scholarly journals Healing ulcers and preventing their recurrences in the diabetic foot

2016 ◽  
Vol 49 (03) ◽  
pp. 302-313 ◽  
Author(s):  
S. Raja Sabapathy ◽  
Madhu Periasamy
Keyword(s):  
Cost Of Care ◽  
Joint Mobility ◽  
Foot Care ◽  
Limited Joint Mobility ◽  
Reconstructive Procedures ◽  
Risk Class ◽  
Class 1 ◽  
Life Threatening ◽  
The Individual ◽  
The Cost

ABSTRACTFifteen percent of people with diabetes develop an ulcer in the course of their lifetime. Eighty-five percent of the major amputations in diabetes mellitus are preceded by an ulcer. Management of ulcers and preventing their recurrence is important for the quality of life of the individual and reducing the cost of care of treatment. The main causative factors of ulceration are neuropathy, vasculopathy and limited joint mobility. Altered bio-mechanics due to the deformities secondary to neuropathy and limited joint mobility leads to focal points of increased pressure, which compromises circulation leading to ulcers. Ulcer management must not only address the healing of ulcers but also should correct the altered bio-mechanics to reduce the focal pressure points and prevent recurrence. An analysis of 700 patients presenting with foot problems to the Diabetic Clinic of Ganga Hospital led to the stratification of these patients into four classes of incremental severity. Class 1 – the foot at risk, Class 2 – superficial ulcers without infection, Class 3 – the crippled foot and Class 4 – the critical foot. Almost 77.5% presented in either Class 3 or 4 with complicated foot ulcers requiring major reconstruction or amputation. Class 1 foot can be managed conservatively with foot care and appropriate foot wear. Class 2 in addition to measures for ulcer healing would need surgery to correct the altered bio-mechanics to prevent the recurrence. The procedures called surgical offloading would depend on the site of the ulcer and would need an in-depth clinical study of the foot. Class 3 would need major reconstructive procedures and Class 4 would need amputation since it may be life-threatening. As clinicians, our main efforts must be focused towards identifying patients in Class 1 and offer advice on foot care and Class 2 where appropriate surgical offloading procedure would help preserve the foot.

scholarly journals A critical review on Rashtriya Arogya Nidhi scheme in India

2018 ◽  
Vol 5 (4) ◽  
pp. 1239
Author(s):  
Yuvaraj Krishnamoorthy ◽  
Manikandanesan Sakthivel ◽  
Gokul Sarveswaran
Keyword(s):  
Tertiary Care ◽  
State Level ◽  
Poverty Line ◽  
Cost Of Care ◽  
Health Coverage ◽  
Financial Benefit ◽  
Care Services ◽  
Life Threatening ◽  
The Cost ◽  
Health Programmes

Patients with life threatening diseases were not able to seek care in tertiary care settings in spite of availability of facilities because of the cost of care involved. This hampers the nation’s progress towards Universal Health Coverage (UHC) by causing inequity in health service utilization and lack of financial protection to the families of the patient suffering from major diseases. Several government financial benefit schemes, both at central and state level, are available to cover the cost of care involved in the patients belonging to below poverty line (BPL) families. However, Rashtriya Arogya Nidhi is the only scheme which has been envisaged for providing comprehensive tertiary care benefit for patients with life threatening diseases belonging to BPL families. No government health programmes offers as much cash benefit as this scheme has been providing. This scheme, if utilized effectively can bring down the out-of-pocket expenditure considerably among the patients belonging to below poverty line families as well as increases the equity in utilization of tertiary care services. Even though the scheme was introduced two decades before, it has not been debated much for its utilization, impact, limitations and scopes for further improvement. Hence this review aims to critically appraise the strengths and limitations of the Rashtriya Arogya Nidhi scheme. 

Nonspecific Chronic Back Pain: Sixth Edition Approaches

2019 ◽  
Vol 24 (5) ◽  
pp. 14-15
Author(s):  
Jay Blaisdell ◽  
James B. Talmage
Keyword(s):  
Back Pain ◽  
Chronic Back Pain ◽  
Intervertebral Disk ◽  
Key Factors ◽  
Sixth Edition ◽  
Whole Person ◽  
Class 1 ◽  
A Cell ◽  
Intervertebral Disk Herniation ◽  
The Individual

Abstract Ratings for “non-specific chronic, or chronic reoccurring, back pain” are based on the diagnosis-based impairment method whereby an impairment class, usually representing a range of impairment values within a cell of a grid, is selected by diagnosis and “specific criteria” (key factors). Within the impairment class, the default impairment value then can be modified using non-key factors or “grade modifiers” such as functional history, physical examination, and clinical studies using the net adjustment formula. The diagnosis of “nonspecific chronic, or chronic reoccurring, back pain” can be rated in class 0 and 1; the former has a default value of 0%, and the latter has a default value of 2% before any modifications. The key concept here is that the physician believes that the patient is experiencing pain, yet there are no related objective findings, most notably radiculopathy as distinguished from “nonverifiable radicular complaints.” If the individual is found not to have radiculopathy and the medical record shows that the patient has never had clinically verifiable radiculopathy, then the diagnosis of “intervertebral disk herniation and/or AOMSI [alteration of motion segment integrity] cannot be used.” If the patient is asymptomatic at maximum medical improvement, then impairment Class 0 should be chosen, not Class 1; a final whole person impairment rating of 1% indicates incorrect use of the methodology.

THEORETICAL PRINCIPLES OF FORECASTING THE COST OF A SOFTWARE PRODUCT

2017 ◽  
Author(s):  
Pavlo Rodionov ◽  
◽  
Anna Ploskonos ◽  
Lesya Gavrutenko ◽  
◽  
...  
Keyword(s):  
Selection Process ◽  
Individual Characteristics ◽  
Successful Implementation ◽  
Software Products ◽  
Software Product ◽  
Continue Research ◽  
Cocomo Model ◽  
Factors Of Influence ◽  
The Individual ◽  
The Cost

The paper analyzes the factors that affect the amount of effort required to create a mobile application and its cost. It is established that the main factors of influence are the design of the application, its functionality, the type of mobile platform, the availability and level of testing and support, as well as the individual characteristics of the developer. Based on the analysis of information sources, the main methods and approaches to forecasting the cost of software products are identified, which include the COCOMO model, Price-to-win method, expert evaluation, algorithmic methods and the method of analogies. It is proposed to consider the method of analogies as a tool that allows you to make predictions about the cost of resources required for the successful implementation of IT projects based on the experience of similar projects. It is proved that the advantages of this method are the simplicity of its implementation and the clarity of the results obtained, which follows from the practical orientation of this tool. Among the limitations of the method of analogy is the mandatory need for reliable data relating to similar projects, as well as the difficulty of taking into account unspecified indicators. Taking into account the mentioned limitations of the method of analogies and on the basis of the analysis of scientific sources the possible directions of its optimization are determined. Thus, among the ways to improve the effectiveness of this method are those aimed at optimizing the project selection process, the data for which are used as a basis for forecasting. Attempts to improve the method of analogies by including parameters that were previously ignored by this technique seem promising. This in turn can lead to an expansion of the scope of the method of analogies and increase the accuracy of forecasts. As prospects for further research, the need to continue research in the field of optimization of the method of analogies with the subsequent practical verification of theoretical positions on the data of real projects.

GSS 2011 Linked with TIFF: Exploring the Cost of Child Care in Canada and the Use of the Child Care Tax Benefit

2019 ◽  
Vol 12 (1) ◽  
pp. 81-103
Author(s):  
Leanne Findlay ◽  
Dafna Kohen
Keyword(s):  
Child Care ◽  
General Social Survey ◽  
Cost Of Care ◽  
Indigenous Identity ◽  
Social Survey ◽  
The Cost ◽  
Care Costs ◽  
Compare And Contrast ◽  
Employment Characteristics ◽  
Different Sources

Affordability of child care is fundamental to parents’, in particular, women’s decision to work. However, information on the cost of care in Canada is limited. The purpose of the current study was to examine the feasibility of using linked survey and administrative data to compare and contrast parent-reported child care costs based on two different sources of data. The linked file brings together data from the 2011 General Social Survey (GSS) and the annual tax files (TIFF) for the corresponding year (2010). Descriptive analyses were conducted to examine the socio-demographic and employment characteristics of respondents who reported using child care, and child care costs were compared. In 2011, parents who reported currently paying for child care (GSS) spent almost $6700 per year ($7,500 for children age 5 and under). According to the tax files, individuals claimed just over $3900 per year ($4,700). Approximately one in four individuals who reported child care costs on the GSS did not report any amount on their tax file; about four in ten who claimed child care on the tax file did not report any cost on the survey. Multivariate analyses suggested that individuals with a lower education, lower income, with Indigenous identity, and who were self-employed were less likely to make a tax claim despite reporting child care expenses on the GSS. Further examination of child care costs by province and by type of care are necessary, as is research to determine the most accurate way to measure and report child care costs.

FUNCTIONING OF THE MENTAL DEFENSES IN THE CONDUCT OF INTERROGATION WITHIN THE CRIMINAL PROCESS

2018 ◽  
Vol 28 (6) ◽  
pp. 2161-2165
Author(s):  
Hristo Ivanov Popnikolov
Keyword(s):  
Objective Assessment ◽  
Critical Conditions ◽  
Criminal Process ◽  
External Influences ◽  
Administration Of Justice ◽  
Individual Protection ◽  
The Subject ◽  
The Individual ◽  
The Cost ◽  
Subjective Side

From the subject presented in the report it is evident that the pre-trial and the court bodies may, to some extent, be influenced both by the person of the accused and by his competence to participate in the criminal process. In this regard as an expert, the psychologist can offer invaluable assistance. Each expertise would assist all actors involved in the administration of justice on their objective assessment of the offenders, the understanding of their individual protection and the inherent self-justification during procedural actions. The involvement of psychologists in the criminal process is key to establishing the truth in the investigation, because every crime as an act has a subjective side, expressed in the psychic attitude of the perpetrator to the committed act. Establishing these psychological motives is a key point in the criminal process with a view to establishing the truth.Psychological protection stabilizes the personality in the critical conditions of counteraction, related to the elimination of the experiences of tension, anxiety, stress and frustration, leading to maximum mobilization of its resources and at the same time to their overpayment. Thus, the individual who is the subject of the process action is protected against the adverse external influences, but at the cost of a lot of effort and enormous loss of nervous-mental energy, which increases his own vulnerability instead of contributing to its reduction. The appearance and functioning of psychological protection can be significantly impeded by the interaction of the investigator with the accused. Even more complicated is the situation when it breaks the communication contact that may arise in the psychological alienation and self-isolation of the accused due to the desire to protect himself.Protective psychological dominance is a real psychic activity that investigators, investigators, investigators and judges need to take into account in order to effectively deal with their task and to overcome the resistance of the investigated persons and in a time to prove in a lawful and moral way their guilt and participation in the commitment of the crimes.

Automated Control of the Microclimate in the Premises of Pig-Breeding Complexes

2020 ◽  
pp. 103-108
Author(s):  
Viktoriya Yu. Ukhanova
Keyword(s):  
Agricultural Production ◽  
Individual Characteristics ◽  
Feed Consumption ◽  
Management Systems ◽  
Research Purpose ◽  
Energy Costs ◽  
Technical Equipment ◽  
Pig Farming ◽  
The Individual ◽  
The Cost

In the pig breeding, a large share of the production cost is accounted for by the cost of electricity and heat. Reducing energy costs is one of the important tasks of the industry. It is important to identify and study modern technologies and equipment for pig farming due to the constant increase in electricity tariffs, significant energy costs for creating and maintaining a microclimate. (Research purpose) The research purpose is in an analysis of modern available technologies and equipment for agricultural production, including pig farming, allowing to reduce the cost of production. (Materials and methods) Authors used a method for determining the standard indicators of energy consumption of energy resources in the pig industry, based on the calculation and analytical method. The article presents an analyze of automated microclimate management systems in pig breeding complexes, taking into account the individual characteristics of farms produced by OWEN. (Results and discussion) Automated microclimate management systems can improve the productivity of pig farms; reduce the cost of electrical and thermal energy, reduce the number of diseases of animal from hypothermia, high humidity or temperature in the room, feed consumption; monitor the chemical composition of the air. The article considers three options for creating a microclimate in rooms with animals, taking into account the individual characteristics of enterprises. (Conclusions) The profitability of pig production depend on the level of technical equipment of farms, automation, and the use of energy-saving technologies and equipment. The use of innovations in agricultural production makes it possible to increase labor productivity up to three times, and savings due to reduced feed costs can reach several million rubles a year.

scholarly journals Budget Impact Analysis of Anticoagulation Clinics in Patients with Atrial Fibrillation under Chronic Therapy with Oral Anticoagulants

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
William Uribe-Arango ◽  
Juan Manuel Reyes Sánchez ◽  
Natalia Castaño Gamboa
Keyword(s):  
Atrial Fibrillation ◽  
Impact Analysis ◽  
Budget Impact ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Group Versus ◽  
Cost Of Care ◽  
Chronic Therapy ◽  
Colombian Government ◽  
The Cost

Objectives To assess budget impact of the implementation of an anticoagulation clinic (AC) compared to usual care (UC), in patients with non-valvular atrial fibrillation (NVAF). Method A decision tree was designed to analyze the cost and events rates over a 1-year horizon. The patients were distributed according to treatment, 30% Direct Oral Anticoagulant (DOAC) regimens and the rest to warfarin. The thromboembolism and bleeding were derived from observational studies which demonstrated that ACs had important impact in reducing the frequency of these events compared with UC, due to higher adherence with DOACs and proportion of time in therapeutic range (TTR) with warfarin. Costs were derived from the transactional platform of Colombian government, healthcare authority reimbursement and published studies. The values were expressed in American dollars (USD). The exchanged rate used was COP $3.693 per dollar. Results During 1 year of follow-up, in a cohort of 228 patients there were estimated 48 bleedings, 6 thromboembolisms in AC group versus 84 bleedings, and 12 thromboembolisms events in patients receiving UC. Total costs related to AC were $126 522 compared with $141 514 in UC. The AC had an important reduction in the cost of clinical events versus UC ($52 085 vs $110 749) despite a higher cost of care facilities ($74 436 vs $30 765). A sensibility analysis suggested that in the 83% of estimations, the AC produced savings varied between $27 078 and $135 391. Conclusions This study demonstrated that AC compared with UC, produced an important savings in the oral anticoagulation therapy for patients with NVAF.

scholarly journals Cost-Effectiveness of an Exercise Programme that Provided Group or Individual Training to Reduce the Fall Risk in Healthy Community-Dwelling People Aged 65–80: A Secondary Data Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 714
Author(s):  
Isaac Aranda-Reneo ◽  
Laura Albornos-Muñoz ◽  
Manuel Rich-Ruiz ◽  
María Ángeles Cidoncha-Moreno ◽  
Ángeles Pastor-López ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Older People ◽  
Incremental Cost ◽  
Fall Risk ◽  
Community Dwelling ◽  
Effective Measure ◽  
The Individual ◽  
The Cost ◽  
Individual Training

Research has demonstrated that some exercise programs are effective for reducing fall rates in community-dwelling older people; however, the literature is limited in providing clear recommendations of individual or group training as a result of economic evaluation. The objective of this study was to assess the cost-effectiveness of the Otago Exercise Program (OEP) for reducing the fall risk in healthy, non-institutionalized older people. An economic evaluation of a multicenter, blinded, randomized, non-inferiority clinical trial was performed on 498 patients aged over 65 in primary care. Participants were randomly allocated to the treatment or control arms, and group or individual training. The program was delivered in primary healthcare settings and comprised five initial sessions, ongoing encouragement and support to exercise at home, and a reinforcement session after six months. Our hypothesis was that the patients who received the intervention would achieve better health outcomes and therefore need lower healthcare resources during the follow-up, thus, lower healthcare costs. The primary outcome was the incremental cost-effectiveness ratio, which used the timed up and go test results as an effective measure for preventing falls. The secondary outcomes included differently validated tools that assessed the fall risk. The cost per patient was USD 51.28 lower for the group than the individual sessions in the control group, and the fall risk was 10% lower when exercises had a group delivery. The OEP program delivered in a group manner was superior to the individual method. We observed slight differences in the incremental cost estimations when using different tools to assess the risk of fall, but all of them indicated the dominance of the intervention group. The OEP group sessions were more cost-effective than the individual sessions, and the fall risk was 10% lower.

scholarly journals ‘Rising demand and decreasing resources’: Theorising the ‘cost of austerity’ as a barrier to social worker discretion

2021 ◽  
pp. 1-18
Author(s):  
CIARÁN MURPHY
Keyword(s):  
Social Worker ◽  
Child Protection ◽  
Child Protection Services ◽  
Radical Reform ◽  
Critical Realist ◽  
Documentary Analysis ◽  
Effective System ◽  
The Individual ◽  
The Uk ◽  
The Cost

Abstract The Munro Review of Child Protection asserted that the English child protection system had become overly ‘defensive’, ‘bureaucratised’ and ‘standardised’, meaning that social workers were not employing their discretion in the interests of the individual child. This paper reports on the results of an ethnographic case study of one of England’s statutory child protection teams. The research sought to explore the extent of social worker discretion relative to Munro’s call for ‘radical reform’ and a move towards a more ‘child-centred’ system. Employing an iterative mixed methods design – encompassing documentary analysis, observation, focus group, questionnaire, interview and ‘Critical Realist Grounded Theory’ – the study positioned the UK Government’s prolonged policy of ‘austerity’ as a barrier to social worker discretion. This was because the policy was seen to be contributing to an increased demand for child protection services; and a related sense amongst practitioners that they were afforded insufficient time with the child to garner the requisite knowledge, necessary for discretionary behaviour. Ultimately, despite evidence of progress relative to assertions that social worker discretion had been eroded, the paper concludes that there may still be ‘more to do’ if we are to achieve the ‘child-centred’ and ‘effective’ system that Munro advocated.

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