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2021 ◽  
Author(s):  
Patrick Chaftari ◽  
Demis N. Lipe ◽  
Monica K. Wattana ◽  
Aiham Qdaisat ◽  
Pavitra P. Krishnamani ◽  
...  

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.


Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1338
Author(s):  
Giuliana S. Oliveira ◽  
Maria Leonor S. Oliveira ◽  
Eliane N. Miyaji ◽  
Tasson C. Rodrigues

The importance of Streptococcus pneumoniae has been well established. These bacteria can colonize infants and adults without symptoms, but in some cases can spread, invade other tissues and cause disease with high morbidity and mortality. The development of pneumococcal conjugate vaccines (PCV) caused an enormous impact in invasive pneumococcal disease and protected unvaccinated people by herd effect. However, serotype replacement is a well-known phenomenon that has occurred after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) and has also been reported for other PCVs. Therefore, it is possible that serotype replacement will continue to occur even with higher valence formulations, but the development of serotype-independent vaccines might overcome this problem. Alternative vaccines are under development in order to improve cost effectiveness, either using proteins or the pneumococcal whole cell. These approaches can be used as a stand-alone strategy or together with polysaccharide vaccines. Looking ahead, the next generation of pneumococcal vaccines can be impacted by the new technologies recently approved for human use, such as mRNA vaccines and viral vectors. In this paper, we will review the advantages and disadvantages of the addition of new polysaccharides in the current PCVs, mainly for low- and middle-income countries, and we will also address future perspectives.


2021 ◽  
Vol 11 (18) ◽  
pp. 8628
Author(s):  
Kang-Moon Park ◽  
Donghoon Shin ◽  
Sung-Do Chi

This paper proposes a deep neural network structuring methodology through a genetic algorithm (GA) using chromosome non-disjunction. The proposed model includes methods for generating and tuning the neural network architecture without the aid of human experts. Since the original neural architecture search (henceforth, NAS) was announced, NAS techniques, such as NASBot, NASGBO and CoDeepNEAT, have been widely adopted in order to improve cost- and/or time-effectiveness for human experts. In these models, evolutionary algorithms (EAs) are employed to effectively enhance the accuracy of the neural network architecture. In particular, CoDeepNEAT uses a constructive GA starting from minimal architecture. This will only work quickly if the solution architecture is small. On the other hand, the proposed methodology utilizes chromosome non-disjunction as a new genetic operation. Our approach differs from previous methodologies in that it includes a destructive approach as well as a constructive approach, and is similar to pruning methodologies, which realizes tuning of the previous neural network architecture. A case study applied to the sentence word ordering problem and AlexNet for CIFAR-10 illustrates the applicability of the proposed methodology. We show from the simulation studies that the accuracy of the model was improved by 0.7% compared to the conventional model without human expert.


2021 ◽  
pp. 000992282110382
Author(s):  
Tracey M. Thompson ◽  
Ty E. Hasselman ◽  
Yanzhi Wang ◽  
David W. Jantzen

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.


2021 ◽  
pp. 24-25
Author(s):  
Vivek Agrawal ◽  
Parikshit Bishnoi ◽  
Anand Nagar ◽  
Shireesh Gupta ◽  
Anshul Mathur ◽  
...  

Introduction : Postoperative pain is variable in intensity,character,duration and is the main factor delaying discharge of patients undergoing day-care procedures including laparoscopy and hence adding to hospital cost and stay. Optimal management has a potential for shortening of hospital stay and for speeding up of recovery.AIM :Comparing the effect of port site and intraperitoneal instillation of 0.5% bupivacaine with adrenaline versus saline for post-operative analgesia in laparoscopic cholecystectomy. To assess the need of rescue analgesics in post- operative period in both groups.Material & Method :A comparative study to be performed on 50 cases receive 40 mls of 0.5% bupivacaine as intraperitoneal infiltration and local infiltration of 20 mls of 0.5% bupivacaine in the port sites (5 ml infiltration in each port) versus 50 cases receive 40 ml of normal saline intraperitoneally Discussion :Reduction in post-operative pain with better cosmesis and early return to work have been the goals to improve cost effectiveness and patient satisfaction. Conclusion : We conclude that instillation of local anaesthetic drug intraperitonialy & Port site local anaesthetic agent injection has added benefits in post operative pain


2021 ◽  
pp. 39-47
Author(s):  
Jurij Fürst ◽  

This paper presents the regulatory framework for medicine in Slovenia and describes its financing. Financing approaches for medicine, with lower prices than the market, are being introduced at several levels. International comparisons show that the availability of medicine in Slovenia is at the average European level. An area in which we are far behind the most developed countries is the use of biosimilars. Suggestions are made to increase their consumption. This will improve cost management and allow new medicine to be introduced faster. This is especially important in the area of medicine for rare diseases (orphan drugs), where we keep facing highly high costs. Proposals to set up a special fund for orphan drugs mean a nonsystematic solution and diversification of funding to several financially and personnel-limited payers, which would weaken Slovenia's bargaining power against pharmaceutical companies and make the medicine less accessible. The current model of drug development and marketing is becoming increasingly socially unacceptable. That is why ideas about how to improve the way medicine is developed, patented, and funded to the benefit of society are emerging


2021 ◽  
pp. OP.21.00042
Author(s):  
Allison M. Scott ◽  
Nancy Grant Harrington

PURPOSE: Patients' desire for cost conversations exceeds the incidence of such conversations, and many oncologists report avoiding cost conversations despite reporting willingness to have them. Our objective was to examine oncologists' attitudes toward cost conversations and how those attitudes affect practice. METHODS: An experienced investigator conducted individual interviews with oncologists practicing in Kentucky. Participants were asked about their attitude toward and experience with cost conversations and their advice for discussing cost with patients. Interview transcripts were analyzed by a four-member team using qualitative descriptive analysis to identify themes. RESULTS: Participants were 32 MDs (male = 68.8%) age 31-77 years who were board-certified in medical oncology (53.1%), surgical oncology (25.0%), or radiation oncology (21.9%). We categorized participants into two groups: (1) those who viewed cost conversations as best practice and reported pursuing such conversations (37.5%) and (2) those who viewed cost conversations as not best practice and reported avoiding them (62.5%). Our analysis revealed three parallel themes for each category: Cost conversation attitudes and practice were based on (1) making good treatment decisions, (2) being a good clinician, and (3) having a good relationship with patients. CONCLUSION: Not all oncologists view cost conversations as best practice. To improve cost conversation attitudes and practice, cost conversations can be framed as a strategic tool that—when used well—fosters optimal decision making, professionalism, and the therapeutic relationship.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
Y C Tan ◽  
T Tien ◽  
N L Ow ◽  
S l Chowdhury

Abstract Introduction Intra-detrusor Botox injections for overactive bladder has shifted to being performed under local anaesthetic rather than general anaesthetic to improve cost and efficiency. However, it may cause the patient pain and discomfort. We aim to assess the feasibility of LA Botox injections in the outpatient setting and to evaluate patient satisfaction. Method Our first cycle assessed whether patients would consider intra-detrusor Botox injections under local anaesthetic in the outpatient setting. Our services were then restructured to run LA Botox clinics. Our second cycle then assessed the patient satisfaction of these clinics using the client satisfaction questionnaire (CSQ-8) template. Results The first cycle showed that 70% (14/20) of patients would consider having outpatient Botox injections under LA. A potential annual saving of £88,434 was estimated. The second cycle showed a high patient satisfaction rate with an average CSQ-8 score of 30/32 in 16 patients who had Botox injections in the outpatient setting. 9 patients reported being “very satisfied” with our service and the remainder reported being “mostly satisfied” Conclusions LA Botox injections in the clinic setting has a high patient satisfaction rate and can provide considerable cost savings. Suitable patients should have LA intra-detrusor Botox injections in the outpatient setting where possible.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Samuel Ekung ◽  
Isaac Odesola ◽  
Michael Oladokun

PurposeAcross the globe, the dearth of certainty about the cost of sustainable buildings (SBs) remains a critical disincentive to their adoption. This study explored the factually incorrect knowledge about the cost of SBs and their implications on adoption.Design/methodology/approachThe study adopted sequenced mixed qualitative and quantitative approaches involving a literature review, Delphi study and survey. Semi-structured and structured self-study questionnaires were administered to a random sample of green building experts, researchers and registered construction professionals with deep knowledge of SB. The dataset from 254 stakeholders was analysed for commonality, principal components and critical misperceptions using multivariate approaches.FindingsThe predominant misperceptions in the study linked low adoption of SB to cost premium, portray cost premium as a property of luxury sustainable features and suggest related practices are suitable for exemplary projects only. The critical misperceptions produced various misinterpretations that inhibit the adoption of SB through the dearth of policies, increased complexities and inflation of budget to curb perceived risks.Practical implicationsThe study buttressed the imperative to improve cost information, knowledge, skills and stakeholders' risk perceptions to increase SB adoption. The results provide insight into the regional misperceptions and knowledge gaps that could explain the low adoption of SB in a typical emerging green market.Originality/valueThe study showed that the prevalent knowledge about the cost of SB among construction stakeholders are unsupported beliefs and directs attention to emerging issues critical to SBs' adoption in emerging markets.


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