Analisi di minimizzazione dei costi del trattamento della leucemia cronica con fludarabina fosfato (Fludara®) e.v. e p.o.: metodologia e risultati di un’indagine empirica

2004 ◽  
Vol 5 (4) ◽  
pp. 265-272
Author(s):  
Carlo Lazzaro
Keyword(s):  
Hospital Stay ◽  
Drug Administration ◽  
Drug Acquisition ◽  
Oral Formulation ◽  
Drug Preparation ◽  
Day Hospital ◽  
Hospital Perspective ◽  
Fludarabine Phosphate ◽  
Before And After ◽  
Outpatient Drug

The aim of the paper is to compare healthcare-related costs of a 5-day course with fludarabine phosphate i.v. vs a 5-day course with oral fludarabine phosphate in Italian patients with chronic leukemia. A cost-minimization analysis was performed from both Italian National Healthcare Service (INHS) and hospital perspectives. Healthcare-related costs were collected from 2 out of a sample of 28 Ematology wards and included those of drug acquisition, drug preparation, drug administration, reception and discharge of patient before and after drug administration; hospital overheads were calculated as a percentage of the total healthcare-related costs. The reimbursement schemes for acquisition and administration of fludarabine phosphate i.v. were gathered from the whole sample of 28 Ematology wards taken into account. Costs were expressed in euros 2004. When compared to fludarabine phosphate i.v., oral fludarabine phosphate allowed savings ranging from 223,47 euros (hospital perspective) to 477,05 euros (INHS perspective) per patient. As far as hospital perspective was concerned, savings associated with oral fludarabine phosphate were due to hospital overheads (115.1%), drug preparation (19.6%), drug administration (17.3%), reception and discharge of patient before and after drug administration (2.9%), whereas costs for drug acquisition was higher for oral formulation (-54.8%). When INHS perspective was taken into account, 3 out of 28 Ematology wards (11%) were reimbursed on a drug-plus-outpatient-drug-administration-basis, whereas 25 out of 28 Ematology wards (89%) were reimbursed on a day-hospital-stay-basis. Savings associated with oral fludarabine phosphate were due to day-hospital stay (253.4%), outpatient drug administration (1.1%), whereas cost for drug acquisition were higher for oral formulation (-154.5%). Sensitivity analysis confirmed the robustness of basecase results. Savings associated with oral fludarabine phosphate may be of relevant interest for INHS policies aimed at reducing public expenditure for drugs in Italy.

scholarly journals Sleep/wake cycle of women submitted to elective gynecological surgery with a one-day hospital stay

2008 ◽  
Vol 16 (5) ◽  
pp. 838-843 ◽  
Author(s):  
Maria Cristina Zaros ◽  
Maria Filomena Ceolim
Keyword(s):  
Sleep Quality ◽  
Hospital Stay ◽  
Elective Surgery ◽  
Descriptive Study ◽  
Daily Routine ◽  
Matched Pairs ◽  
Gynecological Surgery ◽  
Day Hospital ◽  
Before And After ◽  
Total Data

The aim of this descriptive study was to compare preoperative and post-operative sleep/wake cycle (SWC) patterns of 22 women undergoing elective surgery, with up to one day of hospitalization. The study was approved by the local Review Board. Voluntary women (average age 39 ± 9) filled out a Sleep Journal for 23 consecutive days, before and after the surgery (46 days total). Data were analyzed with Wilcoxon's matched-pairs test. The findings showed slight and transitory SWC changes (increased latency, reduced efficiency and later wake-up time) after the surgery. Nevertheless, sleep quality was improved and there was a fast return to the SWC patterns observed before the intervention, perhaps due to the early exposition to daily routine, e.g. the environmental clues that are important to rhythmic synchronization.

scholarly journals Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study

10.2196/24542 ◽  
2021 ◽  
Vol 5 (9) ◽  
pp. e24542
Author(s):  
Yi-Chen Wang ◽  
Chin-Yuan Tsan ◽  
Meng-Chun Chen
Keyword(s):  
Longitudinal Study ◽  
Drug Administration ◽  
The United States ◽  
Medication Administration ◽  
University Hospital ◽  
Drug Preparation ◽  
Stock Management ◽  
Preparation Time ◽  
Before And After ◽  
The Impact

Background A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. Objective This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. Methods We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. Results The drug preparation time of the wards increased significantly (all P<.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item “I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented” (score=4.24). The item with the lowest score was “I have to wait in line to get my patient medications” (score=3.32). Conclusions The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this.

scholarly journals Implementation of an Automated Dispensing Cabinet System and Its Impact on Drug Administration: Longitudinal Study (Preprint)

2020 ◽  
Author(s):  
Yi-Chen Wang ◽  
Chin-Yuan Tsan ◽  
Meng-Chun Chen
Keyword(s):  
Longitudinal Study ◽  
Drug Administration ◽  
The United States ◽  
Medication Administration ◽  
University Hospital ◽  
Drug Preparation ◽  
Stock Management ◽  
Preparation Time ◽  
Before And After ◽  
The Impact

BACKGROUND A technology that has been widely implemented in hospitals in the United States is the automated dispensing cabinet (ADC), which has been shown to reduce nurse drug administration errors and the time nurses spend administering drugs. OBJECTIVE This study aimed to determine the impact of an ADC system on medication administration by nurses as well as safety before and after ADC implementation. METHODS We conducted a 24-month-long longitudinal study at the National Taiwan University Hospital in Taipei, Taiwan. Clinical observations and questionnaires were used to evaluate the time differences in drug preparation, delivery, and returns in the inpatient ward by nurses before and after using the ADC. Drug errors recorded in the Medical Incident Events system were assessed the year before and after ADC implementation. RESULTS The drug preparation time of the wards increased significantly (all <i>P</i>&lt;.005). On average, 2 minutes of preparation time is needed for each patient. Only 1 unit showed an increase in the drug return time, but this was not significant. There were 9 (45%) adverse events during the drug administration phase, and 11 (55%) events occurred during the drug-dispensing phase. Although a decrease in the mean number of events reported was observed during the ADC implementation period, this difference was not significant. As for the questionnaire that were administered to the nurses, the overall mean score was 3.90; the highest score was for the item “I now spend less time waiting for medications that come from the pharmacy than before the ADC was implemented” (score=4.24). The item with the lowest score was “I have to wait in line to get my patient medications” (score=3.32). CONCLUSIONS The nurses were generally satisfied with ADC use over the 9 months following complete implementation and integration of the system. It was acknowledged that the ADC offers benefits in terms of pharmaceutical stock management; however, this comes at the cost of increased nursing time. In general, the nurses remained supportive of the benefits for their patients, despite consequences to their workflows. Their acceptance of the ADC system in this study demonstrates this. CLINICALTRIAL

scholarly journals Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

2020 ◽  
Author(s):  
YuJin Chung ◽  
JinHo Beom ◽  
JiEun Lee ◽  
Incheol Park ◽  
Junho Cho
Keyword(s):  
Emergency Room ◽  
Hospital Stay ◽  
Cancer Patients ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Life Extension ◽  
Medical Decision ◽  
Patient Consent ◽  
Before And After ◽  
The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

scholarly journals Mass drug administration with azithromycin for trachoma elimination and the population structure of Streptococcus pneumoniae in the nasopharynx

2020 ◽  
Author(s):  
Rebecca A. Gladstone ◽  
Ebrima Bojang ◽  
John Hart ◽  
Emma M Harding-Esch ◽  
David Mabey ◽  
...  
Keyword(s):  
Population Structure ◽  
Streptococcus Pneumoniae ◽  
Antimicrobial Resistance ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Macrolide Resistance ◽  
P Value ◽  
Cross Sectional ◽  
The Third ◽  
Before And After

ABSTRACTBackgroundMass drug administration (MDA) with azithromycin for trachoma elimination reduces nasopharyngeal carriage of Streptococcus pneumoniae in the short term. We evaluated S. pneumoniae carried in the nasopharynx before and after a round of azithromycin MDA to determine whether MDA was associated with changes in pneumococcal population structure.MethodsWe analysed 514 pneumococcal isolates cultured from nasopharyngeal samples collected in Gambian villages that received MDA for trachoma elimination. The samples were collected during three cross-sectional surveys conducted before the third round of MDA (CSS-1) and at one (CSS-2) and six (CSS-3) months after MDA. Whole genome sequencing was conducted on randomly selected isolates. Bayesian Analysis of Population Structure (BAPS) was used to cluster related isolates by capturing variation in the core genome. Serotype and multi-locus sequence type were inferred from the genotype. The Antimicrobial Resistance Identification by Assembly (ARIBA) tool was used to identify macrolide resistance genes.ResultsTwenty-seven BAPS clusters were assigned. These consisted of 81 sequence types (STs), 15 of which were novel additions to pubMLST. Two BAPS clusters, BAPS20 (p-value<=0.016) and BAPS22 (p-value<=0.032) showed an increase in frequency at CSS-3 not associated with antimicrobial resistance. Macrolide resistance within BASP17 increased after treatment (p<0.05) and was carried on a mobile transposable element that also conferred resistance to tetracycline.ConclusionsLimited changes in pneumococcal population structure were observed after the third round of MDA suggesting treatment had little effect on the circulating lineages. An increase in macrolide resistance within one BAPS highlights the need for antimicrobial resistance surveillance in treated villages.

scholarly journals Role of β-type natriuretic peptide as predictor of early post-operative outcomes in Chinese patients undergoing anesthesia

2017 ◽  
Vol 12 (4) ◽  
pp. 393
Author(s):  
Chun Chen ◽  
Lei Lin
Keyword(s):  
Hospital Stay ◽  
General Anesthesia ◽  
Natriuretic Peptide ◽  
Elective Surgery ◽  
Chinese Patients ◽  
Operative Outcomes ◽  
Study Results ◽  
Before And After ◽  
Prolonged Hospital ◽  
Relationship Of

<p class="Abstract">The purpose of the present study was to assess whether pre-operative and post-operative B-type natriuretic peptide (BNP) levels could be used as the predictor of post-operative complications in Chinese patients undergoing elective surgery under general anesthesia. A total of 80 adult patients were analyzed. Blood sample to measure BNP was collected from each patient before and after surgery to assess the relationship of pre-operative BNP with all possible clinical outcomes. Elevated BNP levels were associated with prolonged hospital stay and mortality. Our study results suggested that the high levels of BNP predict the prolong hospital stay, increased mortality, and increased usage of balloon pump. Also results suggested that the BNP is one of the key predictors of early post-operative outcomes in Chinese patients undergoing elective surgery under general anesthesia.</p>

scholarly journals Day Hospital and Then…follow-up Two and a Half Years After the Hospitalization

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
R. Pedrosa ◽  
V. Teixeira de Sousa ◽  
J. Marques ◽  
A. Martins ◽  
I. Domingues ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Health Resources ◽  
Cross Sectional Study ◽  
Primary Objective ◽  
Day Hospital ◽  
Inpatient Hospitalization ◽  
Cross Sectional ◽  
Before And After ◽  
Day Hospitals

Psychiatry Day Hospitals deal with a wide spectrum of disorders, being responsible for a psychosocial intervention that intends to improve patient's quality of life. The Psychiatry Day Hospital Department of Hospital de São João has thirty-eight years of activity, and has been one of the first in Portugal. The aim of this Psychiatry Unit, composed by a multidisciplinary team, is to prevent relapses and rehospitalisations, promoting the patients’ social rehabilitation, building a bridge between inpatient hospitalization and their re-entry into the community.The primary objective of this cross-sectional study was to evaluate important aspects of service's quality, such as the use of health resources and results in functional terms. The authors made the follow-up of the patients that had been admitted in 2005 (Jan 2005 - Dez 2005; n= 77). For this purpose, it was assessed the number of attendances to the Emergency Department and hospitalizations two and a half years before and after the treatment in Day Hospital. It was also compared their current employment situation to that which preceded the Day Hospital care.This study was performed in clinical setting among a reduced sample, with the inherent limitations. It would be appealing to replicate this investigation in a larger population and including some other variables.

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