Conservative Medical Management of Traumatic Pharyngoesophageal Perforations

1992 ◽  
Vol 101 (3) ◽  
pp. 209-215 ◽  
Author(s):  
Sanford R. Dolgin ◽  
Narendra R. Kumar ◽  
Thomas W. Wykoff ◽  
Anthony J. Maniglia
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Medical Management ◽  
Penetrating Trauma ◽  
Cost Effective ◽  
Oral Feeding ◽  
Management Approach ◽  
Intravenous Antibiotic ◽  
School Of Medicine ◽  
Selection Of

Traditionally, surgical treatment has been the acceptable management for perforation of the pharyngoesophageal tract secondary to blunt and penetrating trauma. From July 1983 to June 1990, we managed 10 patients with this type of lesion by a conservative medical management approach. Mirror or fiberoptic flexible laryngoscopy was performed in the majority of cases to ascertain the nature of the injury. An esophagogram is very helpful to locate and evaluate the extent of the injury. All patients were treated with broad-spectrum intravenous antibiotic therapy and no oral feeding. There were no complications or need for surgical treatment in any of the cases. The head and neck surgeon, in selected cases, should consider the possibility of using conservative management of pharyngoesophageal perforations. This approach has proven in our hands to be relatively safe and cost-effective, resulting in no disability or prolonged hospitalization of our patients. This study involves two institutions (two affiliated hospitals of Case Western Reserve University School of Medicine) with different surgeons selecting appropriate antibiotic therapy. It is a retrospective review. No controls were made by random selection of cases treated surgically. These cases, if not properly managed, may lead to fatal outcomes.

scholarly journals Analisis Keefektifan Biaya Pengobatan Pada Pasien Pneumonia Balita Di Instalasi Rawat Inap Rumah Sakit Paru Dr. Ario Wirawan Salatiga Tahun 2018

2019 ◽  
Vol 2 (2) ◽  
Author(s):  
Nita Tanti Wulandari ◽  
Ening Listyanti ◽  
Niken Dyahariesti ◽  
Agitya Resti Erwiyani
Keyword(s):  
Antibiotic Therapy ◽  
Evaluation Method ◽  
Acute Infection ◽  
Cost Effective ◽  
Class Ii ◽  
Class I ◽  
Therapeutic Effects ◽  
Class Iii ◽  
Medical Expenses ◽  
Selection Of

Pneumonia adalah infeksi akut yang menyerang jaringan paru-paru yang disebabkan oleh bakteri, virus maupun jamur. Pengobatan pneumonia yang diterapi dengan antibiotik secara efektif dapat meningkatkan efek terapeutik klinis, meminimalkan toksisitas obat mengurangi angka kejadian resistensi dan lebih ekonomis. CEA merupakan suatu metode evaluasi ekonomi yang dapat digunakan dalam mengambil keputusan pemilihan alternatif terbaik pada pemilihan biaya pengobatan pneumonia. Penelitian ini bertujuan  untuk menganalisis keefektifan biaya pengobatan pada pasien pneumonia balita di rawat inap Rumah Sakit Paru dr. Ario Wirawan Salatiga   tahun 2018. Penelitian ini menggunakan merupakan penelitian non eksperimental (observasional) menggunakan pendekatan retrospektif dan dianalisis secara deskriptif. Sampel yang digunakan sebanyak 30 pasien. Sampel dianalisis sesuai dengan metode ACER dan ICER. Efektivitas terapi dilihat dari LOS. Nilai ACER: kelas VIP: Ceftriaxon + Cefixime Rp. 615.177, Cefotaxime + Gentamisin Rp.810.773.  Kelas I: Cefotaxime + Gentamisin Rp. 536.880. Kelas II: Cefotaxime Rp. 408.493, Cefotaxime + Cefixime Rp. 357.397, Cefotaxime + Gentamisin Rp. 385.488 dan Ceftriaxon + Cefixime  Rp. 325.355. Kelas III: Cefotaxime Rp. 278.740, Ceftriaxon Rp. 186.250, Cefotaxime + Gentamisin Rp. 312.734, Cefotaxime + Cefixime Rp.286.128 dan Ceftriaxon + Cefixime Rp.295.100. Nilai ICER pada kelas VIP : Ceftriaxon + Cefixime dan Cefotaxime + Gentamisin Rp. -356.967 dan pada kelas III adalah Ceftriaxon dan Cefotaxime Rp.-91.219. Pada pengobatan bronkopneumonia balita terapi antibiotik yang paling cost-effective di ruang kelas VIP adalah penggunaan antibiotik kombinasi Ceftriaxon + Cefixime, ruang kelas I adalah Cefotaxime + Gentamisin, ruang kelas II adalah Cefotaxime, dan ruang kelas III adalah Cefotaxime.Kata Kunci           : Analisis Keefektifan Biaya, Terapi Antibiotik, PneumoniaPneumonia is an acute infection that attacks lung tissue caused by bacteria, viruses and fungi. Treatment of pneumonia is effectively treated with antibiotics because it can increase clinical therapeutic effects, minimizing drug toxicity reduces the incidence of resistance and more economical. CEA is an economic evaluation method that can be used in making the best decision on the selection of alternatives in the selection of pneumonia treatment costs. To analyze the effectiveness of medical expenses in pneumonia patients under five inpatient hospitalized Dr. Ario Wirawan Salatiga in 2018. This study used a non-experimental (observational) method using a retrospective approach and analyzed descriptively. The sample used was 30 patients. The samples were analyzed according to the ACER and ICER methods. The effectiveness of therapy was seen from LOS. ACER Value: VIP class: Ceftriaxon + Cefixime Rp. 615,177, Cefotaxime + Gentamisin Rp.810,773. Class I: Cefotaxime + Gentamisin Rp. 536,880. Class II: Cefotaxime Rp. 408,493, Cefotaxime + Cefixime Rp. 357,397, Cefotaxime + Gentamisin Rp. 385,488 and Ceftriaxon + Cefixime Rp. 325,355. Class III: Cefotaxime Rp.278,740, Ceftriaxon Rp.186,250, Cefotaxime + Gentamisin Rp. 312,734, Cefotaxime + Cefixime Rp.286,128 and Ceftriaxon + Cefixime Rp.295.100. ICER scores at VIP class: Ceftriaxon + Cefixime and Cefotaxime + Gentamisin Rp. -356,967 and in class III Ceftriaxon and Cefotaxime Rp.-91,219. In bronchopneumonia treatment toddlers the most cost-effective antibiotic therapy in VIP classrooms is the use of a combination antibiotic Ceftriaxon + Cefixime, class I is Cefotaxime + Gentamisin, Class II is Cefotaxime, and Class III is Cefotaxime.Keywords : Cost Effectiveness Analysis, Antibiotic Therapy, Pneumonia

Medical Literature Searches -How Many Bibliographic Databases are Needed for Sufficient Retrieval in Medical Topics?

1985 ◽  
Vol 24 (03) ◽  
pp. 163-165 ◽  
Author(s):  
K. John
Keyword(s):  
Medical Literature ◽  
Cost Effective ◽  
Medical Faculty ◽  
Bibliographic Databases ◽  
Literature Searches ◽  
Selection Of

SummaryAs many bibliographic services in medicine are offered, literature searches in eight databases at DIMDI were performed to find out which database is most important in medicine. The distribution of publications from members of the medical faculty of Frankfurt University was examined. No save prediction is possible as to which database will yield most articles. Overlapping from different databases is often rather low. The selection of an appropriate database mix for sufficient recall and in a cost-effective manner.is a task for an experienced searcher.

Teknologi Esktrasi dan Cara Pemisahannya untuk Mendapatkan Kembali Karotenoid dari Minyak Sawit : Suatu Tinjauan

2016 ◽  
Vol 9 (1) ◽  
pp. 80-95
Author(s):  
Agus Sudibyo ◽  
Sardjono Sardjono
Keyword(s):  
Vitamin A ◽  
Palm Oil ◽  
Beta Carotene ◽  
Cost Effective ◽  
Raw Material ◽  
Extraction And Separation ◽  
Molecular Product ◽  
Industrial Use ◽  
Palm Oil Mill ◽  
Selection Of

Crude palm oil (CPO)is the richest natural plant source of carotenoids in terms of retinol (pro-vitamin A) equivalent, whereas palm oil mill effluent (POME) is generated from palm oil industry that contains oil and carotenes that used to be treated before discharge. Carotenoids are importance in animals and humans for the purpose of the enhancement of immune response, conversion of vitamin A and scavenging of oxygen radicals. This component has different nutritional  functions and benefits to humaan health. The growing interest in the other natural sources of beta-carotene and growing awareness to prevent pollution has stimulated the industrial use of CPO and POME as a raw material for carotenoids extraction. Various technologies of extraction and separation have been developed in order to recover of carotenoids.This article reports on various technologies that have been developed in order to recover of carotenoids from being destroyed in commercial refining of palm oil and effects of some various treatments on the extraction end separation for carotenoid from palm oil and carotenoids concentration. Principally, there are different technologies, and there is one some future which is the use of solvent. Solvent plays important role  in the most technologiest, however the problem of solvents which are used is that they posses potentiaal fire health and environmental hazards. Hence selection of the  most safe, environmentally friendly and cost effective solvent is important to design of alternative extraction methods.Chemical molecular product design is one of the methods that are becoming more popular nowadays for finding solvent with the desired properties prior to experimental testing.ABSTRAKMinyak sawit kasar merupakan sumber karotenoid terkaya yang berasal dari tanaman sawit sebagai senyawa yang sama dengan retinol atau pro-vitamin A; sedangkan limbah pengolahan minyak sawit dihasilkan dari industri pengolahan minyak sawit yang berisi minyak dan karotene yang perlu diberi perlakuan terlebih dahulu sebelum dibuang. Karotenoid merupakan bahan penting yang diperlukan pada hewan dan manusia guna memperkuat tanggapan terhadap kekebalan, konversi ke vitamin A dan penangkapan gugus oksigen radikal. Dengan berkembangnya ketertarikan dalam mencari beta-karotene yang bersumber dari alam lain dan meningkatnya kesadaran untuk mencegah adanya pencemaran lingkungan, maka mendorong suatu industri untuk menggunakan CPO dan POME sebagai bahan baku untuk diekstrak karotenoidnya. Berbagai macam teknologi guna mengekstrak dan memisahkan karotenoid telah dikembangkan untuk mendapatkan kembali karotenoidnya. Makalah ini melaporkan dan membahas berbagai jenis teknologi yang telah dikembangkan guna mendapatkan kembali senyawa karotenoid dari kerusakan di dalam proses pemurnian minyak sawit secara komersial dan pengaruh beberapa perlakuan terhadap ekstrasi dan pemisahan karotenoid dari minyak sawit dan konsentrasi karotenoidnya. Pada prinsipnya, berbagai teknologi yang digunakan untuk mengekstrak dan memisahkan karotenoid terdapat perbedaan, dan terdapat salah satu teknologi yang digunakan untuk esktrasi dan pemisahan karotenoid adalah menggunakan bahan pelarut. Pelarut yang digunakan mempunyai peranan yang penting dalam teknologi ekstrasi; namun pelarut yang digunakan untuk mengekstrak tersebut mempunyai persoalan karena berpotensi mengganggu kesehatan dan membahayakan cemaran lingkungan. Oleh karena itu, pemilihan jenis teknologi yang aman, ramah terhadap lingkungan dan biaya yang efektif untuk penggunaan pelarut merupakan hal penting sebelum dilakukan desain metode/teknologi alternatif untuk esktrasi karotenoid. Pola produk molekuler kimia merupakan salah satu metode yang saat ini menjadi lebih populer untuk mencari pelarut dengan sifat-sifat yang dikehendaki sebelum diujicobakan. Kata kunci :    karotenoid, ekstrasi, pemisahan, teknologi, minyak sawit kasar, limbah industri pengolahan sawit.

scholarly journals Design Considerations and Selection of Cost-Effective Switched Reluctance Drive for Radiator Cooling Fans

Electronics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 917
Author(s):  
Ickjin Son ◽  
Grace Firsta Lukman ◽  
Mazahir Hussain Shah ◽  
Kwang-Il Jeong ◽  
Jin-Woo Ahn
Keyword(s):  
Low Cost ◽  
Cost Effective ◽  
Magnetic Characteristics ◽  
Switched Reluctance Motors ◽  
Switched Reluctance ◽  
Design Considerations ◽  
Cooling Fan ◽  
Cooling Fans ◽  
Power Switches ◽  
Selection Of

Switched reluctance motors (SRMs) are simple in structure, easy to manufacture, magnet-less, brushless, and highly robust compared to other AC motors which makes them a good option for applications that operate in harsh environment. However, the motor has non-linear magnetic characteristics, and it comes with various pole-phase combinations and circuit topologies that causes many difficulties in deciding on which type to choose. In this paper, the viability of SRM as a low-cost, rugged machine for vehicle radiator cooling fan is considered. First, necessary design considerations are presented, then three commonly use types of SRM are analyzed: A 3-phase 6/4, 3-phase 12/8, and a 4-phase 8/6 to find their static and dynamic characteristics so the most suitable type can be selected. Simulation results show that the 8/6 SRM produces the highest efficiency with less phase current which reduces the converter burden. However, with asymmetric half bridge converter, eight power switches are required for 8/6 SRM and thus put a burden on the overall drive cost. As a solution, the Miller converter with only six switches for four phase SRM. To verify the proposed idea, the 8/6 SRM was manufactured and tested. The results show that Miller converter can be used for the proposed SRM with slightly reduced efficiency at 80.4%.

scholarly journals Active Surveillance of Small Renal Masses: A Systematic Review

Kidney Cancer ◽  
2021 ◽  
pp. 1-14
Author(s):  
Elizabeth E. Ellis ◽  
Edward Messing
Keyword(s):  
Active Surveillance ◽  
Meta Analysis ◽  
Cost Effective ◽  
Management Approach ◽  
Small Renal Masses ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Review Current ◽  
Delayed Intervention

Background: Our goal is to review current literature regarding active surveillance (AS) of small renal masses (SRMs) and identify trends in survival outcomes, factors that predict the need for further intervention, and quality of life (QOL). Methods: We performed a comprehensive literature search in PubMed and EMBASE and identified 194 articles. A narrative summary was performed in lieu of a meta-analysis due to the heterogeneity of selected studies. Results: Seventeen articles were chosen to be featured in this review. Growth rate (GR) was not an accurate predictor of malignancy, although it was the characteristic most commonly used to trigger delayed intervention (DI). The mean 5-year overall survival (OS) of all studies was 73.6% ±1.7% for AS groups. The combined cancer specific survival (CSS) for AS is 97.1% ±0.6% , compared to 98.6% ±0.4% for the primary intervention (PI) groups, (p = 0.038). Conclusions: Short and intermediate-term data demonstrate that AS with the option for DI is a management approach whose efficacy (in terms of CSS) approaches that of PI at 5 years, is cost effective, and prevents overtreatment, especially in patients with significant comorbidities.

scholarly journals Is it possible to estimate the need for surgical management in patients with a tubo-ovarian abscess at admission? A retrospective long-term analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Murat Gözüküçük ◽  
Esra Gülen Yıldız
Keyword(s):  
Surgical Treatment ◽  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Medical Treatment ◽  
Length Of Hospital Stay ◽  
Treatment Modalities ◽  
Laboratory Findings ◽  
Factors Affecting ◽  
Laboratory Infection ◽  
Major Factors

Abstract Background This study aimed to determine the possible prognostic factors correlated with the treatment modalities of tubo-ovarian abscesses (TOAs) and thus to assess whether the need for surgery was predictable at the time of initial admission. Materials and methods Between January 2012 and December 2019, patients who were hospitalized with a TOA in our clinic were retrospectively recruited. The age of the patients, clinical and sonographic presentation, pelvic inflammatory risk factors, antibiotic therapy, applied surgical treatment, laboratory infection parameters, and length of hospital stay were recorded. Results The records of 115 patients hospitalized with a prediagnosis of TOA were reviewed for the current study. After hospitalization, TOA was ruled out in 19 patients, and data regarding 96 patients was included for analysis. Twenty-eight (29.2%) patients underwent surgical treatment due to failed antibiotic therapy. Sixty-eight (70.8%) were successfully treated with parenteral antibiotics. Medical treatment failure and need for surgery were more common in patients with a large abscess (volume, > 40 cm3, or diameter, > 5 cm). The group treated by surgical intervention was statistically older than the patients receiving medical treatment (p < 0.05). Conclusions Although the treatment in TOA may vary according to clinical, sonographic, and laboratory findings; age of patients, the abscess size, and volume were seen as the major factors affecting medical treatment failure. Moreover, TOA treatment should be planned on a more individual basis.

Selecting Sanitation Solutions for Peri-urban Areas: A Case Study of Can Tho, Vietnam

2010 ◽  
Vol 5 (4) ◽  
Author(s):  
Naomi Carrard ◽  
Juliet Willetts ◽  
Cynthia Mitchell ◽  
Mick Paddon ◽  
Monique Retamal
Keyword(s):  
Urban Areas ◽  
Cost Effective ◽  
Asset Replacement ◽  
Fit For Purpose ◽  
Infrastructure Investments ◽  
Sanitation Systems ◽  
Can Tho City ◽  
Sustainable Futures ◽  
Sanitation Infrastructure ◽  
Selection Of

In peri-urban areas where infrastructure investments have not yet been made, there is a need to determine the most context-appropriate, fit for purpose and sustainable sanitation solutions. Decision makers must identify the optimal system scale (on the spectrum from centralized to community to cluster scale) and assess the long-term costs and socio-economic/environmental impacts associated with different options. Addressing both cost-effectiveness and sustainability are essential to ensure that institutions and communities are able to continue to bear the costs and management burden of infrastructure operation, maintenance and asset replacement. This paper describes an approach to sanitation planning currently being undertaken as a research study in Can Tho City in southern Vietnam, by the Institute for Sustainable Futures and Can Tho University in collaboration with Can Tho Water Supply and Sewerage Company. The aim of the study is to facilitate selection of the most context-appropriate, fit for purpose, cost effective and sustainable sanitation infrastructure solution. As such, the study compares a range of sanitation alternatives including centralized, decentralized (at household or cluster scale) and resource recovery options. This paper provides an overview of the study and considers aspects of the Can Tho and Vietnamese regulatory, development and institutional context that present drivers and challenges for comparison of options and selection of fit for purpose sanitation systems.

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