scholarly journals Safety and cost analysis of selective histopathological examination following appendicectomy and cholecystectomy (FANCY study): protocol and statistical analysis plan of a prospective observational multicentre study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e035912 ◽  
Author(s):  
Vivian P Bastiaenen ◽  
Bartholomeus JGA Corten ◽  
Elise AJ de Savornin Lohman ◽  
Joske de Jonge ◽  
Anne C Kraima ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Study Protocol ◽  
Histopathological Examination ◽  
Cost Savings ◽  
Institutional Review Board ◽  
Histopathological Diagnosis ◽  
Potential Cost ◽  
Oncological Safety ◽  
Institutional Review ◽  
Operating Surgeon

IntroductionRoutine histopathological examination following appendicectomy and cholecystectomy has significant financial implications and comprises a substantial portion of the pathologists’ workload, while the incidence of unexpected pathology is low. The aim of the selective histopathological examination Following AppeNdicectomy and CholecystectomY (FANCY) study is to investigate the oncological safety and potential cost savings of selective histopathological examination based on macroscopic assessment performed by the surgeon.Methods and analysisThis is a Dutch multicentre prospective observational study, in which removed appendices and gallbladders will be systematically assessed by the operating surgeon for macroscopic abnormalities suspicious for malignant neoplasms. After visual inspection and digital palpation of the removed specimen, the operating surgeon will report whether macroscopic abnormalities suspicious for a malignant neoplasm are present, and if he or she believes additional microscopic examination by the pathologist is indicated. Regardless of the surgeon’s assessment, all specimens will be sent for histopathological examination. In this way, routine histopathological examination can be compared with a hypothetical situation in which specimens are routinely examined by surgeons and only sent to the pathologist on indication. The two main outcomes are oncological safety and potential cost savings of a selective policy. Oncological safety of selective histopathological examination will be assessed by calculating the number of patients in whom a histopathological diagnosis of an appendiceal neoplasm or gallbladder cancer with clinical consequences benefitting the patient would have been missed. A cost analysis will be performed to quantify the potential cost savings.Ethics and disseminationThe study protocol was reviewed by the Institutional Review Board of the Amsterdam UMC, location AMC, which decided that the Dutch Medical Research Involving Human Subjects Act is not applicable. In all participating centres, approval for execution of the FANCY study has been obtained from the local Institutional Review Board before the start of inclusion of patients. The study results will be disseminated through peer-reviewed publications and conference presentations. Guidelines will be revised according to the findings of the study.Trial registration numberNCT03510923.

scholarly journals Oncological Safety and Potential Cost Savings of Routine Versus Selective Histopathological Examination Following Appendectomy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Vivian P. Bastiaenen ◽  
Joske de Jonge ◽  
Bartholomeus J. G. A. Corten ◽  
Elise A. J. de Savornin Lohman ◽  
Anne C. Kraima ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Cost Savings ◽  
Potential Cost ◽  
Oncological Safety

scholarly journals Mixed methods evaluation of a hospital group model using an embedded research approach: study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027086
Author(s):  
Cecilia Vindrola-Padros ◽  
Estela Capelas Barbosa ◽  
Angus I G Ramsay ◽  
Simon Turner ◽  
Stephen Morris ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Study Protocol ◽  
Cost Savings ◽  
Ethics Committee ◽  
Research Approach ◽  
Group Model ◽  
Potential Cost ◽  
Mixed Methods Evaluation ◽  
The Impact ◽  
Hospital Group

IntroductionHospital group models represent an organisational form that aims to bring together multiple provider organisations with a central headquarters and unified leadership responsible for locally managed operating units, standardised systems and a value-set shared across the group. These models seek to improve outcomes by reducing unwarranted variations in care provision and reducing costs through economies of scale. There is limited evidence on the impact and processes of implementing these models, so this study aims to evaluate one case study of a hospital group model.Methods and analysisWe will conduct a formative, mixed-methods evaluation using an embedded research approach to analyse the implementation of the model and its impact on outcomes and costs. We will carry out a multisited ethnography to analyse the programme theory for model design and implementation, the barriers and facilitators in the implementation; and wider contextual issues that influence implementation using semi-structured interviews (n=80), non-participant observations (n=80 hours), ‘shadowing’ (n=20 hours) and documentary analysis. We will also carry out an economic evaluation composed of a cost-consequence analysis and a return on investment analysis to evaluate the costs of creating and running the model and balance these against the potential cost-savings.Ethics and disseminationThe study protocol was reviewed by the local R&D Office and University College London Ethics Committee and classified as a service evaluation, not requiring approval by a research ethics committee. We will follow guidelines for informed consent, confidentiality and information governance, and address issues of critical distance prevalent in embedded research. Findings will be shared at regular time points to inform the implementation of the model. The evaluation will also generate: an evaluation framework to evaluate future changes; recommendations for meaningful baseline data and measuring improvement; identification of implementation costs and potential cost-savings; and lessons for the National Health Service on implementing these models.

Addressing Surgical Instrument Oversupply: A Focused Literature Review and Case-Study in Orthopedic Hand Surgery

Hand ◽  
2021 ◽  
pp. 155894472110172
Author(s):  
Joshua K. Helmkamp ◽  
Elliot Le ◽  
Ian Hill ◽  
Rachel Hein ◽  
Suhail Mithani ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Ambulatory Surgery ◽  
Cost Savings ◽  
Hand Surgery ◽  
Optimization Methods ◽  
Surgical Instrument ◽  
Potential Cost ◽  
Ambulatory Surgery Center ◽  
Instrument Tracking ◽  
Surgery Center

Background Instrument oversupply drives cost in the operating room (OR). We review previously reported methodologies for surgical instrument reduction and report a pilot methodology for optimizing instrument supply via ethnographic instrument tracking of thumb carpometacarpal (CMC) arthroplasties. Additionally, we report a cost analysis of instrument oversupply and potential savings of tray optimization methods. Methods Instrument utilization was tracked over 8 CMC arthroplasties conducted by 2 surgeons at an ambulatory surgery center of a large academic hospital. An optimized supply methodology was designed. A cost analysis was conducted using health-system-specific data and previously published research. Results After tracking instrument use in 8 CMC arthroplasties, a cumulative total of 59 out of the 120 instruments in the Hand & Foot (H&F) tray were used in at least 1 case. Two instruments were used in all cases, and another 20 instruments were used in at least 50% of the cases. Using a reduced tray with 59 instruments, potential cost savings for tray reduction in 60 cases were estimated to be $2086 without peel-packing and $2356 with peel-packing. The estimated cost savings were lower than those reported in literature due to a reduced scope and exclusion of OR time cost in the analysis. Conclusions Instrument oversupply drives cost at our institution’s ambulatory surgery center. Ethnography is a cost-effective method to track instrument utilization and determine optimal tray composition for small services but is not scalable to large health systems. The time and cost required to observe sufficient surgeries to enable supply reduction to motivate the need for more efficient methods to determine instrument utility.

scholarly journals A time and cost analysis of speech pathology paediatric feeding services delivered in-person versus via telepractice

2021 ◽  
pp. 1357633X2110128
Author(s):  
Madeline Raatz ◽  
Elizabeth C Ward ◽  
Jeanne Marshall ◽  
Clare L Burns ◽  
Clifford Afoakwah ◽  
...  
Keyword(s):  
Cost Analysis ◽  
Cost Savings ◽  
Indirect Costs ◽  
Healthcare Services ◽  
Models Of Care ◽  
Speech Pathology ◽  
Potential Cost ◽  
Cost Modelling ◽  
Cost Minimisation ◽  
Financial Burdens

Introduction Telepractice models of care have the potential to reduce the time and financial burdens that consumers may experience accessing healthcare services. The current study aimed to conduct a time and financial cost analysis of paediatric feeding appointments accessed via telepractice (using videoconferencing) compared to an in-person model. Methods Parents of 44 children with paediatric feeding disorders (PFDs) residing in a metropolitan area completed three questionnaires relating to (a) demographics, (b) time and cost for in-person care and (c) time and cost for telepractice. Both cost questionnaires collected data required for direct and indirect costs comparisons (e.g. out-of-pocket costs associated with the appointment (direct), time away from usual duties (indirect)). Average number of services accessed by each participant, and PFD appointments conducted annually by the service, were collected from service statistics. Analysis involved cost minimisation and cost modelling from a societal perspective. Results The telepractice appointment resulted in significant time ( p = 0.007) and cost (AUD$95.09 per appointment, SD = AUD$64.47, p = < 0.0001) savings per family. The health service cost was equivalent for both models (AUD$58.25). Cost modelling identified cost savings of up to AUD$475.45 per family if 50% of appointments in a 10-session block were converted to telepractice. Potential cost savings of AUD$68,750.07 per annum to society could be realised if 50% of feeding appointments within the service were provided via telepractice. Discussion The telepractice model offered both time and cost benefits. Future service re-design incorporating hybrid services (in-person and telepractice) will help optimise benefits and minimise burden for families accessing services for PFDs.

Cost-analysis of virtual reality training based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial

2019 ◽  
Vol 35 (5) ◽  
pp. 373-378 ◽  
Author(s):  
M. Kamrul Islam ◽  
Iris Brunner
Keyword(s):  
Virtual Reality ◽  
Cost Analysis ◽  
Upper Extremity ◽  
Cost Savings ◽  
Multicenter Trial ◽  
Potential Cost ◽  
Randomized Controlled ◽  
Subacute Stroke ◽  
Vr Training ◽  
Time Required

AbstractObjectivesStroke is a major cause of lasting disability worldwide. Virtual reality (VR) training has been introduced as a means of increasing the effectiveness of rehabilitation by providing large doses of task-related training with many repetitions and different modes of feedback. As VR is increasingly used in neurorehabilitation, cost considerations are important.MethodsA cost-analysis was conducted based on the Virtual Reality for Upper Extremity in Subacute stroke (VIRTUES) trial, a recent international randomized controlled observer-blind multicenter trial. Average therapist time required per therapy session may differ between VR and conventional training (CT), leading to potential cost savings due to a therapist being able to supervise more than one patient at a time. Exploratory cost analyses are presented to explore such assumptions.ResultsBased on our calculations, VR incurs extra costs as compared with CT when the same amount of therapist contact is provided, as was the case in VIRTUES. However, the exploratory analyses demonstrated that these costs may be rapidly counterbalanced when time for therapist supervision can be reduced.ConclusionsExtra costs for VR can be outweighed by reduced therapist time and decreasing VR system costs in the nearer future, and not least by increased patient motivation.

F.N.A.C. AS DIAGNOSTIC TOOL OF PAROTID TUMORS AND ASSOCIATED PITFALLS IN CORRELATION WITH HISTOPATHOLOGY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Bhawana Pant ◽  
Sanjay Gaur ◽  
Prabhat Pant
Keyword(s):  
Preoperative Diagnosis ◽  
Histopathological Examination ◽  
Clinical Information ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Histopathological Diagnosis ◽  
Cytological Diagnosis ◽  
Tertiary Referral Centre ◽  
Clear Cut ◽  
Parotid Tumors

F.NA.C has been used for ages as a safe and economical tool for fast preoperative diagnosis of parotid tumors. It has certain pitfall which sometimes leads to misdiagnosis and consequently it may have affect on treatment of the tumors. Keeping in view of the diverse classification of parotid tumors’ information from cytology should be combined with radiology as well as clinical diagnosis. Aim: To discuss some cases where there was discrepancy between cytological diagnosis and histopathological result and also suggest measures to improve the efficacy of F.N.A.C. Material and methods: The study includes 50 cases of parotid tumours who presented to the  department of ENT at Government medical college Haldwani which is a tertiary referral centre during 2009 to 2016. Only adult patients were included and inflammatory swelling were excluded from the study. All patients evaluated  Contrast enhanced computerized tomography(CECT) and  Magnetic resonance imaging (MRI) followed by Fine needle aspiration cytology .Preoperative diagnosis was made upon the findings of the above investigations and different types of  parotid surgeries  were done. . Final diagnosis was made on  histopathological  examination. Result :The most common tumour  came out to be pleomorphic adenoma (23 cases-46%) followed by mucoepidermoid carcinoma(12cases-24%). In ten  cases there was no clear cut  association between cytological diagnosis and final histopathological diagnosis. Conclusion: FNAC is highly sensitive and specific technique for diagnosis of many salivary gland swellings. FNAC can be used preoperatively to avoid unnecessary surgery and biopsy. Details of clinical information and radiologic features may help the pathologist to arrive at the appropriate diagnosis and reduce false interpretation. Pitfalls may also occur with improper technique of FNAC which can be overcome by proper caution.

Integrated Tubulars Supply Model Provides Cost Savings to Drilling Projects

2020 ◽  
Author(s):  
M. Hamzah
Keyword(s):  
Supply Chain ◽  
Cost Savings ◽  
Asia Pacific ◽  
Potential Cost ◽  
Alternative Scheme ◽  
Safety Stocks ◽  
Storage Location ◽  
Supply Planning ◽  
Drilling Site ◽  
Drilling Project

Classical Oil Country Tubular Goods (OCTG) procurement approach has been practiced in the indus-try with the typical process of setting a quantity level of tubulars ahead of the drilling project, includ-ing contingencies, and delivery to a storage location close to the drilling site. The total cost of owner-ship for a drilling campaign can be reduced in the range of 10-30% related to tubulars across the en-tire supply chain. In recent decades, the strategy of OCTG supply has seen an improvement resulting in significant cost savings by employing the integrated tubular supply chain management. Such method integrates the demand and supply planning of OCTG of several wells in a drilling project and synergize the infor-mation between the pipes manufacturer and drilling operators to optimize the deliveries, minimizing inventory levels and safety stocks. While the capital cost of carrying the inventory of OCTG can be reduced by avoiding the procurement of substantial volume upfront for the entire project, several hidden costs by carrying this inventory can also be minimized. These include storage costs, maintenance costs, and costs associated to stock obsolescence. Digital technologies also simplify the tasks related to the traceability of the tubulars since the release of the pipes from the manufacturing facility to the rig floor. Health, Safety, and Environmental (HSE) risks associated to pipe movements on the rig can be minimized. Pipe-by-pipe traceability provides pipes’ history and their properties on demand. Digitalization of the process has proven to simplify back end administrative tasks. The paper reviews the OCTG supply methods and lays out tangible improvement factors by employ-ing an alternative scheme as discussed in the paper. It also provides an insight on potential cost savings based on the observed and calculated experiences from several operations in the Asia Pacific region.

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