scholarly journals A feed-centric hypoglycaemia pathway ensures appropriate care escalation in at-risk infants

2021 ◽  
Vol 10 (4) ◽  
pp. e001296
Author(s):  
Suresh Chandran ◽  
Jia Xuan Siew ◽  
Victor Samuel Rajadurai ◽  
Rachel Wei Shan Lim ◽  
Mei Chien Chua ◽  
...  
Keyword(s):  
At Risk ◽  
Total Duration ◽  
Cost Of Care ◽  
Intravenous Glucose ◽  
Starting Point ◽  
Before And After ◽  
The Cost ◽  
Glucose Management ◽  
Skin To Skin ◽  
The Impact

BackgroundThere is a lack of clarity of what constitutes the starting point of a clinical pathway for infants at-risk of hypoglycaemia. Glucose-centric pathways (GCP) identify low glucose in the first 2 hours of life that may not represent clinical hypoglycaemia and can lead to inappropriate glucose management with infusions and medications.ObjectiveTo study the impact of a feed-centric pathway (FCP) on the number of admissions for hypoglycaemia to level 2 special care nursery (SCN) and the need for parenteral glucose/medications, compared to GCP.MethodsThis project was conducted over 2 years, before and after switching from a GCP to FCP in our institution. FCP involves skin-to-skin care, early breast feeding, checking glucose at 2 hours and use of buccal glucose. The primary outcome was the number of SCN admissions for hypoglycaemia. Secondary outcomes include the number of infants needing intravenous glucose, medications and length of SCN stay.ResultsOf 23 786 live births, 4438 newborns were screened. We screened more infants at-risk for hypoglycaemia using the FCP (GCP:1462/11969, 12.2% vs FCP:2976/11817, 25.1%) but significantly reduced SCN admissions (GCP:246/1462, 16.8% vs FCP:102/2976, 3.4%; p<0.0001). Fewer but proportionally more FCP newborns required intravenous glucose (GCP: 136/246, 55% vs FCP: 88/102, 86%; p=0.000). Compared with GCP, FCP reduced the total duration of stay in SCN by 104 days per annum, reducing the cost of care. However, the mean length of SCN stay for FCP was higher (GCP:2.43 days vs FCP:3.49 days; p=0.001). There were no readmissions for neonatal hypoglycaemia to our institution.ConclusionThe use of FCP safely reduced SCN admissions, averted avoidable escalation of care and helped identify infants who genuinely required intravenous glucose and SCN care, allowing more efficient utilisation of healthcare resources.

scholarly journals Monetary Transmission through Interest Rate Channel in Vietnam Before and After the Crisis

2014 ◽  
Vol 222 ◽  
pp. 51-75
Author(s):  
Hương Trầm Thị Xuân ◽  
Vinh Võ Xuân ◽  
CẢNH NGUYỄN PHÚC
Keyword(s):  
Monetary Policy ◽  
Interest Rate ◽  
Monetary Transmission ◽  
Var Model ◽  
Macroeconomic Theory ◽  
Cost Channel ◽  
Before And After ◽  
The Cost ◽  
The Impact ◽  
Interest Rate Channel

The paper employs the VAR model to examine the impact of monetary policy on the economy through interest rate channel (IRC) and levels of transmission before and after the 2008 crisis. The results indicate that in the period before the financial crisis, IRC exists in accordance with macroeconomic theory; however, the crisis period, in which increases in SBV monetary policy rates lead to increased inflation, has proved the existence of the cost channel of monetary transmission in Vietnam.

scholarly journals The Impact of COVID-19 Crisis upon the Consumer Buying Behavior of Fresh Vegetables Directly from Local Producers. Case Study: The Quarantined Area of Suceava County, Romania

2020 ◽  
Vol 17 (15) ◽  
pp. 5485 ◽  
Author(s):  
Alina Butu ◽  
Ioan Sebastian Brumă ◽  
Lucian Tanasă ◽  
Steliana Rodino ◽  
Codrin Dinu Vasiliu ◽  
...  
Keyword(s):  
Sociodemographic Factors ◽  
The State ◽  
Buying Behavior ◽  
State Of Emergency ◽  
Purchasing Intention ◽  
Starting Point ◽  
Fresh Vegetables ◽  
Before And After ◽  
The Impact ◽  
Consumer Buying Behavior

The present paper intends to address the impact of COVID-19 crisis upon the consumer buying behavior of fresh vegetables directly from local producers as observed 30 days later, after enforcing the state of emergency in Romania within a well-defined area, namely, the quarantined area of Suceava. The study relies on the interpretation of answers received from the quarantined area (N = 257) to a questionnaire applied online nationwide. The starting point of this paper is the analysis of the sociodemographic factors on the purchasing decision of fresh vegetables directly from local producers before declaring the state of emergency in Romania (16 March 2020). Further research has been conducted by interpreting the changes triggered by the COVID-19 crisis on the purchasing intention of such products before and after the end of the respective crisis. The aim of this scientific investigation relies on identifying the methods by which these behavioral changes can influence the digital transformation of short food supply chains.

scholarly journals The Effect of Initiation of Anti-TNF Therapy on the Subsequent Direct Health Care Costs of Inflammatory Bowel Disease

2019 ◽  
Vol 25 (10) ◽  
pp. 1718-1728 ◽  
Author(s):  
Laura E Targownik ◽  
Eric I Benchimol ◽  
Julia Witt ◽  
Charles N Bernstein ◽  
Harminder Singh ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
Population Based ◽  
World Population ◽  
Median Cost ◽  
Future Health ◽  
Before And After ◽  
Future Health Care ◽  
The Cost ◽  
The Impact

Abstract Background Anti–tumor necrosis factor (anti-TNF) drugs are highly effective in the treatment of moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), but they are very costly. Due to their effectiveness, they could potentially reduce future health care spending on other medical therapies, hospitalization, and surgery. The impact of downstream costs has not previously been quantified in a real-world population-based setting. Methods We used the University of Manitoba IBD Database to identify all persons in a Canadian province with CD or UC who received anti-TNF therapy between 2004 and 2016. All inpatient, outpatient, and drug costs were enumerated both in the year before anti-TNF initiation and for up to 5 years after anti-TNF initiation. Costs before and after anti-TNF initiation were compared, and multivariate linear regression analyses were performed to look for predictors of higher costs after anti-TNF initiation. Results A total of 928 people with IBD (676 CD, 252 UC) were included for analyses. The median cost of health care in the year before anti-TNF therapy was $4698 for CD vs $6364 for UC. The median cost rose to $39,749 and $49,327, respectively, in the year after anti-TNF initiation, and to $210,956 and $245,260 in the 5 years after initiation for continuous anti-TNF users. Inpatient and outpatient costs decreased in the year after anti-TNF initiation by 12% and 7%, respectively, when excluding the cost of anti-TNFs. Conclusions Direct health care expenditures markedly increase after anti-TNF initiation and continue to stay elevated over pre-initiation costs for up to 5 years, with only small reductions in the direct costs of non-drug-related health care.

scholarly journals Impact of 2013 ASCO/CAP guidelines on various HER2 reporting categories in breast cancer by fluorescent in-situ hybridization and Immunohistochemistry: A meta-analysis with systematic review

2020 ◽  
Vol 5 ◽  
pp. 14-26 ◽  
Author(s):  
Sunil Pasricha ◽  
Smita Asthana ◽  
Satyanarayana Labani ◽  
Uma Kailash ◽  
Abhinav Srivastav ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Paired Data ◽  
Treatment Benefit ◽  
Before And After ◽  
Primary Test ◽  
The Cost ◽  
The Impact

Objective: The ASCO/CAP guidelines for reporting HER2 in breast cancer, first released in 2007, aimed to standardize the reporting protocol, and were updated in 2013 and 2018, to ensure right treatment. Several studies have analyzed the changes attributed to 2013 updated guidelines, and majority of them found increase in positive and equivocal cases. However, the precise implication of these updated guidelines is still contentious, in spite of the latest update (2018 guidelines) addressing some of the issues. We conducted systematic review and meta- analysis to see the impact of 2013 guidelines on various HER2 reporting categories by both FISH and IHC. Materials and Methods: After extensively searching the pertinent literature, 16 studies were included for the systematic review. We divided our approach in three strategies: (1) Studies in which breast cancer cases were scored for HER2 by FISH or IHC as a primary test concurrently by both 2007 and 2013 guidelines, (2) Studies in which HER2 results were equivocal by IHC and were followed by reflex-FISH test by both 2007 and 2013 guidelines, and (3) Studies in which trends of HER2 reporting were compared in the two periods before and after implementation of updated 2013 guidelines. All the paired data in these respective categories was pooled and analyzed statistically to see the overall impact of the updated guidelines. Results: In the first category, by pooled analysis of primary FISH testing there has been a significant increase in the equivocal cases (P < 0.001) and positive cases (P = 0.037). We also found 8.3% and 0.8% of all the negative cases from 2007 guidelines shifted to equivocal and positive categories, respectively. Similarly by primary IHC testing there has been a significant increase in both equivocal cases (P < 0.001) and positive cases (P = 0.02). In the second category of reflex-FISH testing there was a substantial increase in the equivocal cases (P < 0.0001); however there is insignificant decrease (10% to 9.7%; P = 0.66) in the amplified cases. In the third approach for evaluating the trend, with the implementation of 2013 guidelines, there was increase in the equivocal category (P = 0.025) and positive category (P = 0.0088) by IHC. By FISH test also there was significant increase in the equivocal category (P < 0.001) while the increase in the positive category was non-significant (P = 0.159). Conclusions: The updated 2013 guidelines has significantly increased the positive and equivocal cases using primary FISH or IHC test and with further reflex testing, thereby increasing the double equivocal cases and increasing the cost and delaying the decision for definite management. However, whether the additional patients becoming eligible for HDT will derive treatment benefit needs to be answered by further large clinical trials.

Reflections on the theme issue outcomes: Expo 2020: what will be the impact on Dubai?

2019 ◽  
Vol 11 (3) ◽  
pp. 346-350 ◽  
Author(s):  
Sanjay Nadkarni ◽  
Richard Teare
Keyword(s):  
Collaborative Work ◽  
Theme Issue ◽  
Content Type ◽  
Starting Point ◽  
Before And After ◽  
Collaborative Working ◽  
The Impact ◽  
Practical Implications ◽  
Detailed Picture ◽  
Selection Of

Purpose The purpose of this paper is to profile the Worldwide Hospitality and Tourism Themes (WHATT) theme issue “Expo 2020: What will be the impact on Dubai?” with reference to the experiences of the theme editor and writing team. Design/methodology/approach This paper uses structured questions to enable the theme editor to reflect on the rationale for the theme issue question, the starting point, the selection of the writing team and material and the editorial process. Findings This paper provides a framework to facilitate discussion between academics and practitioners engaged with Dubai’s Expo 2020, identifies ways of improving competitiveness as an events destination and contributes to thinking about sustainable development before and after the event. The outcomes of a broad-ranging collaboration yield fresh insights, a deeper understanding of the issues and an array of possible responses to the theme issue question. Practical implications The theme issue outcomes provide lines of enquiry for others to explore and they reinforce the value of WHATT’s approach to collaborative working and writing. Originality/value The collaborative work reported in this theme issue offers a unified but contrarian response to the theme’s strategic question. Taken together, the collection of articles provides a detailed picture of the on-going preparation for Expo 2020 and plans to ensure continued growth in the post-Expo phase.

Beyond acute stroke: Rate of stroke transfers to a tertiary centre following the implementation of a dedicated inpatient teleneurology network

2019 ◽  
pp. 1357633X1986809
Author(s):  
Sami Al Kasab ◽  
Eyad Almallouhi ◽  
Ellen Debenham ◽  
Nancy Turner ◽  
Kit N Simpson ◽  
...  
Keyword(s):  
Cost Reduction ◽  
Stroke Patients ◽  
Consultation Service ◽  
Tertiary Centre ◽  
Before And After ◽  
Baseline Characteristics ◽  
Significant Cost Reduction ◽  
The Cost ◽  
Mean Cost ◽  
The Impact

Introduction This study evaluated the impact of establishing an inpatient teleneurology consultation service alongside an already established telestroke network on the stroke transfers to the hub. The study also aimed to assess the financial impact of establishing this network. Methods Prospectively collected data on all stroke patients evaluated through our telestroke and teleneurology networks between January 2008 and March 2018 were interrogated. For all spokes (eight sites) that had both teleneurology and telestroke services, we compared the rate of transfers to the hub before and after the establishment of the teleneurology network in August 2014. The cost reduction was estimated using the Medicare 5% standard analytic files. Results A total of 4296 stroke patients were evaluated during the study period. Of these, 2493 were seen before and 1803 were seen after the implementation of the teleneurology network at the included sites. Patients in the pre-teleneurology group were older (66.4 years ( SD = 14.7 years) vs. 67.8 years ( SD = 15.1 years); p = 0.002). Otherwise, there were no differences in baseline characteristics. Patients in the pre-teleneurology group were more likely to be transferred to the telestroke hub (29.4% vs. 20.2%; p < 0.001). The estimated mean cost reduction for each one minus the cost of transfer was estimated to be US$4997. Discussion The implementation of an inpatient teleneurology network was associated with a significant reduction in the transfer rate of stroke patients to hospitals with a higher level of care and could lead to a significant cost reduction.

scholarly journals 567. Does Universal Nasal Decolonization with an Alcohol-Based Nasal Antiseptic Reduce Infection Risk and Cost?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S268-S268
Author(s):  
Scott Arden
Keyword(s):  
Surgical Procedures ◽  
Surgical Site Infections ◽  
Infection Risk ◽  
Practice Change ◽  
Screening Tests ◽  
Contact Precautions ◽  
Chlorhexidine Bathing ◽  
Before And After ◽  
The Cost ◽  
The Impact

Abstract Background Nasal decolonization with mupirocin to reduce infection risk, has been associated with mupirocin-resistant Staphylococcus aureus (SA). A community hospital identified two patients colonized with methicillin and mupirocin-resistant SA (MRSA), one scheduled for surgery, one for inpatient IV antibiotic therapy. Instead of mupirocin, an alcohol based nasal antiseptic was applied to these patients twice daily for 5 days, resulting in a negative MRSA nasal screening test in both patients. Neither patient developed an infection during or after treatment. Building on this success, a plan was made to assess the impact of universal nasal decolonization to replace screening and contact precautions for MRSA colonized patients, and to reduce surgical site infections (SSI). Methods A 12-month project using a before and after design, was initiated in April 2018. The project involved twice daily application of alcohol-based nasal antiseptic for all inpatients, and preoperatively for all surgical patients in addition to existing preoperative chlorhexidine bathing. No other practice change was made during this period. Assessment of impact was planned by comparing the incidence of MRSA bacteremia and SSI at baseline (2017) and after project implementation, in addition to costs avoided with reduction of nasal screening and CP. Results Compared with baseline, between April 2018 and March 2019, there was a decrease in MRSA bacteremia from 3/1,000 patient-days to 0/1,000 patient-days, a reduction in CP from 3.78 to 1.53/1,000 patient-days, a reduction in nasal screens from 3,874 to 605, and a reduction of all-cause (Gram-negative and Gram-positive) SSI after all surgical procedures from 3/4,313 procedures to 0/4,872 procedures. After accounting for the cost of the nasal antiseptic, the reduction in gowns, gloves and nasal screening tests resulted in $104,099.91costs avoided. Conclusion House-wide application of alcohol-based nasal antiseptic in place of screening and contact precautions, resulted in a reduced incidence of both MRSA bacteremia and SSI for all types of surgical procedures, in addition to significant costs avoided. Disclosures All authors: No reported disclosures.

Consensus treatment guidelines for urgent symptoms in cholangiocarcinoma (CC) patients (pts) with biliary stents or catheters using the modified RAND/UCLA Delphi process.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 452-452 ◽  
Author(s):  
Renuka V. Iyer ◽  
Susan G. Acquisto ◽  
John A. Bridgewater ◽  
Michael A. Choti ◽  
Theodore S. Hong ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Unmet Need ◽  
Cost Of Care ◽  
Delphi Process ◽  
Biliary Stents ◽  
Clinical Scenarios ◽  
Consensus Statements ◽  
Before And After ◽  
The Uk ◽  
The Impact

452 Background: CC pts with biliary stents or catheters often present with fever and/or jaundice requiring urgent treatment for which there is no uniform guideline. We aimed to develop an expert panel consensus on this topic using the modified RAND/UCLA Delphi process to rate treatment appropriateness. Methods: We recruited 13 physician experts from relevant specialty, geography, and practice settings. Patient scenarios were developed based on a literature review, and therapies were rated by the experts before and after a face-to-face discussion. The appropriateness of various therapies was rated on a 1-9 scale and classified as appropriate, inappropriate, or uncertain. Scenarios with > 2 ratings of 1-3 (inappropriate) and > 2 ratings of 7-9 (appropriate) were considered to have disagreement and were not assigned an appropriateness rating. Results: Panelists were from all US regions (92%) and the UK (8%); had practiced for a mean 16.5 years (4-33 years) and reported seeing an average of 120 unique CC patients a year (0-900 pts). Panelists rated 288 clinical scenarios. Experts decided that ongoing treatment with chemotherapy did not influence decision-making. Disagreement decreased from 37.5% before the meeting to 10.4% after. Consensus statements are summarized in table 1. Conclusions: The Delphi process produced consensus guidelines to fill an unmet need in urgent management of ascending cholangitis in pts with CC. Studies of the impact of these guidelines on cost of care and pt outcomes are warranted. (Support: The Cholangiocarcinoma Foundation)[Table: see text]

Computing the cost of care per day of breast cancer survivor care.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 10-10 ◽  
Author(s):  
Douglas W. Blayney ◽  
Craig Lindquist ◽  
Tina Seto ◽  
Nhat Minh Hoang ◽  
Allison W. Kurian
Keyword(s):  
Breast Cancer ◽  
Cancer Survivor ◽  
Breast Cancer Survivor ◽  
Radiation Treatment ◽  
Cost Of Care ◽  
Survivorship Care ◽  
Co Morbidity ◽  
Social Security Death Index ◽  
The Cost ◽  
The Impact

10 Background: Cost of breast cancer survivor surveillance, of survivorship care and of variation in care practices are unknown. Furthermore, it is not known whether intense surveillance care adds value. We developed a method to measure the cost of surveillance to account for varying follow-up duration [cost of care per day (CCPD)], and explored the impact of surveillance cost on survival. Methods: We queried the Oncoshare database {Kurian et al Cancer 2014}, which amalgamates data from Stanford Health Care’s (SHC) electronic health record (EHR) (imaging, infused drugs, inpatient and outpatient facility and professional services), from the California Cancer Registry, and the Social Security Death Index. We included breast cancer patients diagnosed 2000-2014, Stages 0-III who had surgery, chemotherapy or radiation treatment at SHC, and who had more than two visits at SHC within 3 years of their treatment completion. We tallied Common Procedural Terminology (CPT©) codes assigned to each service, and mapped each CPT code to the corresponding code and date in the CMS Medicare fee schedule. For patients with breast cancer relapse, we explored the post-relapse survival of the costliest 20% compared with the other patients. Results: CCPD was $2.45 for care delivered at SHC. Among the three breast cancer subtypes (luminal, Her-2 over-expressed and triple negative) there was no difference in cost. Among patients who relapsed, those in the most expensive 20% CCPD had significantly shorter survival than other patients. The high-cost patients had more co-morbidity [cerebrovascular disease (4% for low cost vs 7% for high), chronic pulmonary disease (5% vs 10%), CHF (2% vs 7%), diabetes (4% vs 7%), liver disease (4% vs 9%)]. Conclusions: Cost of care per day (CCPD) is a useful metric to assess value of surveillance and survivorship care, and is also applicable to initial treatment and post-relapse care, to identify “positive deviants” ( those who have developed best practices) in high value care delivery. We captured only costs for treatment at SHC, and merging our data with claims data from 3rd party carriers could increase the accuracy and validity of the CCPD. We identified a model for further testing to reduce total spending for high-quality oncology care.

Cost-effectiveness of two screening strategies for Chlamydia trachomatis and Neisseria gonorrhoeae as part of the PrEP programme in the Netherlands: a modelling study

2021 ◽  
pp. sextrans-2020-054741
Author(s):  
Francine van Wifferen ◽  
Elske Hoornenborg ◽  
Maarten F Schim van der Loeff ◽  
Janneke Heijne ◽  
Albert Jan van Hoek
Keyword(s):  
At Risk ◽  
Cost Effectiveness ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Infection Model ◽  
Baseline Scenario ◽  
Life Years ◽  
The Difference ◽  
The Cost ◽  
The Impact

ObjectivesPre-exposure prophylaxis (PrEP) users are routinely tested four times a year (3 monthly) for asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections on three anatomical locations. Given the high costs of this testing to the PrEP programme, we assessed the impact of 3 monthly screening(current practice), compared with 6 monthly on the disease burden. We quantified the difference in impact of these two testing frequencies on the prevalence of CT and NG among all men who have sex with men (MSM) who are at risk of an STI, and explored the cost-effectiveness of 3-monthly screening compared with a baseline scenario of 6-monthly screening.MethodsA dynamic infection model was developed to simulate the transmission of CT and NG among sexually active MSM (6500 MSM on PrEP and 29 531 MSM not on PrEP), and the impact of two different test frequencies over a 10-year period. The difference in number of averted infections was used to calculate incremental costs and quality-adjusted life-years (QALY) as well as an incremental cost-effectiveness ratio (ICER) from a societal perspective.ResultsCompared with 6-monthly screening, 3-monthly screening of PrEP users for CT and NG cost an additional €46.8 million over a period of 10 years. Both screening frequencies would significantly reduce the prevalence of CT and NG, but 3-monthly screening would avert and extra ~18 250 CT and NG infections compared with 6-monthly screening, resulting in a gain of ~81 QALYs. The corresponding ICER was ~€430 000 per QALY gained, which exceeded the cost-effectiveness threshold of €20 000 per QALY.ConclusionsThree-monthly screening for CT and NG among MSM on PrEP is not cost-effective compared with 6-monthly screening. The ICER becomes more favourable when a smaller fraction of all MSM at risk for an STI are screened. Reducing the screening frequency could be considered when the PrEP programme is established and the prevalence of CT and NG decline.

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