scholarly journals Cost comparison of different treatment approaches of dacryocystitis and dacrocystocele

2020 ◽  
Vol 12 ◽  
pp. 251584142092628
Author(s):  
Erin G. Sieck ◽  
Leonid Zukin ◽  
Jennifer L. Patnaik ◽  
Anne M. Lynch ◽  
Peggy Kelley ◽  
...  
Keyword(s):  
Chart Review ◽  
Low Cost ◽  
Operating Time ◽  
Cost Benefit ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Nasolacrimal Duct ◽  
Cost Comparison ◽  
Nasal Endoscopy ◽  
Surgical Approaches

Purpose: Congenital dacrocystocele with potential for dacryocystitis are common ophthalmic findings in children. There are multiple surgical approaches to open the mucocele. In this study, we look at the financial impact of these different approaches. Methods: A retrospective chart review of 17 patients with dacrocystocele or dacryocystitis was performed. We examined four approaches: (1) bedside nasal endoscopy with marsupialization of nasolacrimal duct (NLD) cyst, (2) surgically performed nasal endoscopy with marsupialization of NLD cyst, (3) NLD probe, and (4) a combination of procedures. Cost of the procedure and length of anesthesia were collected. Reoccurrence of symptoms and disease post-procedure were also collected. Results: The lowest cost billed procedure was bedside nasal endoscopy performed by an otolaryngologist (US$435; n = 1). A nasal endoscopy ( n = 2) performed in the operating room (OR) had an average OR fee of US$14,557 [standard deviation (SD): US$7598] for 108.5 (SD: 87.0) min of operating time. An NLD probe ( n = 5) performed by pediatric ophthalmologists resulted in an average OR fee of US$5540 (SD: US$1752) for 31.0 min (SD: 8.6 min) of operating time. A combination of both nasal endoscopy and NLD probing ( n = 9) had an average OR fee US$10,325 (SD: US$4137) for 69 min (SD: 34.5 min) of operating time. Conclusion: This is the first study looking at cost benefit of four different approaches to treating dacrocystoceles/dacryocystitis. A NLD probe was a low-cost OR intervention and had the shortest operating time. The combination procedure was more cost-effective than nasal endoscopy or NLD probing alone.

scholarly journals Study and Implementation of a Cost-Effective 3L-Active Rectifier for DC Collection in WECS

2019 ◽  
Vol 118 ◽  
pp. 02065
Author(s):  
Muhammad Luqman ◽  
Gang Yao ◽  
Lidan Zhou ◽  
Di Yang ◽  
Anil Lamichhane
Keyword(s):  
Low Cost ◽  
Cost Effective ◽  
Cost Comparison ◽  
Multilevel Converters ◽  
Wind Generators ◽  
Active Rectifier ◽  
Vienna Rectifier ◽  
Three Phase ◽  
Control Scheme ◽  
Parallel Configuration

Power electronic converters are widely used in wind energy conversion system (WECS) applications. Therefore, with the increasing manufacturing capacity of multi-MW wind generators, multi-level converters, or parallel configuration of converters are becoming more attractive solutions towards DC collection from the wind generator. Among the multilevel converters, three-level full-scale neutral point diode clamped (3L-NPC) converter are using extensively for such applications in order to reduce the voltage stress on the semiconductor devices. In this article, a comparative study based on several devices used by NPC, capacitor clamped (CC) as well as Vienna rectifier has been done. Furthermore, their estimated cost comparison and complexity of control switches have been debated. By keeping in view the merits and demerits of these rectifiers, a low cost three-level active rectifier having a smaller number of active switches with a simple control scheme have been implemented. Considering a three-phase electric grid as a generated source, a 2.2KW low-cost three-level Vienna rectifier is simulated using MATLAB/Simulink. DSP (TMS320F28335) based experimental results ratify the simulated circuit with THD<5%.

Nasolacrimal duct tumours in the era of endoscopic dacryocystorhinostomy: literature review

2013 ◽  
Vol 127 (7) ◽  
pp. 670-675 ◽  
Author(s):  
F Tanweer ◽  
K Mahkamova ◽  
P Harkness
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Chart Review ◽  
Case Reports ◽  
Retrospective Chart Review ◽  
Malignant Tumour ◽  
Nasolacrimal Duct ◽  
Solitary Fibrous Tumour ◽  
Endoscopic Dacryocystorhinostomy ◽  
Service Framework

AbstractBackground:Nasolacrimal duct tumours are rare and are often found inadvertently during dacryocystorhinostomy. Anecdotal case reports have been published, mostly in ophthalmology journals. Since the era of endoscopic dacryocystorhinostomy, such cases are more frequently encountered by ENT surgeons.Method:This paper reports a retrospective chart review of patients who underwent endoscopic dacryocystorhinostomy over the last 10 years in our dedicated epiphora clinic. It also provides a systematic literature review of nasolacrimal duct tumour cases published in English over the last 16 years.Results:Four of 525 endoscopic dacryocystorhinostomy procedures exposed a tumour (inverted papilloma, oncocytoma, lymphoma and solitary fibrous tumour). The literature review revealed 118 published case reports. Papilloma was the most frequently reported benign tumour and lymphoma was the most common malignant tumour.Conclusion:Since the advent of endoscopic dacryocystorhinostomy, tumours are being diagnosed relatively early when smaller in size. Because of the rarity of this condition, it is advisable that such cases are managed through a dedicated epiphora service framework.

Orbital Complications in Functional Endoscopic Sinus Surgery

1993 ◽  
Vol 109 (5) ◽  
pp. 814-820 ◽  
Author(s):  
Jacquelynne P. Corey ◽  
Robert Bumsted ◽  
William Panje ◽  
Ari Namon
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Nasolacrimal Duct ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Previous Surgery ◽  
Steroid Use ◽  
Orbital Complications ◽  
Lateral Canthotomy

Endoscopic sinus surgery can result in both minor and major complications. Among these, orbital complications—including retroorbital hematoma—are among the most feared. Injuries can be direct or indirect from pulling on diseased structures. A retrospective chart review of 616 endoscopic sinus procedures revealed eight orbital complications in seven patients. These included two medial rectus injuries, five orbital hemorrhages, and one nasolacrimal duct injury. Predisposing factors may include hypertension, lamina papyracia dehiscences, extensive polypoid disease, previous surgery, inability to visualize the maxillary ostia, violent coughing or sneezing, and chronic steroid use. Suggested management in the literature includes lateral canthotomy, steroids, and mannitol with ophthalmologic consultation. Opening of the wound by means of an external ethmoidectomy incision has also been suggested. We suggest that adding orbital decompression by means of multiple incisions into the periorbita should be added for fully effective relief. A “management” tree of decision parameters relevant to orbital complications is presented.

scholarly journals 3D Printing of Rapid, Low-Cost and Patient-Specific Models of Brain Vasculature for Use in Preoperative Planning in Clipping of Intracranial Aneurysms

2021 ◽  
Vol 10 (6) ◽  
pp. 1201
Author(s):  
Maciej Błaszczyk ◽  
Redwan Jabbar ◽  
Bartosz Szmyd ◽  
Maciej Radek
Keyword(s):  
3D Visualization ◽  
Low Cost ◽  
Cost Benefit ◽  
Image Data ◽  
Cost Effective ◽  
3D Models ◽  
Urgent Care ◽  
Patient Specific ◽  
Stl File ◽  
3D Printed

We developed a practical and cost-effective method of production of a 3D-printed model of the arterial Circle of Willis of patients treated because of an intracranial aneurysm. We present and explain the steps necessary to produce a 3D model from medical image data, and express the significant value such models have in patient-specific pre-operative planning as well as education. A Digital Imaging and Communications in Medicine (DICOM) viewer is used to create 3D visualization from a patient’s Computed Tomography Angiography (CTA) images. After generating the reconstruction, we manually remove the anatomical components that we wish to exclude from the print by utilizing tools provided with the imaging software. We then export this 3D reconstructions file into a Standard Triangulation Language (STL) file which is then run through a “Slicer” software to generate a G-code file for the printer. After the print is complete, the supports created during the printing process are removed manually. The 3D-printed models we created were of good accuracy and scale. The median production time used for the models described in this manuscript was 4.4 h (range: 3.9–4.5 h). Models were evaluated by neurosurgical teams at local hospital for quality and practicality for use in urgent and non-urgent care. We hope we have provided readers adequate insight into the equipment and software they would require to quickly produce their own accurate and cost-effective 3D models from CT angiography images. It has become quite clear to us that the cost-benefit ratio in the production of such a simplified model is worthwhile.

scholarly journals Curating Local Knowledge: Experimental Evidence from Small Retailers in Indonesia

2021 ◽  
Author(s):  
Patricio S Dalton ◽  
Julius Rüschenpöhler ◽  
Burak Uras ◽  
Bilal Zia
Keyword(s):  
Cost Benefit Analysis ◽  
Low Cost ◽  
Cost Benefit ◽  
Cost Effective ◽  
Business Practices ◽  
Performance Improvements ◽  
Effective Manner ◽  
Behavioral Constraints ◽  
And Performance ◽  
Outstanding Question

Abstract Business practices and performance vary widely across businesses within the same sector. A key outstanding question is why profitable practices do not readily diffuse. We conduct a field experiment among urban retailers in Indonesia to study whether alleviating informational and behavioral frictions can facilitate such diffusion in a cost-effective manner. Through quantitative and qualitative fieldwork, we curate a handbook that associates locally relevant practices with performance, and provides idiosyncratic implementation guidance informed by exemplary local retailers. We complement this handbook with two light-touch interventions to facilitate behavior change. A subset of retailers is invited to a documentary movie screening featuring the paths to success of exemplary peers. Another subset is offered two 30 minute personal visits by a local facilitator. A third group is offered both. Eighteen months later, we find significant impacts on practice adoption when the handbook is coupled with the two behavioral nudges, and up to a 35% increase in profits and 16.7% increase in sales. These findings suggest both informational and behavioral constraints are at play. The types of practices adopted map the performance improvements to efficiency gains rather than other channels. A simple cost-benefit analysis shows such locally relevant knowledge can be codified and scaled successfully at relatively low cost.

Clinical findings and interventions in cancer patients referred to a cachexia clinic (CC)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20551-e20551
Author(s):  
Z. Nooruddin ◽  
D. Hui ◽  
S. Dalal ◽  
E. Bruera ◽  
E. Del Fabbro
Keyword(s):  
Weight Loss ◽  
Low Cost ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Median Number ◽  
Clinical Findings ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Effective Interventions ◽  
Secondary Causes

e20551 Background: The cancer-related anorexia/cachexia syndrome is primarily caused by an aberrant inflammatory response and neurohormonal dysfunction. Secondary causes that contribute to diminished nutrient intake include early satiety, constipation, nausea, vomiting, mood alterations, dysgeusia, and dysphagia. We determined the frequency and management of both secondary cachexia causes and metabolic/endocrine alterations in a new CC at a Comprehensive Cancer Center. Methods: We conducted a retrospective chart review of 159 consecutive patients who underwent structured assessments at the CC. Demographics, weight loss, secondary causes and specific treatments were analyzed. Results: The patients had the following characteristics: median age 59, females 39%, median body mass index 20.3, median weight loss over the preceding 3 months 7%, and hypoalbuminemia 76%. At consultation, 102 (64%) were on chemotherapy/radiation and 13 (8%) were on enteral or parenteral nutrition. Appetite stimulants prior to consult included megestrol (n=36, 22%), corticosteroids (n=21, 13%) and dronabinol (n=10, 6%). The median number of secondary causes was 3 (Q1-Q3 2–4), with a median of 2 (Q1-Q3 1–3) interventions per patient. 22 (14%), 105 (66%) and 32 (20%) patients had 0–1, 2–4 and 5–8 secondary cachexia causes, respectively. The table lists the significant findings and corresponding interventions. 52 (33%) were enrolled onto clinical trials for primary cachexia. Conclusions: A total of 411 treatable secondary cachexia causes and 89 endocrine/metabolic alterations were identified in our cohort. Low cost effective interventions were available for most of the common findings. [Table: see text] No significant financial relationships to disclose.

Syndesmotic Screw Removal in a Clinic Setting Is Safe and Cost-effective

2019 ◽  
Vol 13 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Michelle T. Sugi ◽  
Brandon Ortega ◽  
Lane Shepherd ◽  
Charalampos Zalavras
Keyword(s):  
Operating Room ◽  
Chart Review ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Level Of Evidence ◽  
Superficial Infection ◽  
Syndesmotic Screw ◽  
Level 1 ◽  
Level 1 Trauma Center

Background. There is no consensus in the literature regarding the necessity of syndesmotic screw removal, but the majority of surgeons prefer screw removal in the operating room. Purpose. The aim of this study is to analyze the safety and cost-effectiveness of syndesmotic screw removal in the clinic. Methods. A retrospective chart review was performed on all acute, traumatic ankle fractures that required syndesmotic stabilization over 5 years at a level 1 trauma center. Radiographs were evaluated for maintenance of syndesmotic reduction. Orthopaedic clinic visits and operating room costs were calculated. Results. Of 269 patients, syndesmotic screws were successfully removed in the clinic in 170 patients and retained in 99 patients. Two superficial infections (1.2%) developed following screw removal. The superficial infection rate was 3.3% (2 of 60) in patients who did not receive antibiotics compared with 0% (0 of 110) in patients who received antibiotics (P = .12). No patient lost syndesmotic reduction after screw removal. Cost savings of $13 829 per patient were achieved by syndesmotic screw removal in the clinic. Conclusion. Our study demonstrates that syndesmotic screw removal in the clinic is safe, does not result in tibiofibular diastasis, is cost-effective, and results in substantial financial savings. Level of Evidence: Level IV

scholarly journals Optimizing Costs to Collect Local Infauna through Grabs: Effect of Sampling Size and Replication

Diversity ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 410
Author(s):  
Lidia N. Álvarez ◽  
Sara García-Sanz ◽  
Néstor E. Bosch ◽  
Rodrigo Riera ◽  
Fernando Tuya
Keyword(s):  
Sample Size ◽  
Cost Efficiency ◽  
Low Cost ◽  
Cost Benefit ◽  
Cost Effective ◽  
Wiener Index ◽  
Ecological Studies ◽  
Local Site ◽  
Optimal Sample ◽  
Size Accuracy

Most ecological studies require a cost-effective collection of multi-species samples. A literature review unravelled that (1) large-sized grabs to collect infauna have been used at greater depths, despite no consistent relationship between grab size and replication across studies; and (2) the total number of taxa and individuals is largely determined by the replication. Then, infauna from a sedimentary (sandy) seabed at Gran Canaria Island was collected through van Veen grabs of three sizes: 0.018, 0.042 and 0.087 m2 to optimize, on a simple cost-benefit basis, sample size and replication. Specifically, (1) the degree of representativeness in the composition of assemblages, and (2) accuracy of three univariate metrics (species richness, total infaunal abundances and the Shannon-Wiener index), was compared according to replication. Then, by considering mean times (a surrogate of costs) to process a sample by each grab, (3) their cost-efficiency was estimated. Representativeness increased with grab size. Irrespective of the grab size, accuracy of univariate metrics considerably increased when n > 10 replicates. Costs associated with the 0.087 m2 grab were consistently lower than costs by the other grabs. In conclusion, because of high representativeness and low cost, a 6.87 L grab appears to be the optimal sample size to assess infauna at our local site.

scholarly journals SILS: Is It Cost- and Time-Effective Compared to Standard Pediatric Laparoscopic Surgery?

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Saidul Islam ◽  
Stephen D. Adams ◽  
Anies A. Mahomed
Keyword(s):  
Laparoscopic Surgery ◽  
Operative Time ◽  
Small Sample Size ◽  
Operating Time ◽  
Cost Benefit ◽  
Cost Effective ◽  
Small Sample ◽  
Limiting Factor ◽  
Single Incision Laparoscopic Surgery ◽  
Significant Difference

The aim of the study was to review our experience with single-incision laparoscopic surgery (SILS) and to compare costs and operative time to standard laparoscopic surgery (SLS). A prospectively collected database of operative times and costs was analysed for the years 2008–2011. SILS cases were compared to standard laparoscopy on a procedure-matched basis. Patient demographics, on-table time and consumable costs were collated. Descriptive statistics and Mann-WhitneyU-test were utilized with SPSS for windows. Analysis of the data demonstrate that neither consumable costs nor operative time were significantly different in each group. Comparing operative costs, SILS appendicectomy, nephrectomy/heminephrectomy, and ovarian cystectomy/oophorectomy showed cost benefit over SLS (£397 versus£467;£942 versus£1127;£394 versus£495). A trend toward higher cost for SILS Palomo procedure is noted (£734 versus£400). Operative time for SILS appendicectomy, nephrectomy/heminephrectomy, and Palomo was lower compared to SLS (60 versus 103 minutes[mins.]; 130 versus 60 mins.; 60 versus 80 mins.). In conclusion, SILS appears to be cost-effective for the common pediatric surgical operations. There is no significant difference in operating time in this series, but small sample size is a limiting factor. Studies with larger numbers will be necessary to validate these initial observations.

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