scholarly journals Cost-Consequences Analysis of Increased Utilization of Triple-Chamber-Bag Parenteral Nutrition in Preterm Neonates in Seven European Countries

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2531
Author(s):  
Alexander Kriz ◽  
Antony Wright ◽  
Mattias Paulsson ◽  
Stephen Tomlin ◽  
Venetia Simchowitz ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Clinical Outcomes ◽  
Time Budget ◽  
National Level ◽  
European Countries ◽  
Preterm Neonates ◽  
Full Time ◽  
Consequence Analysis ◽  
Cost Consequence ◽  
The Impact

The safety of parenteral nutrition (PN) remains a concern in preterm neonates, impacting clinical outcomes and health-care-resource use and costs. This cost-consequence analysis assessed national-level impacts of a 10-percentage point increase in use of industry-prepared three-chamber bags (3CBs) on clinical outcomes, healthcare resources, and hospital budgets across seven European countries. A ten-percentage-point 3CB use-increase model was developed for Belgium, France, Germany, Italy, Portugal, Spain, and the UK. The cost-consequence analysis estimated the impact on compounding error harm and bloodstream infection (BSI) rates, staff time, and annual hospital budget. Of 265,000 (52%) preterm neonates, 133,000 (52%) were estimated to require PN. Baseline compounding methods were estimated as 43% pharmacy manual, 16% pharmacy automated, 22% ward, 9% outsourced, 3% industry provided non-3CBs, and 7% 3CBs. A modeled increased 3CB use would change these values to 39%, 15%, 18%, 9%, 3%, and 17%, respectively. Modeled consequences included −11.6% for harm due to compounding errors and −2.7% for BSIs. Labor time saved would equate to 41 specialized nurses, 29 senior pharmacists, 26 pharmacy assistants, and 22 senior pediatricians working full time. Budget impact would be a €8,960,601 (3.4%) fall from €260,329,814 to €251,369,212. Even a small increase in the use of 3CBs in preterm neonates could substantially improve neonatal clinical outcomes, and provide notable resource and cost savings to hospitals.

The Benefits of Parenteral Nutrition (PN) Versus Enteral Nutrition (EN) Among Adult Critically Ill Patients: What is the Evidence? A Literature Review

2019 ◽  
Vol 35 (7) ◽  
pp. 615-626 ◽  
Author(s):  
Angel Joel Cadena ◽  
Sara Habib ◽  
Fred Rincon ◽  
Stephanie Dobak
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Nutrition Support ◽  
Mechanical Ventilation Duration ◽  
The Impact

Malnutrition is frequently seen among patients in the intensive care unit. Evidence shows that optimal nutritional support can lead to better clinical outcomes. Recent clinical trials debate over the efficacy of enteral nutrition (EN) over parenteral nutrition (PN). Multiple trials have studied the impact of EN versus PN in terms of health-care cost and clinical outcomes (including functional status, cost, infectious complications, mortality risk, length of hospital and intensive care unit stay, and mechanical ventilation duration). The aim of this review is to address the question: In critically ill adult patients requiring nutrition support, does EN compared to PN favorably impact clinical outcomes and health-care costs?

The Impact of Perioperative Glutamine-supplemented Parenteral Nutrition on Outcomes of Patients Undergoing Abdominal Surgery: A Meta-analysis of Randomized Clinical Trials

2013 ◽  
Vol 79 (5) ◽  
pp. 506-513 ◽  
Author(s):  
Chao Yue ◽  
Weiliang Tian ◽  
Wei Wang ◽  
Qian Huang ◽  
Risheng Zhao ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Abdominal Surgery ◽  
Parenteral Nutrition ◽  
Hospital Stay ◽  
Clinical Outcomes ◽  
Nitrogen Balance ◽  
Infectious Complication ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Impact

The objective of this study was to evaluate the impact of perioperative glutamine-supplemented parenteral nutrition (GLN-PN) on clinical outcomes in patients undergoing abdominal surgery. MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. Eligible studies were randomized controlled trials (RCTs) that compared the effect of GLN-PN and standard PN on clinical outcomes in patients undergoing abdominal surgery. Clinical outcomes of interest were postoperative mortality, length of hospital stay, morbidity of infectious complication, and cumulative nitrogen balance. Statistical analysis was conducted by RevMan 5.0 software from the Cochrane Collaboration. Sixteen RCTs with 773 patients were included in this meta-analysis. The results showed a significant decrease in the infectious complication rates of patients undergoing abdominal surgery receiving GLN-PN (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.32 to 0.72; P = 0.0004). The overall effect indicated glutamine significantly reduced the length of hospital stay in the form of alanyl-glutamine (weighted mean difference [WMD], -3.17; 95% CI, -5.51 to -0.82; P = 0.008) and in the form of glycyl-glutamine (WMD, -3.40; 95% CI, -5.82 to -0.97; P = 0.006). A positive effect in improving postoperative cumulative nitrogen balance was observed between groups (WMD, 7.40; 95% CI, 3.16 to 11.63; P = 0.0006), but no mortality (RR, 1.52; 95% CI, 0.21 to 11.9; P = 0.68). Perioperative GLN-PN is effective and safe to shorten the length of hospital stay, reduce the morbidity of postoperative infectious complications, and improve nitrogen balance in patients undergoing abdominal surgery.

scholarly journals Impact of external shocks, trends and prospects of non-primary non-energy exports of the Samara region

2021 ◽  
Vol 12 (3) ◽  
pp. 90-101
Author(s):  
Galina A. Khmeleva ◽  
Dmitry V. Abramov ◽  
Marina V. Kurnikova
Keyword(s):  
Global Financial Crisis ◽  
National Level ◽  
Border Region ◽  
European Countries ◽  
Positive Contribution ◽  
Mutual Relations ◽  
Export Destination ◽  
The Global Financial Crisis ◽  
Political Economic ◽  
The Impact

The development of foreign economic activity and the increase in exports and the share of non-primary non-energy exports are the most important tasks for the development of the regional economy. The research contains a retrospective analysis of trade and economic cooperation in the Samara region and an assessment of changes influenced by significant political, economic and global events and phenomena. It has been shown that significant developments since the beginning of the XX century (the global financial crisis of 2008 and the sharp fall in oil prices in 2009, 2015, the imposition of sanctions in 2014, the COVID-19 crisis) have necessitated and state policy has created the conditions for a consistent shift towards the expansion of non-primary non-energy exports. The evaluation showed that the Samara regions economy has entered a new stage of increasing the positive contribution of non-primary non-energy exports. The regions economy has successfully adapted to the impact of economic sanctions, reducing the role of European countries as an export destination and diversifying its export portfolio towards Asia and Africa. The authors have identified fast-growing five-year export countries for which special promotional policies have been proposed. The research has identified certain European countries that, despite the pan-European sanctions policies, are actively recovering exports from the Samara region, as well as European countries where local friendly policies can encourage mutual trade growth. The conclusion was reached that more attention should be paid to the border Kazakhstan, which has recently witnessed a trend towards the cooling of mutual relations at the national level. However, the neighborhood with Kazakhstan makes it impossible to ignore the policy of strengthening friendly relations in order to increase the economic stability and security of the border region of Samara.

scholarly journals The International comparison of Systems of care and patient outcomes In minor Stroke and Tia (InSIST) study: A community-based cohort study

2019 ◽  
Vol 14 (2) ◽  
pp. 186-190 ◽  
Author(s):  
Christopher R Levi ◽  
Daniel Lasserson ◽  
Debbie Quain ◽  
Jose Valderas ◽  
Helen M Dewey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Systems Of Care ◽  
Recurrent Stroke ◽  
Minor Stroke ◽  
Full Time ◽  
Vascular Events ◽  
Processes Of Care ◽  
General Practices ◽  
The Impact

Rationale Rapid response by health-care systems for transient ischemic attack and minor stroke (TIA/mS) is recommended to maximize the impact of secondary prevention strategies. The applicability of this evidence to Australian non-hospital-based TIA/mS management is uncertain. Aims Within an Australian community setting we seek to document processes of care, establish determinants of access to care, establish attack rates and determinants of recurrent vascular events and other clinical outcomes, establish the performance of ABC2-risk stratification, and compare the processes of care and outcomes to those in the UK and New Zealand for TIA/mS. Sample size estimates Recruiting practices containing approximately 51 full-time-equivalent general practitioners to recruit 100 TIA/mS per year over a four-year study period will provide sufficient power for each of our outcomes. Methods and design An inception cohort study of patients with possible TIA/mS recruited from 16 general practices in the Newcastle-Hunter Valley-Manning Valley region of Australia. Potential TIA/mS will be ascertained by multiple overlapping methods at general practices, after-hours collaborative, and hospital in-patient and outpatient services. Participants’ index and subsequent clinical events will be adjudicated as TIA/mS or mimics by an expert panel. Study outcomes Process outcomes—whether the patient was referred for secondary care; time from event to first patient presentation to a health professional; time from event to specialist acute-access clinic appointment; time from event to brain and vascular imaging and relevant prescriptions. Clinical outcomes—recurrent stroke and major vascular events; and health-related quality of life. Discussion Community management of TIA/mS will be informed by this study.

scholarly journals Mean Vitamin D levels in 19 European Countries & COVID-19 Mortality over 10 months

2021 ◽  
Author(s):  
Amar Ahmad ◽  
Christian Heumann ◽  
Raghib Ali ◽  
Tim Oliver
Keyword(s):  
Vitamin D ◽  
National Level ◽  
European Countries ◽  
P Value ◽  
Poor Responders ◽  
Food Fortification ◽  
Mixed Effect ◽  
Initial Report ◽  
Vitamin D Levels ◽  
The Impact

ABSTRACTObjectivesReports early in the epidemic linking low mean national Vitamin D level with increased COVID-19 death, and until recently little research on the impact of Vitamin D deficiency on severity of COVID-19, led to this update of the initial report studying mortality up to the end of January 2021.Methods, Design and SettingCoronavirus pandemic data for 19 European countries were downloaded from Our World in Data, which was last updated on January 24, 2021. Data from March 21, 2020 to January 22, 2021 were included in the statistical analysis. Vitamin-D (25)-HD mean data were collected by literature review. Poisson mixed-effect model was used to model the data.ResultsEuropean countries with Vitamin-D (25)-HD mean less than or equal to 50 have higher COVID-19 death rates as compared with European countries with Vitamin-D (25)-HD mean greater than 50, relative risk of 2.155 (95% CI: 1.068 – 4.347, p-value = 0.032). A statistically significant negative moderate Spearman rank correlation was observed between Vitamin-D (25)-HD mean and the number of COVID-19 deaths for each 14-day period during the COVID-19 pandemic time period.ConclusionsThe observation of the significantly lower COVID-19 mortality rates in countries with lowest annual sun exposure but highest mean Vitamin-D (25)-HD levels provides support for more awareness and possible use of food fortification. The need to consider re-configuring vaccine strategy due to emergence of large number of COVID-19 variants and studies identifying poor responders to Vaccine provides an opportunity to undertake therapeutic randomized control trials to confirm these observations.Strengths of this studyLarge number of different European populations studied with different policies of food fortification and different population Vitamin D levelsTen months of longitudinal study during rise and fall and rise again of the epidemicLimitations of this studyBased on population Vitamin D levels published before the beginning of the pandemic. Though there hasn’t been a pan-European national/international health education initiative about Vitamin D and COVID-19 infection, it has been well covered in the media and could have resulted in changes, though probably minor, at the national level. Because there have been many differences in response to the pandemic in these countries, there could be other factors involved as well

scholarly journals Special Measures for Quality and Challenged Providers: Study Protocol for Evaluating the Impact of Improvement Interventions in NHS Trusts

2019 ◽  
Author(s):  
Naomi Fulop ◽  
Estela Capelas Barbosa ◽  
Melissa Hill ◽  
Jean Ledger ◽  
Christopher Sherlaw-Johnson ◽  
...  
Keyword(s):  
National Level ◽  
Readiness For Change ◽  
Quality Improvements ◽  
Programme Theory ◽  
Quantitative Metrics ◽  
Key Stakeholders ◽  
Cost Consequence ◽  
Improvement Interventions ◽  
The Right ◽  
The Impact

Background: Healthcare organisations in England rated as inadequate in terms of leadership and one other domain enter the Special Measures for Quality (SMQ) regime to receive increased support and oversight. There is also a ‘watch list’ of challenged National Health Service (NHS) providers at risk of going into SMQ that receive support. There is limited knowledge about whether the interventions used to deliver this support drive improvements in quality, their costs, and whether they strike the right balance between support and scrutiny. The study will seek to determine how provider organisations respond to these interventions, and whether and how these interventions impact organisations’ capacity to achieve and sustain quality improvements over time. Methods: This is a multi-site, mixed methods study. We will carry out interviews at national level to understand the programme theory underpinning the interventions. We will conduct 8 NHS case studies to explore the impact and implementation of the interventions that form part of the SMQ and challenged providers programme. We will use a conceptual framework based on models of organisational readiness for change and draw on board maturity research for implementing quality improvement. We will also review the use of quantitative metrics and data for tracking the progress of improvements in quality of care and sustainability upon leaving SMQ, as well as the costs and benefits of the interventions through a cost-consequence analysis (CCA). Discussion: High-quality interventions that successfully support struggling healthcare organisations are essential and an issue that is an international concern. Our study will allow a greater understanding of the programme theory, impact, and staff views and experiences of the SMQ and challenged providers regime. Formative feedback will be reported to key stakeholders

scholarly journals Are fears of an increase in casualization due to Covid-19 justified?

MASKANA ◽  
2020 ◽  
Vol 11 (2) ◽  
pp. 1-4
Author(s):  
Jan Feyen
Keyword(s):  
Higher Education ◽  
National Level ◽  
Full Time ◽  
Tuition Fees ◽  
General Will ◽  
The Public ◽  
The United Kingdom ◽  
Financial Challenges ◽  
Commercial Sources ◽  
The Impact

Will the education sector be immune from the financial debacle caused by Covid-19? The impact will be acute, universities in the United Kingdom, for example, has recognized serious financial challenges ahead and London Economics is indicating a potential sector-wide loss of tuition fees of 2.6 billion pounds next year. This will be hard for the private universities which mainly derive their income from registration fees and donations. However, the public universities will also be hit financially by Covid-19, since a lower-income at the national level will reduce the government’s funding. With further pressure likely to land on research funding from public, charitable, and commercial sources, universities, in general, will be facing significant financial challenges ahead. To offset drops in government funding higher education institutions might, as a measure of cost-saving, stagnate or even decline the number of full-time permanent positions, and shift to casual or contract positions. Switching a tenure position to a contractual appointment will be juridical difficult, probably not possible. But it is not unlikely, that when full-time professors retire, the vacancies will be filled with a casual or contract position. Thus, it is to be expected that in the coming years the number of tenure positions in higher education will drop.

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