Efficiency and Safety of Binocular Cataract Phacoemulsification

A literature review is presented on the comparative assessment of two options for conducting cataract phacoemulsification — monocular phacoemulsification of cataract, (delayed sequential bilateral cataract surgery, DSBCS) and binocular phacoemulsification of cataract (immediate sequential bilateral cataract surgery, ISBCS). It has been established that to date in the literature there is a sufficient amount of data indicating the positive aspects of ISBCS, associated with faster rehabilitation, better functional results, as well as time, financial, and economic aspects. The safety of ISBCS is determined by the minimum likelihood of postoperative bilateral endophthalmitis with careful selection of patients, the required surgeon qualifications and strict adherence to the surgical protocol. Comparatively, in accordance with the results obtained, postoperative refractive indices, the value of the maximum corrected distance visual acuity, the frequency of complications and the degree of patient satisfaction were the same regardless of whether the bilateral cataract surgery was performed simultaneously or sequentially. The effectiveness of ISBCS is determined by quick rehabilitation, the need for only one pair of glasses, a decrease in visits to the clinic, the absence of anisometropia between operations, as well as only one general anesthesia (if necessary). The experience of clinics where such procedures were carried out shows that after ISBCS, minor refractive errors occur, while they are almost always symmetrical, characterized by a slight deviation from the target refraction and rapid recovery of binocular and stereoscopic vision. In financial terms, in accordance with the calculations carried out, the cost of DSBCS in various countries may be higher than the cost of ISBCS by 10.8–47.9 %. In absolute terms, simultaneous cataract surgery on two eyes (Finland) saved €449 per patient in medical costs and €739 after travel and home care costs were included. Taking into account the cost of lost work time, the savings were €849 per patient. The wider distribution of ISBCS is associated with the approval of the ophthalmological community and insurance companies, as well as the development of standardized teaching materials for practicing ophthalmologists.

Pengukuran Efektivitas Kinerja Excavator pada Pengupasan Overburden (OB) Menggunakan Metode Overall Equipment Effectiveness (OEE): Studi Kasus di Pit 7 PT XYZ Kintap, Kalimantan Selatan

Based on production data of overburden (OB) stripping at Pit 7 PT XYZ in February 2019, productivity of the excavators doesn’t reach the desired target. To find out the potential for increased productivity and effectiveness of using excavators, it’s necessary to do an analysis using the Overall Equipment Effectiveness (OEE) method. OEE is a performance measurement tool that has the ability to identify the root of the problem and it’s causative factors so that improvement efforts are more focused. The parameters used in the calculation of OEE value are: Availability, Utilization, and Productivity Index. Based on the result of data processing, the OEE value were 56,00% for excavator EX2313 and 34,19% for excavator EX2325. This means that the OEE value hasn’t been able to meet the world class standard OEE value in medium category, namely 60%. Improvement are made by reducing lost work time but obstacles can be avoided, so as to increase utilization. The proposed improvement provide increased in the OEE value were 12,73% for excavator EX2313 and 11,61% for excavator EX2325. This shows that the OEE value of PC800 with number EX2313 reaches the world class standard in medium category or productivity can be considered reasonable, namely 68,73%. Meanwhile, the OEE value of PC800 with number EX2325 still doesn’t reach the world class standard in medium category, namely 45,80%.

Quality improvement study into the effectiveness of the semi-custom, prefabricated shoe insert program (Quadrastep System) at reducing complaints of discomfort in an industrial setting.

A common source of reduced productivity and lost work time in the industrial setting is musculoskeletal discomfort in the feet, knees, hips, and low back. Even when working identical job posts, these symptoms can vary widely between employees, and could potentially be caused by intrinsic foot biomechanics coupled with long-term standing activities. Therefore, to prevent injury and reduce daily discomfort, onesize-fits-all approaches such as anti-fatigue mats or off-the-shelf shoe insoles may be less effective than treating each employee’s specific biomechanical traits. The Quadrastep System is a prefabricated, semi-custom shoe insert system that bridges the gap between more expensive, fully customized orthotics and off-the-shelf options. We studied the effectiveness of the system in a large manufacturing plant by assessing and providing Quadrastep inserts to 28 volunteers. After 2 months of daily wear, 94% of these volunteers said they received some benefit from the inserts, while 52% reported full resolution of daily symptoms.

1376 Latex Allergies: Seeking an Alternative to Minimise Risk in The Operating Theatre

Introduction Natural Rubber Latex (NRL) gloves have been ubiquitously used in surgical practice. Over the past few decades, there have been many reports of NRL allergies associated with their use presenting a safety hazard to both patients and healthcare workers. Powder-free and latex-free gloves have been shown to offer reductions in incidence of allergic reactions, as well as cost savings. Method We performed a literature search to identify the rates of reaction to latex across the population in addition to the associated costs including litigation costs, costs of admission, and lost work time associated. We further looked at the rates of perforation of alternatives and the costs associated with such a transition. Results The UK prevalence of sensitisation amongst healthcare workers has been estimated to be 10%. The average cost of litigation to the employer was found to be $21,402 per claim. The mean cost of inpatient care for anaphylaxis has been cited as £469.88, with additional costs such as follow-up representing approximately £400. A 14-month study found cost savings of $10,000pa with a switch to non-latex gloves. Furthermore, an overall perforation rate of 80% in a latex-free glove compared to 34.4% in a latex glove. Conclusions From a business perspective, there is evidence of cost-savings arising from a switch to latex-free gloves, however, formal cost-effectiveness analyses would inform future decisions. Furthermore, comfort and reducing the chances of allergic reactions through removing the offending allergen all represent benefits of switching to latex-free gloves, however, non-inferiority analyses will inform future strategies both locally and nationally.

COVID-19 Associated Contact Restrictions in Germany: Marked Decline in Children’s Outpatient Visits for Infectious Diseases without Increasing Visits for Mental Health Disorders

Children have a low risk for severe COVID-19 infections, but indirect consequences of the pandemic may affect their health. We evaluated nationwide data on children’s outpatient visits before and during the first wave of the COVID-19 pandemic in Germany. Data from the National Association of Statutory Health Insurance Physicians for all children with statutory health insurance and at least one physician’s office visit between January 2019 and June 2020 were evaluated for total visits and selected diagnoses for the 2nd quarter of 2019 (8.29 million children, controls) and the 2nd quarter of 2020 (8.5 million, pandemic). Outpatient visits per child fell by 18% during the first wave of the pandemic. Outpatient visits associated with diagnosed infections fell markedly by 51%, particularly for children up to age 5 years for gastroenteritis (73%), otitis media (71%), and streptococcal angina (78%). Outpatient visits for diagnosed chronic physical disorders (diabetes, celiac disease, and hay fever) and mental and behavioral disorders showed little change. Reduced contact between children appears to markedly reduce infection transmission. Infection risks in educational settings should be attenuated after the pandemic through targeted education and counseling and appropriate relationship prevention measures to improve quality of life and opportunities for children and to reduce stress and lost work time for parents.

Productivity loss and indirect costs in the year following acute coronary events in Switzerland

Acute coronary syndrome (ACS) is highly prevalent in Switzerland and a leading cause of death. Associated productivity loss and indirect costs have rarely been studied. We investigated these factors in the first year after ACS in 24 Swiss patients (mean (SD) age 56 (8) years, 79% male). Data on patient productivity loss, absenteeism, presenteeism and caregiver assistance, were collected with the Productivity Cost Questionnaire during a routine cardiologist visit 3 to 12 months after hospitalisation for ACS and at least 4 weeks after patients returned to work. To estimate costs, lost hours were converted into 8-hour workdays, pro-rated to 1 year, combined with time off work due to initial hospitalisation and sick leave, and valued at Swiss labour costs. Additional data came from medical records. ACS patients lost on average (SD, range) 79 (81, 0.3–294) workdays; 38 (36, 0.3–153) days due to the initial hospitalisation and sick leave, 37 (75, 0–243) due to absenteeism after patients returned to work, and 4 (11, 0–41) due to presenteeism. Caregivers lost 10 (23, 0–90) additional workdays. The total indirect costs amounted to CHF 43,205 (44,026, 122–148,648); including CHF 18,514 (17,507, 122-74,619) for initial hospitalisation and sick leave and CHF 17,988 (36,394, 122–143,277) and CHF 1,849 (5181, 0–20,158) for absenteeism and presenteeism after patients returned to work, respectively. Costs of caregiver assistance amounted to CHF 4,855 (11,015, 0–43,843). This study showed that ACS patients lost on average 36% of their annual productive time. Caregivers lost an additional 5%. Lost work time was associated with substantial indirect costs that exceeded estimates of direct costs for ACS during 1 year. This suggests that costs and burden could be reduced through better risk reduction management.

IMPROVEMENT OF WORK TEMPERATURE AT CONTENT PRINTING WORKSTATION IN PUBLISHERS AND PRINTING CV GRAFIKA DUA TUJUH

CV. Grafika Dua Tujuh is an industry engaged in publishing and printing books and student worksheets located in Klaten. The average output produced daily is 85.400 books and student worksheets, while the company has a production target of 90.000 books and student worksheets. Based on the results of interviews with workers, the level of production that is not maximal is caused by an uncomfortable working environment. Workers in the production room complained about the condition of a hot work environment so that workers feel easily tired and lack of concentration. To overcome the hot workplace, workers often go to the restroom and they work while holding the hand fan. This condition disturbed their concentration and cause work errors. If this condition is carried out continuously, there will be a lot of lost work time which can cause a decrease in productivity. This study aims to analyze the improvement of working temperature conditions in the production room of CV. Grafika Dua Tujuh. This research was conducted by directly measuring thermal conditions in the entire production room of CV. Grafika Dua Tujuh. Determination of the coordinate point of room temperature measurement is based on SNI: 16-7061-2004. Workload assessment is carried out based on SNI 7269: 2009. The results of the measurement of work climate at the content printing workstation are the values of air temperature, humidity, and wind speed i.e 33.32 °C, 39.9%, and 0 m/s. In addition, Wet Bulb Globe Temperature Index (WBGT) value is obtained which is on the verge of a limit, i.e 29.90 °C for the category of the heavy workload with an allocation of working time of 87.5%. The temperature is above the standard set by the Ministry of Health of the Republic of Indonesia No. 1405 / MENKES / 2002 which sets the temperature in an industrial room ranging from 18 °C - 28 °C. Improvement for working temperature is done by engineering control, namely the installation of a turbine ventilator or exhaust fan.

Mending Disconnects in Cancer Care: Setting an Agenda for Research, Practice, and Policy

Cancer in the United States accounts for $600 billion in health care costs, lost work time and productivity, reduced quality of life, and premature mortality. The future of oncology delivery must mend disconnects to equitably improve patient outcomes while constraining costs and burden on patients, caregivers, and care teams. Embedding learning health systems into oncology can connect care, engaging patients and providers in fully interoperable data systems that remotely monitor patients; generate predictive and prescriptive analytics to facilitate appropriate, timely referrals; and extend the reach of clinicians beyond clinic walls. Incorporating functional learning systems into the future of oncology and follow-up care requires coordinated national attention to 4 synergistic strategies: (1) galvanize and shape public discourse to develop and adopt these systems, (2) demonstrate their value, (3) test and evaluate their use, and (4) reform policy to incentivize and regulate their use.

Can the risk of anal fistula development after perianal abscess drainage be reduced?

SUMMARY OBJECTIVE Perianal abscesses are frequently seen in clinical practice, and perianal fistulas develop in 30%–50% of cases after treatment. This study investigated whether the type of dressing applied after abscess drainage is correlated with fistula development. Prevention of fistula formation would reduce both the loss of work and healthcare costs. METHODS The records of patients who underwent drainage of perianal abscesses between January 2015 and January 2018 were retrospectively reviewed. Patients with postoperative dressings changed with washing of the area in the hospital were included as Group 1. Patients with dressings changed at home and the area bathed in 10% povidone-iodine sitz bath were included as Group 2. The frequency and time of fistula formation, age, sex, cost, and workdays lost in the two groups were compared. RESULTS Between-group differences in age, sex, body mass index, and type of fistula that developed after months and 1 year of the abscess drainage were not statistically significant (p > 0.05). During follow-up, fistula development was significantly lower in Group 1 than in Group 2 (p < 0.001). The risk of perianal fistula development was significantly increased in those with a body mass index (BMI) > 30 (p = 0.004). CONCLUSIONS After perianal abscess drainage, in-hospital washing and dressing of the abscess area until abscess closure reduced the risk of perianal fistula, lost work time, and cost. The risk of perianal fistula development appeared to increase with BMI. A large, prospective study is needed for confirmation.