scholarly journals Sugammadex compared with Neostigmine/Glycopyrrolate: An Analysis of Total PACU Time, Responsiveness, and Potential for Economic Impact

2019 ◽  
Vol 10 (3) ◽  
pp. 1
Author(s):  
Kayla Leigh Money ◽  
Yoon Jung Lee ◽  
Amber Elliott
Keyword(s):  
Neuromuscular Blockade ◽  
Acquisition Cost ◽  
Cost Savings ◽  
Future Research ◽  
Original Research ◽  
Potential Cost ◽  
Average Decrease ◽  
Article Type ◽  
Patient Responsiveness ◽  
Pacu Stay

Studies have previously shown sugammadex works faster and more effectively than neostigmine/glycopyrrolate at reversal of neuromuscular blockade by rocuronium and vecuronium. The purpose of this quality improvement study was to evaluate for differences in patient time spent in the operating room (OR), post-anesthesia care unit (PACU), and patient responsiveness between the sugammadex and neostigmine/glycopyrrolate groups at a small surgical center. Additionally, a cost analysis was conducted to assess potential savings associated with sugammadex use, taking into account the differences in OR time, PACU time, and medication acquisition cost. We conducted a prospective analysis of OR time, PACU time, and responsiveness for a total of 152 patients, 76 patients receiving neostigmine/glycopyrrolate and 76 patients receiving sugammadex, undergoing planned surgery over an 8-week period. We identified an average decrease in total OR time of 6 minutes in the sugammadex group (neostigmine/glycopyrrolate [Mean: 86 min, Median: 77 min, Range 32-211 min] vs sugammadex [Mean: 80 min, Median: 77 min, Range 40-150 min]). Furthermore, there was an average decrease in total PACU time of 6 minutes in the sugammadex group (neostigmine/glycopyrrolate [Mean: 60 min, Median: 56 min, Range 32-154 min] vs sugammadex [Mean: 54 min, Median: 51 min, Range: 28-94 min]). Additionally, the percent of patients fully awake at the end of PACU stay was higher in the sugammadex group than the neostigmine/glycopyrrolate group (86% vs 79% respectively). Cost was evaluated for generating hypotheses. The additional cost of using sugammadex was estimated at $77 per person when compared to neostigmine/glycopyrrolate. However, if the use of sugammadex decreased the time in OR and PACU by an average of 12 minutes per patient, it is possible that it could provide a potential savings of $579 per patient after estimating a soft savings of reduced OR, PACU, and staff time. Overall cost saving per patient with sugammadex, which was calculated after subtracting additional medication acquisition cost, is $502. It is possible that if this value is extrapolated to 988 patients, this might suggest a potential cost savings of $495,976 per year. We hope this study provokes future research to determine if Sugammadex is a potentially viable economical option for the routine reversal of neuromuscular blockade.   Article Type: Original Research

scholarly journals Constrained Urban Airspace Design for Large-Scale Drone-Based Delivery Traffic

Aerospace ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 38
Author(s):  
Malik Doole ◽  
Joost Ellerbroek ◽  
Victor L. Knoop ◽  
Jacco M. Hoekstra
Keyword(s):  
Traffic Congestion ◽  
Urban Areas ◽  
Large Scale ◽  
Cost Savings ◽  
Future Research ◽  
Fast Time ◽  
Potential Cost ◽  
Horizontal Structure ◽  
Traffic Demand ◽  
Demand Patterns

Large-scale adoption of drone-based delivery in urban areas promise societal benefits with respect to emissions and on-ground traffic congestion, as well as potential cost savings for drone-based logistic companies. However, for this to materialise, the ability of accommodating high volumes of drone traffic in an urban airspace is one of the biggest challenges. For unconstrained airspace, it has been shown that traffic alignment and segmentation can be used to mitigate conflict probability. The current study investigates the application of these principles to a highly constrained airspace. We propose two urban airspace concepts, applying road-based analogies of two-way and one-way streets by imposing horizontal structure. Both of the airspace concepts employ heading-altitude rules to vertically segment cruising traffic according to their travel direction. These airspace configurations also feature transition altitudes to accommodate turning flights that need to decrease the flight speed in order to make safe turns at intersections. While using fast-time simulation experiments, the performance of these airspace concepts is compared and evaluated for multiple traffic demand densities in terms of safety, stability, and efficiency. The results reveal that an effective way to structure drone traffic in a constrained urban area is to have vertically segmented altitude layers with respect to travel direction as well as horizontal constraints imposed to the flow of traffic. The study also makes recommendations for areas of future research, which are aimed at supporting dynamic traffic demand patterns.

scholarly journals The Potential of Blockchain in Building Construction

Buildings ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. 77 ◽  
Author(s):  
Zakaria Dakhli ◽  
Zoubeir Lafhaj ◽  
Alan Mossman
Keyword(s):  
Transaction Costs ◽  
No Value ◽  
Significant Proportion ◽  
Cost Savings ◽  
Future Research ◽  
Potential Cost ◽  
Client Group ◽  
Blockchain Technology ◽  
The Uk ◽  
Real Estate Company

Construction customers want more complex facilities delivered faster and at a lower cost. Transaction costs account for a significant proportion of each new or refurbished facility (a 2017 report from the Infrastructure Client Group in the UK suggests as high as 50%), yet they contribute no value to the customer. Blockchain is being suggested as a way to reduce transaction costs by eliminating the need for intermediaries to build trust as a prerequisite for successfully executed agreements. This study first describes the thinking that underpins blockchain technology, outlining how it works, and the potential limitations of the technology. Second, using a case study, reviews the potential cost savings from the use of blockchain for a real estate company. The results reveal a potential cost savings from blockchain deployment at 8.3% of the total cost of residential construction, with a standard deviation of 1.26%. Third, we explore the implications, risks and applications of blockchain technology for improving flow in the end-to-end design and construction process and we identify opportunities for future research on blockchain applications in construction.

Understanding the absence of renewable electricity imports to the European Union

2016 ◽  
Vol 10 (3) ◽  
pp. 291-311 ◽  
Author(s):  
Johan Lilliestam ◽  
Saskia Ellenbeck ◽  
Charikleia Karakosta ◽  
Natàlia Caldés
Keyword(s):  
European Union ◽  
Energy Policy ◽  
Public Discourse ◽  
Cost Savings ◽  
Macro Level ◽  
Future Research ◽  
The European Union ◽  
Renewable Electricity ◽  
Potential Cost ◽  
Content Type

Purpose This paper aims to analyse reasons for the absence of renewable electricity (RE) imports to the European Union, for which the authors develop a multi-level heuristic. Design/methodology/approach The heuristic covers three sequential acceptance levels: political attractiveness (macro-level), the “business case” (micro-level) and civil society perspectives (public discourse level). Findings Numerous factors on all three levels determine the success/demise of renewables trade. So far, trade has failed on the macro-level, because European policymakers perceive that targets can be achieved domestically with significant co-benefits and because exporter countries have rapidly increasing electricity demand, limiting the realisable exports. As policymakers deemed it unattractive, they have not implemented policy-supported business cases. Public opposition against trade has not been an issue as no concrete plans or projects have been proposed. Research limitations/implications The authors show that the factors determining whether a RE programme is successful are plentiful and extend far beyond potential cost savings. This suggests that future research and the energy policy debate should better account for how cost savings are weighed against other policy aims and explicitly include the perspectives of investors and the public. Originality/value This paper adds the first holistic analysis of success/failure factors for RE trade to Europe. The three-level, sequential framework is new to energy policy analysis.

scholarly journals Consumer Reports - Best Buy Drugs' Outreach Project in Minnesota

2013 ◽  
Vol 4 (2) ◽  
Author(s):  
Jon C. Schommer ◽  
Marcia M. Worley ◽  
Stephen Schondelmeyer
Keyword(s):  
Information Seeking ◽  
Drug Information ◽  
Cost Savings ◽  
Original Research ◽  
Potential Cost ◽  
Face To Face ◽  
Telephone Interviews ◽  
Consumer Reports ◽  
Almost All ◽  
Evaluation Survey

The objectives for this study were to apply four different approaches for disseminating Consumer Reports Best Buy Drugs (CR-BBD) information about effectiveness, safety, and cost to patients for therapeutic classes of medications that they were using and then (1) evaluate the usefulness of the information to participants and (2) document resultant information seeking. For the three approaches that utilized face-to-face contact (Approaches 2 through 4), we also compared them in terms of (1) number of medications reviewed per person, (2) availability of CR-BBD information per person, (3) changes that could be made for each person, and (4) potential/likely cost savings (per person per month). Finally, we described the availability of CR-BBD information for each participant categorized by the 19 therapeutic classes of medications for which there were Best Buy Drugs reports. Data were collected via self-administered surveys, in-person interviews, and telephone interviews. The results showed that almost all of the participants in the information sessions held for this study had at least one medication for which Best Buy Drug information was available with significant savings potential to be gained by using the recommended Best Buy Drug. Potential cost savings through the use of recommended Best Buy Drugs was $89.47 per person per month averaged over all participants (n = 172) and was $157.20 per person per month for those with savings over zero dollars (n = 98). Thirty-two percent of respondents to our evaluation survey reportedly sought more information from a physician and 30 percent sought more information from a pharmacist. We concluded that provision of information about effectiveness, safety, and cost to patients has the potential for achieving significant cost savings. Recommendations regarding (1) the timing of provision, (2) targeting of recipients and (3) traversing impediments are given.   Type: Original Research

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.

Improved Oxygen Dissolution Control for Oxygen Activated Sludge

1988 ◽  
Vol 20 (4-5) ◽  
pp. 101-108 ◽  
Author(s):  
R. C. Clifft ◽  
M. T. Garrett
Keyword(s):  
Activated Sludge ◽  
Control Method ◽  
Control Strategies ◽  
Cost Savings ◽  
Utilization Efficiency ◽  
Oxygen Production ◽  
Oxygen Utilization ◽  
Potential Cost ◽  
Oxygen Dissolution ◽  
The City

Now that oxygen production facilities can be controlled to match the requirements of the dissolution system, improved oxygen dissolution control can result in significant cost savings for oxygen activated sludge plants. This paper examines the potential cost savings of the vacuum exhaust control (VEC) strategy for the City of Houston, Texas 69th Street Treatment Complex. The VEC strategy involves operating a closed-tank reactor slightly below atmospheric pressure and using an exhaust apparatus to remove gas from the last stage of the reactor. Computer simulations for one carbonaceous reactor at the 69th Street Complex are presented for the VEC and conventional control strategies. At 80% of design loading the VEC strategy was found to provide an oxygen utilization efficiency of 94.9% as compared to 77.0% for the conventional control method. At design capacity the oxygen utilization efficiency for VEC and conventional control was found to be 92.3% and 79.5%, respectively. Based on the expected turn-down capability of Houston's oxygen production faciilities, the simulations indicate that the VEC strategy will more than double the possible cost savings of the conventional control method.

Cost-minimization analysis of drugs used in the treatment of Asthma and COPD diseases in India

2020 ◽  
Vol 15 ◽  
Author(s):  
Billu Payal ◽  
Anoop Kumar ◽  
Harsh Saxena
Keyword(s):  
Generic Drugs ◽  
Cost Minimization ◽  
Cost Savings ◽  
Chronic Obstructive ◽  
Pulmonary Medicine ◽  
Potential Cost ◽  
Maximum Cost ◽  
Cost Minimization Analysis ◽  
Cost Variation ◽  
The Cost

Background: Asthma and Chronic Obstructive Pulmonary Diseases (COPD) are well known respiratory diseases affecting millions of peoples in India. In the market, various branded generics, as well as generic drugs, are available for their treatment and how much cost will be saved by utilizing generic medicine is still unclear among physicians. Thus, the main aim of the current investigation was to perform cost-minimization analysis of generic versus branded generic (high and low expensive) drugs and branded generic (high expensive) versus branded generic (least expensive) used in the Department of Pulmonary Medicine of Era Medical University, Lucknow for the treatment of asthma and COPD. Methodology: The current index of medical stores (CIMS) was referred for the cost of branded drugs whereas the cost of generic drugs was taken from Jan Aushadi scheme of India 2016. The percentage of cost variation particularly to Asthma and COPD regimens on substituting available generic drugs was calculated using standard formula and costs were presented in Indian Rupees (as of 2019). Results: The maximum cost variation was found between the respules budesonide high expensive branded generic versus least expensive branded generic drugs and generic versus high expensive branded generic. In combination, the maximum cost variation was observed in the montelukast and levocetirizine combination. Conclusion: In conclusion, this study inferred that substituting generic antiasthmatics and COPD drugs can bring potential cost savings in patients.

scholarly journals Opportunities and Challenges of Green-Lean: An Integrated System for Sustainable Construction

2020 ◽  
Vol 12 (11) ◽  
pp. 4460 ◽  
Author(s):  
Mohammadsoroush Tafazzoli ◽  
Ehsan Mousavi ◽  
Sharareh Kermanshachi
Keyword(s):  
Cost Savings ◽  
Integrated Approach ◽  
Integrated System ◽  
Waste Minimization ◽  
Sustainable Construction ◽  
Future Research ◽  
Safety Improvement ◽  
The Individual ◽  
High Level ◽  
Industry Professionals

Although the two concepts of lean and sustainable construction have been developed due to different incentives, and they do not pursue the same exact goals, there exists considerable commonality between them. This paper discusses the potentials for integrating the two approaches and their practices and how the resulting synergy from combining the two methods can potentially lead to higher levels of fulfilling the individual goals of each of them. Some limitations and challenges to implementing the integrated approach are also discussed. Based on a comprehensive review of existing papers related to sustainable and lean construction topics, the commonality between the two approaches is discussed and grouped in five categories of (1) cost savings, (2) waste minimization, (3) Jobsite safety improvement, (4) reduced energy consumption, and (5) customers’ satisfaction improvement. The challenges of this integration are similarly identified and discussed in the four main categories of (1) additional initial costs to the project, (2) difficulty of providing specialized expertise, (3) contractors’ unwillingness to adopt the additional requirements, and (4) challenges to establish a high level of teamwork. Industry professionals were then interviewed to rank the elements in each of the two categories of opportunities and challenges. The results of the study highlight how future research can pursue the development of a new Green-Lean approach by investing in the communalities and meeting the challenges of this integration.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

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