Outcomes of Patients Placed in an Emergency Department Observation Unit of a Comprehensive Cancer Center

PURPOSE Emergency department observation units (EDOUs) have been shown to decrease length of stay and improve cost effectiveness. Yet, compared with noncancer patients, patients with cancer are placed in EDOUs less often. In this study, we aimed to describe patients who were placed in a cancer center's EDOU to discern their clinical characteristics and outcomes. METHODS We performed a retrospective observational study that included all patients age 18 years and older who presented to our emergency department (ED) and were placed in the EDOU between March 1, 2019, and February 29, 2020. The patients' electronic medical records were queried for demographics, comorbidities, diagnosis at the time of placement in the EDOU, length of stay, disposition from the EDOU, ED return within 72 hours after discharge from the EDOU, and mortality outcomes at 14 and 30 days. RESULTS A total of 2,461 visits were eligible for analysis. Cancer-related pain was the main reason for observation in more than one quarter of the visits. The median length of stay in the EDOU was approximately 23 hours, and 69.6% of the patients were discharged. The ED return rate for unscheduled visits at 72 hours was 1.9%. The 14- and 30-day mortality rates were significantly higher for patients who were admitted than for those who were discharged (14 days: 1.7% v 0.3%, P < .001; 30 days: 5.9% v 1.8%, P < .001). CONCLUSION Our data suggest that placing patients with cancer in EDOUs is safe, reduces admissions, and reserves hospital resources for patients who can receive the most benefit without compromising care.

Appropriateness and Cost-Effectiveness of Echocardiograms Ordered by Pediatric Cardiologists and Primary Care Providers for Syncope

The pediatric appropriate use criteria (AUC) were applied to transthoracic echocardiograms (TTE) ordered by primary care providers (PCPs) and pediatric cardiologists for the diagnosis of syncope to compare appropriateness ratings and cost-effectiveness. Included were patients ≤18 years of age from October 2016 to October 2018 with syncope who underwent initial outpatient pediatric TTE ordered by a PCP or were seen in Pediatric Cardiology clinic. Ordering rate of TTE by pediatric cardiologists, AUC classification, and TTE findings were obtained. PCPs ordered significantly more TTEs than pediatric cardiologists for “rarely appropriate” indications (61.5% vs 7.5%, P < .001). Cardiologists ordered TTEs at 17.2% of visits. Using appropriateness as a marker of effect, with the incremental cost-effectiveness ratio, it was more cost-effective ($543.33 per patient) to refer to a pediatric cardiologist than to order the TTE alone. This suggests that improved PCP education of the AUC and appropriate indications of TTEs for syncope may improve cost-effectiveness when using order appropriateness as a marker of effectiveness.

Novel Outside-Facility Renovation Technology to Improve Cost-Effectiveness by Long-Term Safe Use

In order to provide telecommunication and FTTH services, we, NTT, have installed a large number of facilities such as utility poles and optical cables. The number of poles is about 11.9 million and the total length of all installed cables is now about 2.3 million km. These facilities are inspected and maintained by visual inspection by workers every 5 to 10 years, which imposes great costs on the operator. Therefore, we are researching a novel outside-facility renovation technology that can improve cost-effectiveness by long-term safe use. This technology consists of two techniques: a visualization technique of unbalanced tension and a quantitative analysis technique to determine the relationship between unbalanced tension and structural deterioration. In this paper, we describe the concept of the proposed technology. When a utility pole is newly installed, its design assumes that the maximum load consists of wind pressure on the cables. However, when it is impossible to construct a guy wire for bearing the load applied to the utility pole, an unbalanced load occurs because the load cannot be balanced. In addition, when the number of users of various services increases and cables are newly laid, unbalanced loads are generated. Utility poles carrying these unbalanced loads are at significant risk of collapse due to the presence of deflection, inclination, and cracks. Our proposal focuses on the unbalanced load itself, and by detecting and countering it, we aim to enable the use of outside-facilities for a longer period than at present and to reduce replacement costs without sacrificing safety and security. In addition, we also describe how ensuring the long-term safe use of outside-facilities can improve cost-effectiveness. The proposed technique first acquires 3D point cloud data by using 3D laser scanner. It then creates a 3D facility model and calculates the tension in utility poles and cables. In addition, we introduce a novel method to estimate the loads and tension of a whole span from part of the span. Experiments are conducted to compare the estimated and measured values. The results confirm the good agreement of the values (within 10%) which validates the proposal. We aim to realize a tension visualization scheme with improved accuracy.

Valuation of Life With Disability: An International Comparison Study in Vietnam, Peru, and Haiti

The authors measured perceived quality of life for 4 disabilities among 450 adults in 3 resource-limited countries, measuring mean utilities using time trade-off, and surveying participants on 35 sociocultural characteristics to compare utilities for disabilities by country and examine associated sociocultural characteristics. Mean utilities were >0 for mild and moderate, but <0 for severe and profound. Utilities differed across countries ( P = .007, .000, .017, .000 for mild, moderate, severe, profound, respectively). Vietnamese utilities correlated with residence ( P = .03, moderate), education ( P = .03, severe), and number of children ( P = .03, moderate). Peruvian utilities correlated with education ( P = .05, mild; P = .05, severe), experience with disability ( P = .001, mild), gender ( P = .04, moderate; P = .03, profound), number of hospitalizations ( P = .04, severe). In Haiti, the only correlate was rejection ( P = .02, moderate). Culture-specific variables differentially shape perceptions of disability in developing countries, thereby affecting cost-effectiveness calculations. Given substantially negative perceptions, reducing major disability would improve cost-effectiveness of health-policy decisions more than reducing mortality.

A study on the key factors of suitability for performance-based logistics using a multi-criteria decision-making method

In response to worldwide changes in logistics, the Korean Ministry of Defense has introduced performance-based logistics (PBL) to improve cost-effectiveness and availability in sustaining their weapon system. Thus, the procurement of reduced parts and the maintenance period improve the availability of equipment, and the reduction of the inventory level lowers overall logistics costs. Based on these achievements, the Ministry of National Defense is pursuing a policy to expand the PBL project. However, the criteria for selecting equipment subject to the application are ambiguous. Therefore, it is difficult to expand to all areas. Consequently, this paper aims to present the criteria for selecting future PBL projects by providing objective judgment factors and quantifying the suitable equipment for the application of PBL. For this, a delphi-analytic approach was used to derive the key factors for performance-based logistics experts, and the survey was carried out twice. A total of eight key factors were derived from the survey analysis. Subsequently, a third survey was conducted to determine the level of assessment for each key factor and to prioritize each card according to this conjoint method to determine the utility of each factor according to its level. Through this, a performance-based suitability model that combines the weighting of key factors with the level of each factor was presented. This study is meaningful in that it selected key factors for determining the suitability of performance-based military applications based on objective data. Further, their reference values can be comprehensively determined by calculating the utility of each factor level.

The intravenous to oral switch of taxanes: strategies and current clinical developments

The taxanes paclitaxel, docetaxel and cabazitaxel are important anticancer agents that are widely used as intravenous treatment for several solid tumor types. Switching from intravenous to oral treatment can be more convenient for patients, improve cost–effectiveness and reduce the demands of chemotherapy treatment on hospital care. However, oral treatment with taxanes is challenging because of pharmaceutical and pharmacological factors that lead to low oral bioavailability. This review summarizes the current clinical developments in oral taxane treatment. Intravenous parent drugs, strategies in the oral switch, individual agents in clinical trials, challenges and further perspectives on treatment with oral taxanes are subsequently discussed.

Time to make enhanced recovery after surgery the standard

Multimodality perioperative interventions could accelerate patient recovery and improve cost-effectiveness. An evidence review found an association between enhanced recovery after surgery and decreased length of stay, while complications and recovery time were unchanged or reduced. More specialties should develop and implement enhanced recovery after surgery pathways.

INFLUENCE OF FALLS REDUCTION ON THE COST-EFFECTIVENESS OF ADVANCED HYDRAULIC MICROPROCESSOR CONTROLLED KNEE PROTHESES IN ELDERLY PATIENTS WITH LOWER LIMB AMPUTATIONS

INTRODUCTION The assessment of cost-effectiveness and the use of health economical methods becomes of increasing importance when evaluating the impact of modern medical technology. The cost effectiveness of advanced hydraulic microprocessor controlled knees (MPKs) had recently by shown by RAND 1. A new generation of advanced hydraulic microprocessor controlled knee (MPK) components became available to address specifically the needs of elderly individuals The reduction of concomitant factors such as falls may significantly improve cost-effectiveness. Abstract PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/32041/24455 How to cite: Krüger H, Hahn A, Kuhlmann A. INFLUENCE OF FALLS REDUCTION ON THE COST-EFFECTIVENESS OF ADVANCED HYDRAULIC MICROPROCESSOR CONTROLLED KNEE PROTHESES IN ELDERLY PATIENTS WITH LOWER LIMB AMPUTATIONS. CANADIAN PROSTHETICS & ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018; ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: https://doi.org/10.33137/cpoj.v1i2.32041 Abstracts were Peer-reviewed by the American Orthotic Prosthetic Association (AOPA) 101st National Assembly Scientific Committee. http://www.aopanet.org/