, operating time, and duration of hospital stay, complications and cost effectiveness of the procedure. Data was analysed using Stata version 16.0software. Results: A total of 105 thyroidectomies were done in the study period out of which 16 were done under local anaesthesia. All 16 patients (16 females, 100%) and majority 11 (68.75%) were aged between 30 and 50 years. 11 (68.75) had grade IB goitres. The most frequently performed surgery was thyroid lobectomy 12 (75%) and in 75% of cases the surgery was completed between 60 and 90 minutes. Most patients, 9 (56.25%) were discharged home within 48 hours following surgery. The cost of treatment was averagely 30% less compared to same surgery under general anaesthesia. No complications were recorded in the post-operative period. Conclusions: Comprehensive clinical assessment and careful patient selection for thyroidectomy under local anaesthesia result in good surgical outcomes. The procedure is safe and cost-effective and should be performed by experienced surgeons for the best outcomes.

The IBM-PC in electron microscopy

1996 ◽  
Vol 54 ◽  
pp. 612-613
Author(s):  
James F. Mancuso
Keyword(s):  
Head Start ◽  
Image Acquisition ◽  
Cost Effective ◽  
Financial Applications ◽  
Number Of Factors ◽  
Instrument Control ◽  
The Cost ◽  
Training And Support ◽  
Control Image ◽  
Ibm Pc

IBM PC compatible computers are widely used in microscopy for applications ranging from control to image acquisition and analysis. The choice of IBM-PC based systems over competing computer platforms can be based on technical merit alone or on a number of factors relating to economics, availability of peripherals, management dictum, or simple personal preference.IBM-PC got a strong “head start” by first dominating clerical, document processing and financial applications. The use of these computers spilled into the laboratory where the DOS based IBM-PC replaced mini-computers. Compared to minicomputer, the PC provided a more for cost-effective platform for applications in numerical analysis, engineering and design, instrument control, image acquisition and image processing. In addition, the sitewide use of a common PC platform could reduce the cost of training and support services relative to cases where many different computer platforms were used. This could be especially true for the microscopists who must use computers in both the laboratory and the office.

Sonographically guided, transcatheter foam sclerotherapy of the great saphenous vein

Phlebologie ◽  
2007 ◽  
Vol 36 (06) ◽  
pp. 309-312 ◽  
Author(s):  
T. Schulz ◽  
M. Jünger ◽  
M. Hahn
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Clinical Stage ◽  
Clinical Signs ◽  
Cost Effective ◽  
Duplex Sonography ◽  
Foam Sclerotherapy ◽  
Average Loss ◽  
One Year ◽  
The Cost

Summary Objective: The goal of the study was to assess the effectiveness and patient tolerability of single-session, sonographically guided, transcatheter foam sclerotherapy and to evaluate its economic impact. Patients, methods: We treated 20 patients with a total of 22 varicoses of the great saphenous vein (GSV) in Hach stage III-IV, clinical stage C2-C5 and a mean GSV diameter of 9 mm (range: 7 to 13 mm). We used 10 ml 3% Aethoxysklerol®. Additional varicoses of the auxiliary veins of the GSV were sclerosed immediately afterwards. Results: The occlusion rate in the treated GSVs was 100% one week after therapy as demonstrated with duplex sonography. The cost of the procedure was 207.91 E including follow-up visit, with an average loss of working time of 0.6 days. After one year one patient showed clinical signs of recurrent varicosis in the GSV; duplex sonography showed reflux in the region of the saphenofemoral junction in a total of seven patients (32% of the treated GSVs). Conclusion: Transcatheter foam sclerotherapy of the GSV is a cost-effective, safe method of treating varicoses of GSV and broadens the spectrum of therapeutic options. Relapses can be re-treated inexpensively with sclerotherapy.

A Digital Economy Model for Talent Prediction Data Analytic

2019 ◽  
Vol 2 (4) ◽  
pp. 260-266
Author(s):  
Haru Purnomo Ipung ◽  
Amin Soetomo
Keyword(s):  
Business Model ◽  
Industrial Revolution ◽  
Technology Innovation ◽  
Cost Effective ◽  
Sharing Economy ◽  
Token Economy ◽  
Economy Model ◽  
New Business ◽  
The Cost ◽  
Data Analytic

This research proposed a model to assist the design of the associated data architecture and data analytic to support talent forecast in the current accelerating changes in economy, industry and business change due to the accelerating pace of technological change. The emerging and re-emerging economy model were available, such as Industrial revolution 4.0, platform economy, sharing economy and token economy. Those were driven by new business model and technology innovation. An increase capability of technology to automate more jobs will cause a shift in talent pool and workforce. New business model emerge as the availabilityand the cost effective emerging technology, and as a result of emerging or re-emerging economic models. Both, new business model and technology innovation, create new jobs and works that have not been existed decades ago. The future workers will be faced by jobs that may not exist today. A dynamics model of inter-correlation of economy, industry, business model and talent forecast were proposed. A collection of literature review were conducted to initially validate the model.

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.

Production of Asbestos-free Brake Pad Using Groundnut Shell as Filler Material

2018 ◽  
Vol 4 (12) ◽  
Author(s):  
W. C. Solomon ◽  
M. T. Lilly ◽  
J. I. Sodiki
Keyword(s):  
Phenolic Resin ◽  
Cost Effective ◽  
Filler Material ◽  
Particle Sizes ◽  
Brake Pad ◽  
Brake Pads ◽  
Environmental Friendly ◽  
Sieve Size ◽  
Groundnut Shell ◽  
The Cost

The development and evaluation of brake pads using groundnut shell (GS) particles as substitute material for asbestos were carried out in this study. This was with a view to harnessing the properties of GS, which is largely deposited as waste, and in replacing asbestos which is carcinogenic in nature despite its good tribological and mechanical properties. Two sets of composite material were developed using varying particle sizes of GS as filler material, with phenolic resin as binder with percentage compositions of 45% and 50% respectively. Results obtained indicate that the compressive strength and density increase as the sieve size of the filler material decreases, while water and oil absorption rates increase with an increase in sieve size of GS particle. This study also indicates that the cost of producing brake pad can be reduced by 19.14 percent if GS is use as filler material in producing brake pad. The results when compared with those of asbestos and industrial waste showed that GS particle can be used as an effective replacement for asbestos in producing automobile brake pad. Unlike asbestos, GS-based brake pads are environmental friendly, biodegradable and cost effective.

Janus – A New Approach to Air Combat Pilot Training

2019 ◽  
Vol 2019 (4) ◽  
pp. 7-22
Author(s):  
Georges Bridel ◽  
Zdobyslaw Goraj ◽  
Lukasz Kiszkowiak ◽  
Jean-Georges Brévot ◽  
Jean-Pierre Devaux ◽  
...  
Keyword(s):  
Low Cost ◽  
Cost Effective ◽  
High Energy ◽  
Training System ◽  
Embedded Sensors ◽  
Pilot Training ◽  
New Approach ◽  
Combat Aircraft ◽  
Air Combat ◽  
The Cost

Abstract Advanced jet training still relies on old concepts and solutions that are no longer efficient when considering the current and forthcoming changes in air combat. The cost of those old solutions to develop and maintain combat pilot skills are important, adding even more constraints to the training limitations. The requirement of having a trainer aircraft able to perform also light combat aircraft operational mission is adding unnecessary complexity and cost without any real operational advantages to air combat mission training. Thanks to emerging technologies, the JANUS project will study the feasibility of a brand-new concept of agile manoeuvrable training aircraft and an integrated training system, able to provide a live, virtual and constructive environment. The JANUS concept is based on a lightweight, low-cost, high energy aircraft associated to a ground based Integrated Training System providing simulated and emulated signals, simulated and real opponents, combined with real-time feedback on pilot’s physiological characteristics: traditionally embedded sensors are replaced with emulated signals, simulated opponents are proposed to the pilot, enabling out of sight engagement. JANUS is also providing new cost effective and more realistic solutions for “Red air aircraft” missions, organised in so-called “Aggressor Squadrons”.

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