scholarly journals Costs of postoperative morbidity following paediatric cardiac surgery: observational study

2020 ◽  
Vol 105 (11) ◽  
pp. 1068-1074 ◽  
Author(s):  
Emma Hudson ◽  
Katherine Brown ◽  
Christina Pagel ◽  
Jo Wray ◽  
David Barron ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Health Service ◽  
Financial Burden ◽  
Hospital Costs ◽  
Incidence Rates ◽  
Care Quality ◽  
Patient Costs ◽  
Paediatric Cardiac Surgery ◽  
The Uk

ObjectiveEarly mortality rates for paediatric cardiac surgery have fallen due to advancements in care. Alternative indicators of care quality are needed. Postoperative morbidities are of particular interest. However, while health impacts have been reported, associated costs are unknown. Our objective was to calculate the costs of postoperative morbidities following paediatric cardiac surgery.DesignTwo methods of data collection were integrated into the main study: (1) case-matched cohort study of children with and without predetermined morbidities; (2) incidence rates of morbidity, measured prospectively.SettingFive specialist paediatric cardiac surgery centres, accounting for half of UK patients.PatientsCohort study included 666 children (340 with morbidities). Incidence rates were measured in 3090 consecutive procedures.MethodsRisk-adjusted regression modelling to determine marginal effects of morbidities on per-patient costs. Calculation of costs for hospital providers according to incidence rates. Extrapolation using mandatory audit data to report annual financial burden for the health service.Outcome measuresImpact of postoperative morbidities on per-patient costs, hospital costs and UK health service costs.ResultsSeven of the 10 morbidity categories resulted in significant costs, with mean (95% CI) additional costs ranging from £7483 (£3–£17 289) to £66 784 (£40 609–£103 539) per patient. On average all morbidities combined increased hospital costs by 22.3%. Total burden to the UK health service exceeded £21 million each year.ConclusionPostoperative morbidities are associated with a significant financial burden. Our findings could aid clinical teams and hospital providers to account for costs and contextualise quality improvement initiatives.

National trends and cost of litigation in UK National Health Service (NHS): a specialty-specific analysis from the past decade

2021 ◽  
Vol 66 (4) ◽  
pp. 168-174
Author(s):  
Jenni Lane ◽  
Rahul Bhome ◽  
Bhaskar Somani
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Financial Burden ◽  
Total Annual Cost ◽  
Legal Reforms ◽  
Specific Analysis ◽  
Uk National Health Service ◽  
The Uk ◽  
National Trends

Background and aims Medical litigation claim and costs in UK are rising. This study aims to analyse the 10-year trend in litigation costs for individual clinical specialties in the UK from 2009/10 to 2018/19. Methods Data were procured from National Health Service (NHS) Resolution. Number of claims, total litigation costs and cost per claim were ascertained for each financial year. The data collected also includes the number of claims and average amount per claim per speciality during the years 2009–2019 (2009/2010 to 2018/2019 financial years). Results The total annual cost of NHS litigation is currently £3.6 billion(2018/2019). Damages make up the greatest proportion of costs(£1.5 billion). Surgical specialties have the greatest number of claims annually(2847) but Obstetrics has the greatest total litigation(£1.9 billion) and cost per claim(£2.6 million). Number of claims, total costs and cost per claim are significantly greater in 2018/2019 than in 2009/2010. Conclusions Addressing the issue of litigations is complex. Medically there are speciality specific issues that require attention, whilst some general measures are common to all: effective communication, setting realistic targets and maintaining a motivated, adequately staffed workforce. These, alongside legal reforms, may reduce the financial burden of increasing litigation on the NHS.

scholarly journals Incidence of Lyme disease in the United Kingdom and association with fatigue: a population-based, historical cohort study

2021 ◽  
Author(s):  
Florence Brellier ◽  
Mar Pujades-Rodriguez ◽  
Emma Powell ◽  
Kathleen Mudie ◽  
Eliana Mattos Lacerda ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lyme Disease ◽  
Incidence Rate ◽  
Chronic Fatigue ◽  
Disease Diagnosis ◽  
Population Based ◽  
Incidence Rates ◽  
Historical Cohort ◽  
Historical Cohort Study ◽  
The Uk

Objectives To evaluate incidence rates of Lyme disease in the UK and to investigate a possible association with subsequent fatigue Design Population-based historical cohort study with a comparator cohort matched by age, sex, and general practice Setting Patients treated in UK general practices contributing to IQVIA Medical Research Data Participants 2,130 patients with a first diagnosis of Lyme disease between 2000 and 2018, and 8,510 randomly-sampled matched comparators, followed-up for a median time of 3 years and 8 months. Main outcome measures Time from Lyme disease diagnosis to consultation for any fatigue-related symptoms or diagnosis and for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Adjusted hazard ratios (HRs) were estimated from Cox models. Results Average incidence rate for Lyme disease across the UK was 5.18 per 100,000 py between 2000 and 2018, increasing from 2.55 in 2000 to 9.33 in 2018. In total 929 events of any types of fatigue were observed, i.e. an incidence rate of 307.90 per 10,000 py in the Lyme cohort (282 events) and 165.60 in the comparator cohort (647 events). Effect of Lyme disease on any subsequent fatigue varied by index season with highest adjusted HRs in autumn [3.14 (95%CI: 1.92 to 5.13)] and winter [2.23 (1.21 to 4.11)]. Incidence rates of ME/CFS were 11.16 per 10,000 py in Lyme patients (12 events) and 1.20 in comparators (5 events), corresponding to an adjusted HR of 16.95 (5.17 to 55.60). Effect on any types of fatigue and ME/CFS was attenuated 6 months after diagnosis but still clearly visible. Conclusions UK primary care records provided strong evidence that Lyme disease was associated with acute and chronic fatigue. Albeit weaker, these effects persisted beyond 6 months, suggesting that patients and healthcare providers should remain alert to fatigue symptoms months to years following Lyme disease diagnosis.

Meeting the Challenge of Stroke

1997 ◽  
Vol 42 (5) ◽  
pp. 145-147 ◽  
Author(s):  
N.U. Weir ◽  
M.S. Dennis
Keyword(s):  
Health Service ◽  
Hospital Costs ◽  
The Elderly ◽  
High Tech ◽  
Appropriate Use ◽  
Total Hospital ◽  
Stroke Incidence ◽  
The Uk

It is the elderly who carry the burden of stroke. Whilst 130,000 people suffer a stroke in the UK every year, nearly three quarters of these cases occur over the age of 65 and nearly half occur over the age of 7 5.1 As the proportion of elderly in the population continues to grow, inevitably this burden will increase. With Scotland probably experiencing the highest stroke incidence in the UK and stroke already accountingfor 5.5% of total hospital costs,2 challenges clearly lie ahead for the health service and Scottish society as a whole. The extent to which we are able to meet this challenge is becoming clearer. Thus far, therapeutic advance has been rather “low-tech”, with organisation of services and the appropriate use of existing interventions showing modest and, just occasionally, dramatic benefits. In contrast, the high hopes raised by many “high-tech ” solutions have largely been dashed or remain promising but unproven.

scholarly journals The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: a national cohort study using the UK Obstetric Surveillance System (UKOSS)

2021 ◽  
Author(s):  
◽  
Nicola Vousden ◽  
Kathryn Bunch ◽  
Edward Morris ◽  
Nigel Simpson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Surveillance System ◽  
Absolute Risk ◽  
Preterm Births ◽  
Incidence Rates ◽  
Minority Ethnic Group ◽  
Symptom Status ◽  
The Uk ◽  
In Pregnancy

ABSTRACTBackgroundEvidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management.Methods and FindingsWe conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with symptomatic SARS-CoV-2 was 2.0 per 1000 maternities (95% CI 1.9-2.2) and for asymptomatic SARS-CoV-2 was 1.2 per 1000 maternities (95% CI 1.1-1.4). Compared to pregnant women without SARS-CoV-2, women hospitalized with symptomatic SARS-CoV-2 were more likely to be overweight or obese (adjusted OR 1.86, 95% CI 1.39-2.48 and aOR 2.07, 95% CI 1.53-2.29 respectively), to be of Black, Asian or Other minority ethnic group (aOR 6.24, 95% CI 3.93-9.90, aOR 4.36, 95% CI 3.19-5.95 and aOR 12.95, 95% CI 4.93-34.01 respectively), and to have a relevant medical comorbidity (aOR 1.83, 95% CI 1.32-2.54). Compared to pregnant women without SARS-CoV-2, hospitalized pregnant women with symptomatic SARS-CoV-2 were more likely to be admitted to intensive care (aOR 57.67, 95% CI 7.80-426.70) but the absolute risk of poor outcomes was low. Cesarean births and neonatal unit admission were increased regardless of symptom status (symptomatic aOR 2.60, 95% CI 1.97-3.42 and aOR 3.08, 95% CI 1.99-4.77 respectively; asymptomatic aOR 2.02, 95% CI 1.52-2.70 and aOR 1.84, 95% 1.12-3.03 respectively). Iatrogenic preterm births were more common in women with symptomatic SARS-CoV-2 (aOR 11.43, 95% CI 5.07-25.75). The risks of stillbirth or neonatal death were not significantly increased, regardless of symptom status but numbers were small. The limitations of this study include the restriction to women hospitalized with SARS-CoV-2, who may by nature of their admission have been at greater risk of adverse outcome.ConclusionsWe have identified factors that increase the risk of symptomatic and asymptomatic SARS-CoV-2 in pregnancy. The increased risks of cesarean and iatrogenic preterm birth provide clear evidence of the indirect impact of SARS-CoV-2 on mothers and maternity care in high income settings. Clinicians can be reassured that the majority of women do not experience severe complications of SARS-CoV-2 in pregnancy and women with mild disease can be discharged to continue their pregnancy safely.

scholarly journals Hospital treatment and management in relapse of schizophrenia in the UK: associated costs

2011 ◽  
Vol 35 (3) ◽  
pp. 95-100 ◽  
Author(s):  
Janet Munro ◽  
Sarah Osborne ◽  
Lindsay Dearden ◽  
Katie Pascoe ◽  
Aline Gauthier ◽  
...  
Keyword(s):  
Hospital Costs ◽  
Length Of Hospital Stay ◽  
Hospital Treatment ◽  
Clinical Implications ◽  
Treatment Length ◽  
Patient Costs ◽  
Unit Costs ◽  
National Health Service Trust ◽  
Heavy Burden ◽  
The Uk

Aims and methodRelapse in schizophrenia carries a heavy burden. This study aimed to describe the characteristics of patients admitted to hospital for relapse and to explore the treatment, length of stay and associated in-patient costs. The sample comprised individuals discharged from a London National Health Service trust following a relapse of schizophrenia. The costs of hospital treatment were obtained by applying referenced unit costs.ResultsThe cohort comprised 71 patients. Treatment non-adherence was implicated in 76% of relapses. Mean length of hospital stay was 138.9 days (range 1 week-1.8 years). Mean admission cost was £25 852 (range £1270-120 000). Over 97% of costs were hospital costs and less than 3% drug costs.Clinical implicationsHospital treatment for relapse of schizophrenia carries a considerable economic burden, as shown in this study. Treatment non-adherence is a significant factor contributing to relapse.

A survey of trainees supported by oral and maxillofacial surgery units while studying for a second degree

2014 ◽  
Vol 96 (10) ◽  
pp. e19-e23
Author(s):  
R O’Connor ◽  
R Bhandari
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Ad Hoc ◽  
Financial Burden ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Tuition Fees ◽  
The Uk ◽  
Medical Disciplines

Training in oral and maxillofacial surgery (OMfs) in the UK and other european countries is unique, requiring degrees in both dentistry and medicine. This rewards trainees with a varied skillset but carries a financial burden that has been exacerbated by increasing tuition fees and the pay freeze for national health service (nhs) employees. 1 although not a new concept, working through university is a necessity for many. however, work is often undertaken ad hoc or as a locum in dental or medical disciplines unrelated to omfs.

scholarly journals Incidence of Lyme disease in the UK: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025916 ◽  
Author(s):  
Victoria Cairns ◽  
Christopher Wallenhorst ◽  
Stephan Rietbrock ◽  
Carlos Martinez
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Lyme Disease ◽  
Population Based ◽  
Incidence Rates ◽  
Annual Incidence ◽  
Secondary Outcome ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk

ObjectivesThe purpose of this study was to estimate the annual incidence of Lyme disease (LD) in the UK.DesignThis was a retrospective descriptive cohort study.SettingStudy data were extracted from the Clinical Practice Research Datalink (CPRD), a primary care database covering about 8% of the population in the UK in 658 primary care practices.ParticipantsCohort of 8.4 million individuals registered with general practitioners with 52.4 million person-years of observation between 1 January 2001 and 31 December 2012.Primary and secondary outcome measuresLD was identified from recorded medical codes, notes indicating LD, laboratory tests and use of specific antibiotics. Annual incidence rates and the estimated total number of LD cases were calculated separately for each UK region.ResultsThe number of cases of LD increased rapidly over the years 2001 to 2012, leading to an estimated incidence rate of 12.1 (95% CI 11.1 to 13.2) per 100 000 individuals per year and a UK total of 7738 LD cases in 2012. LD was detected in every UK region with highest incidence rates and largest number of cases in Scotland followed by South West and South England. If the number of cases has continued to rise since the end of the study period, then the number in the UK in 2019 could be over 8000.ConclusionsThe incidence of LD is about threefold higher than previously estimated, and people are at risk throughout the UK. These results should lead to increased awareness of the need for preventive measures.Trial registration numberThis study was approved by the Independent Scientific Advisory Committee for CPRD research (Protocol number 13_210R).

scholarly journals ‘Use of antipsychotics in children and adolescents: a picture from the ARITMO population-based European cohort study’

2020 ◽  
Vol 29 ◽  
Author(s):  
Florentia Kaguelidou ◽  
Jakob Holstiege ◽  
Tania Schink ◽  
Irene Bezemer ◽  
Elisabetta Poluzzi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Children And Adolescents ◽  
First Generation ◽  
Paediatric Population ◽  
Population Based ◽  
Incidence Rates ◽  
Steady Increase ◽  
Off Label Use ◽  
Electronic Healthcare Databases ◽  
The Uk

Abstract Aims Prevalence of the use of antipsychotics (APs) in the paediatric population is globally increasing. The aim of this study was to describe multinational trends and patterns in AP use in children and adolescents in Europe. Methods This was a dynamic retrospective cohort study comprising all children and adolescents (⩽18 years of age). Data were extracted from five population-based electronic healthcare databases in Europe (Denmark, Germany, Italy, the Netherlands and United Kingdom) from 2000 to 2010. Yearly prevalence and incidence of AP use was expressed per 1000 person-years (PYs). Results Prevalence increased from 1.44 to 3.41/1000 PYs (2008) in Denmark and from 2.07 to 4.35/1000 PYs in the NL (2009), moderately increased from 2.8 to 3.24/1000 in UK (2009) and from 1.53 to 1.74/1000 PYs in Germany (2008) and remained low from 0.61 to 0.34/1000 PYs in Italy (2010). Similarly, incidence rates increased from 0.69 to 1.52/1000 PYs in Denmark and from 0.86 to 1.49/1000 PYs in the NL, stabilised from 2.29 to 2.37/1000 PYs in the UK and from 0.79 to 0.80/1000 PYs in Germany and remained low from 0.32 to 0.2/1000 PYs in Italy. AP use was highest in 15–18 year olds and in boys compared to girls. Yet, the use observed in the 5–9 year olds was found to be comparatively high in the NL. Prescriptions of second generation APs, especially risperidone, were privileged but the first generation APs were still prescribed in the youngest. Conclusions A steady increase in AP use in children and adolescents was observed essentially in the NL and Denmark. The use in Germany and Italy was lowest among countries. The use of APs under 9 years of age underlines their off-label use and should be carefully monitored as the risk/benefit ratio of these medications remains unclear in young children. AP use was altogether lower in Europe as compared to that reported in North America.

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