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Naved N, Umer F, Khowaja AR. Irreversible pulpitis in mature permanent teeth: a cost-effectiveness analysis of pulpotomy versus root canal treatment. BMC Oral Health 2024; 24:285. [PMID: 38418999 PMCID: PMC10902936 DOI: 10.1186/s12903-024-04052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Evidence-based dentistry suggests pulpotomy as a potential alternative to root canal treatment in mature permanent teeth with irreversible pulpitis. However, the evidence surrounding the cost-valuation and cost-efficacy of this treatment modality is not yet established. In this context, we adopted an economic modeling approach to assess the cost-effectiveness of pulpotomy versus root canal treatment, as this could aid in effective clinical decision-making. METHODS A Markov model was constructed following a mature permanent tooth with irreversible pulpitis in an 18-year-old patient over a lifetime using TreeAge Pro Healthcare 2022. Transition probabilities were estimated based on existing literature. Costs were estimated based on the United States healthcare following a private-payer perspective and parameter uncertainties were addressed using Monte-Carlo simulations. The model was validated internally by sensitivity analyses, and face validation was performed by an experienced endodontist and health economist. RESULTS In the base case scenario, root canal treatment was associated with additional health benefit but at an increased cost (1.08 more years with an incremental cost of 311.20 USD) over a period of an individual's lifetime. The probabilistic sensitivity analysis revealed pulpotomy to be cost-effective at lower Willingness-To-Pay (WTP) values (99.9% acceptable at 50 USD) whereas increasing the values of WTP threshold root canal treatment was a cost-effective treatment (99.9% acceptable at 550 USD). CONCLUSION Based on current evidence, pulpotomy was a cost-effective treatment option at lower WTP values for the management of irreversible pulpitis in mature permanent teeth. However, by increasing the WTP threshold, root canal treatment became a more cost-effective treatment option over a period of lifetime of an individual.
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Affiliation(s)
- Nighat Naved
- Operative Dentistry & Endodontics, Aga Khan University Hospital, Karachi, Pakistan
| | - Fahad Umer
- Operative Dentistry & Endodontics, Aga Khan University Hospital, Karachi, Pakistan.
| | - Asif R Khowaja
- Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
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Barmon D, Tak A, Baruah U, Begum D, Gupta S, Khanikar D, Nath J, Yadav G. Pattern of Care of Recurrent Cervical Cancer in Low-resource Settings: Challenges and Patient-initiated Follow-up as a Novel Opportunity. J Midlife Health 2023; 14:205-211. [PMID: 38312765 PMCID: PMC10836429 DOI: 10.4103/jmh.jmh_103_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/29/2023] [Accepted: 07/29/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction The availability of optimum diagnostic strategies remains a major problem in resource-constraint countries. This technique of patient-initiated follow-up (PIFU) has been recently adopted in the UK for gynecological cancers and has proven cost benefits. However, no study from the Indian subcontinent has ever been reported. Aims and Objectives The primary objective was to study the pattern of care of recurrent cervical cancer in low-resource settings. The secondary objective was to compare the reliability of symptomatology/clinical evaluation and imaging methods on follow-up to detect recurrence and thus explore the feasibility of symptom-based PIFU. Materials and Methods This was a single-institutional retrospective analysis of recurrent cervical cancer cases for a period of 3 years from January 2019 to January 2022. Patients who followed up for minimum of 6 months were included in the study. Results In 57 of the total 69 patients, symptoms alone were the index diagnostic method. Interestingly, neither of the methods of recurrence detection had impact on overall survival (OS). Cox regression analysis revealed adverse impact of erratic/lost to follow-up (hazard ratio [HR] = 3.8) and pelvic side wall disease (HR = 1.33) on survival. Patients with positive para-aortic nodes had significantly shorter disease-free interval of 11 months, so adding systemic therapy to adjuvant treatment in this cohort needs to be further investigated. Conclusion Our analysis showed that patients with recurrence who were diagnosed with clinical manifestations alone vis-à-vis the ones who were diagnosed primarily on routine follow-up visit by some imaging or diagnostic test had comparable oncologic outcomes. PIFU can be a "practice changing modality" in patient management system, especially in low-resource settings. It will prove to be a simple cost-effective method to detect recurrence and prevent fallouts. Our study points to the feasibility of PIFU in Indian scenario.
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Affiliation(s)
- Debabrata Barmon
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Apoorva Tak
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Upasana Baruah
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Dimpy Begum
- Department of Gynecologic Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sakshi Gupta
- Department of Oncopathology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Duncan Khanikar
- Department of Medical Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jyotiman Nath
- Department of Radiation Oncology, Dr. Bhubaneswar Cancer Institute, Guwahati, A Grant in Aid Unit of DAE India and Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Garima Yadav
- Department of Obstetrics and Gynaecology, AIIMS, Jodhpur, Rajasthan, India
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Lewis KN, Tilford JM, Goudie A, Beavers J, Casey PH, McKelvey LM. Cost-benefit analysis of home visiting to reduce infant mortality among preterm infants. J Pediatr Nurs 2023:S0882-5963(23)00111-2. [PMID: 37183165 DOI: 10.1016/j.pedn.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE The Following Baby Back Home (FBBH) visiting program, which is provided by nurse and social worker teams, supports families of low-birthweight preterm infants after discharge from a neonatal intensive care unit. Enrollment in the FBBH program has been documented to reduce the likelihood of infant death. In this study, we conducted a cost-benefit analysis of the FBBH program. DESIGN AND METHODS Infants enrolled in the FBBH program (N = 416) were identified through administrative records. Infants in the FBBH program were propensity score matched with comparison infants to estimate the difference in healthcare costs in the first year of life. RESULTS Infants enrolled in the FBBH program incurred similar medical care costs compared to a comparison group. Avoided deaths, program costs, healthcare costs resulted in net economic benefits of the FBBH program to avoid infant death estimate at $83,020, cost per life saved at $3080, and benefit-to-cost ratio at 27.95. CONCLUSIONS The FBBH program's net economic benefits from avoided deaths suggest a substantial return on investment of resources, yielding benefits in excess of program and healthcare costs. PRACTICE IMPLICATIONS It is economically beneficial to provide home visiting services to families of low-birthweight babies by a team comprised of a registered nurse and social worker.
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Affiliation(s)
- Kanna N Lewis
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
| | - J Mick Tilford
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Anthony Goudie
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America; Arkansas Center for Health Improvement, Little Rock, AR, United States of America
| | - Jared Beavers
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Patrick H Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Lorraine M McKelvey
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
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Chambers LC, Hallowell BD, Zang X, Rind DM, Guzauskas GF, Hansen RN, Fuchs N, Scagos RP, Marshall BDL. The estimated costs and benefits of a hypothetical supervised consumption site in Providence, Rhode Island. Int J Drug Policy 2022; 108:103820. [PMID: 35973341 PMCID: PMC10131249 DOI: 10.1016/j.drugpo.2022.103820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Overdose deaths have increased dramatically in the United States, including in Rhode Island. In July 2021, the Rhode Island government passed legislation supporting a two-year pilot program authorizing supervised consumption sites (SCSs) in response to this crisis. We estimated the costs and benefits of a hypothetical SCS in Providence, Rhode Island. METHODS We utilized a decision analytic mathematical model to compare costs and outcomes for people who inject drugs under two scenarios: (1) a SCS that includes syringe services provision, and (2) a syringe service program only (i.e., status quo). We assumed 0.95% of injections result in overdose, the SCS would serve 400 clients monthly and have a net cost of $783,899 annually, 46% of overdoses occurring outside of the SCS result in an ambulance run and 43% result in an emergency department (ED) visit, 0.79% of overdoses occurring within the SCS result in an ambulance run and ED visit, and the SCS would lead to a 25.7% reduction in fatal overdoses near the site. The model was developed from a modified societal perspective with a one-year time horizon. RESULTS A hypothetical SCS in Providence would prevent approximately 2 overdose deaths, 261 ambulance runs, 244 ED visits, and 117 inpatient hospitalizations for emergency overdose care annually compared to a scenario that includes a syringe service program only. The SCS would save $1,104,454 annually compared to the syringe service program only, accounting only for facility costs and short-term costs of emergency overdose care and ignoring savings associated with averted deaths. Influential parameters included the percentage of injections resulting in overdose, the total annual injections at the SCS, and the percentage of overdoses outside of the SCS that result in an ED visit. CONCLUSION A SCS in would result in substantial cost savings due to prevention of costly emergency overdose care.
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Affiliation(s)
- Laura C Chambers
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA; Division of Infectious Diseases, The Miriam Hospital, Providence, Rhode Island, USA.
| | - Benjamin D Hallowell
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Xiao Zang
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - David M Rind
- Institute for Clinical and Economic Review, Boston, Massachusetts, USA
| | - Greg F Guzauskas
- Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, Washington, USA
| | - Ryan N Hansen
- Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, Washington, USA
| | - Nathaniel Fuchs
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Rachel P Scagos
- Drug Overdose Surveillance Program, Rhode Island Department of Health, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
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Alfonso L, Gharesifard M, Wehn U. Analysing the value of environmental citizen-generated data: Complementarity and cost per observation. J Environ Manage 2022; 303:114157. [PMID: 34839172 DOI: 10.1016/j.jenvman.2021.114157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
The proliferation of Citizen Science initiatives has increased the expectations of practitioners who need data for design, analysis, management and research in environmental applications. Many Citizen Science experiences have reported tangible societal benefits related to improved governance of natural resources due to the involvement of citizens and communities. However, from the perspective of data generation, most of the literature on Citizen Science tends to regard it as a potentially cost-effective source of data, with major concerns about the quality of data. The Ground Truth 2.0 project brought the opportunity to examine the scope of this potential by analysing the value of citizen-generated data. We propose a methodology to account for the value of citizen observations as a function of their complementarity to existing environmental observations and the evolution of their costs in time. The application of the proposed methodology in the chosen case studies that were all established using a co-design approach shows that the cost of obtaining Citizen Science data is not as low as frequently stated in literature. This is because the costs associated with co-design events for creating a Citizen Science community, as well as the functional and technical design of the tools, are much higher than the costs of rolling out the actual observation campaigns. In none of the considered cases did an increment in the number of preparatory events translate into an immediate increase in the collected observations. Nevertheless, Citizen Science appears to have the greatest value in places where in-situ environmental monitoring is not implemented.
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Affiliation(s)
- Leonardo Alfonso
- Department of Hydroinformatics and Socio-technical Innovation IHE Delft Institute of Water Education, Westvest 7, 2611AX, Delft, the Netherlands.
| | | | - Uta Wehn
- Department of Hydroinformatics and Socio-technical Innovation IHE Delft Institute of Water Education, Westvest 7, 2611AX, Delft, the Netherlands
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Curtis K, Sivabalan P, Bedford DS, Considine J, D'Amato A, Shepherd N, Fry M, Munroe B, Shaban RZ. Implementation of a structured emergency nursing framework results in significant cost benefit. BMC Health Serv Res 2021; 21:1318. [PMID: 34886873 PMCID: PMC8655998 DOI: 10.1186/s12913-021-07326-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patients are at risk of deterioration on discharge from an emergency department (ED) to a ward, particularly in the first 72 h. The implementation of a structured emergency nursing framework (HIRAID) in regional New South Wales (NSW), Australia, resulted in a 50% reduction of clinical deterioration related to emergency nursing care. To date the cost implications of this are unknown. The aim of this study was to determine any net financial benefits arising from the implementation of the HIRAID emergency nursing framework. Methods This retrospective cohort study was conducted between March 2018 and February 2019 across two hospitals in regional NSW, Australia. Costs associated with the implementation of HIRAID at the study sites were calculated using an estimate of initial HIRAID implementation costs (AUD) ($492,917) and ongoing HIRAID implementation costs ($134,077). Equivalent savings per annum (i.e. in less patient deterioration) were calculated using projected estimates of ED admission and patient deterioration episodes via OLS regression with confidence intervals for incremental additional deterioration costs per episode used as the basis for scenario analysis. Results The HIRAID-equivalent savings per annum exceed the costs of implementation under all scenarios (Conservative, Expected and Optimistic). The estimated preliminary savings to the study sites per annum was $1,914,252 with a payback period of 75 days. Conservative projections estimated a net benefit of $1,813,760 per annum by 2022–23. The state-wide projected equivalent savings benefits of HIRAID equalled $227,585,008 per annum, by 2022–23. Conclusions The implementation of HIRAID reduced costs associated with resources consumed from patient deterioration episodes. The HIRAID-equivalent savings per annum to the hospital exceed the costs of implementation across a range of scenarios, and upscaling would result in significant patient and cost benefit.
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Affiliation(s)
- Kate Curtis
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia. .,Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong, NSW, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia. .,George Institute for Global Health, University of NSW, Kensington, Australia. .,Faculty of Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
| | - Prabhu Sivabalan
- Business School, University of Technology Sydney, Sydney, NSW, Australia
| | - David S Bedford
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia
| | - Julie Considine
- Deakin University, School of Nursing and Midwifery, Geelong, NSW, Australia.,Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Alfa D'Amato
- Performance Analysis for Transformation in Healthcare (PATH) Group, UTS Business School, Ultimo, NSW, Australia.,System Financial Performance, NSW Ministry of Health, North Sydney, NSW, Australia
| | - Nada Shepherd
- Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Margaret Fry
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia.,Research & Practice Development Unit, Northern Sydney Local Health District, St Leonards, Sydney, NSW, Australia
| | - Belinda Munroe
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Ramon Z Shaban
- Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Office 169, RC Mills Building, Camperdown, NSW, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, NSW, Australia.,Division of Infectious Diseases and Sexual Health, Westmead Hospital and the New South Wales Biocontainment Centre, Western Sydney Local Heath District and New South Wales Ministry of Health, Westmead, NSW, Australia
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Xin Y, Davies A, Briggs A, McCombie L, Messow CM, Grieve E, Leslie WS, Taylor R, Lean MEJ. Type 2 diabetes remission: 2 year within-trial and lifetime-horizon cost-effectiveness of the Diabetes Remission Clinical Trial (DiRECT)/Counterweight-Plus weight management programme. Diabetologia 2020; 63:2112-2122. [PMID: 32776237 PMCID: PMC7476973 DOI: 10.1007/s00125-020-05224-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/19/2020] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS Approximately 10% of total healthcare budgets worldwide are spent on treating diabetes and its complications, and budgets are increasing globally because of ageing populations and more expensive second-line medications. The aims of the study were to estimate the within-trial and lifetime cost-effectiveness of the weight management programme, which achieved 46% remissions of type 2 diabetes at year 1 and 36% at year 2 in the Diabetes Remission Clinical Trial (DiRECT). METHODS Within-trial analysis assessed costs of the Counterweight-Plus intervention in DiRECT (including training, programme materials, practitioner appointments and low-energy diet), along with glucose-lowering and antihypertensive medications, and all routine healthcare contacts. Lifetime cost per quality-adjusted life-year (QALY) was estimated according to projected durations of remissions, assuming continued relapse rates as seen in year 2 of DiRECT and consequent life expectancy, quality of life and healthcare costs. RESULTS Mean total 2 year healthcare costs for the intervention and control groups were £3036 and £2420, respectively: an incremental cost of £616 (95% CI -£45, £1269). Intervention costs (£1411; 95% CI £1308, £1511) were partially offset by lower other healthcare costs (£796; 95% CI £150, £1465), including reduced oral glucose-lowering medications by £231 (95% CI £148, £314). Net remission at 2 years was 32.3% (95% CI 23.5%, 40.3%), and cost per remission achieved was £1907 (lower 95% CI: intervention dominates; upper 95% CI: £4212). Over a lifetime horizon, the intervention was modelled to achieve a mean 0.06 (95% CI 0.04, 0.09) QALY gain for the DiRECT population and mean total lifetime cost savings per participant of £1337 (95% CI £674, £2081), with the intervention becoming cost-saving within 6 years. CONCLUSIONS/INTERPRETATION Incorporating the lifetime healthcare cost savings due to periods of remission from diabetes and its complications, the DiRECT intervention is predicted to be both more effective (QALY gain) and cost-saving in adults with type 2 diabetes compared with standard care. This conclusion appears robust to various less favourable model scenarios, providing strong evidence that resources could be shifted cost-effectively to support achieving remissions with the DiRECT intervention. TRIAL REGISTRATION ISRCTN03267836 Graphical abstract.
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Affiliation(s)
- Yiqiao Xin
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Davies
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Louise McCombie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow, G31 2ER, UK
| | - C Martina Messow
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Eleanor Grieve
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Wilma S Leslie
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow, G31 2ER, UK
| | - Roy Taylor
- Newcastle Magnetic Resonance Centre, Translational and Clinical Research Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Michael E J Lean
- Human Nutrition, School of Medicine, Dentistry and Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Level 2, New Lister Building, Glasgow Royal Infirmary, 8-16 Alexandra Parade, Glasgow, G31 2ER, UK.
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Butzer JF, Virva R, Kozlowski AJ, Cistaro R, Perry ML. Participation by design: Integrating a social ecological approach with universal design to increase participation and add value for consumers. Disabil Health J 2020; 14:101006. [PMID: 32994140 DOI: 10.1016/j.dhjo.2020.101006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Physical activity is an essential component of a healthy lifestyle. Health clubs encourage sustained healthy lifestyles but are still largely not accessible to people with disabilities. Cost is a barrier for accessibility enhancements. HYPOTHESIS We postulate that: (A) universal design coupled with a social ecological approach improves measured accessibility compared with existing fitness facilities constructed since the adoption of the ADA; (B) increased accessibility coupled with an environment friendly to people with disabilities attracts more participants to a YMCA than predicted by traditional industry market research producing a recovery of the cost of increased accessibility; and (C) attitudes of facility members toward people with disabilities may improve if an accessible facility facilitates more personal interactions between people with and without disabilities. METHODS Accessibility is measured with the Accessibility Instruments Measuring Fitness and Recreation Environments (AIMFREE). Cost recovery is determined by comparing excess membership revenue to the cost of universal design elements beyond regulatory requirements, and attitudes toward people with disabilities are measured with the Attitudes Toward Disabled Persons Scale. RESULTS AIMFREE scores were significantly higher than comparison facilities in all areas except for equipment, parking, training, and programs. Excess revenue exceeded the extra cost of accessibility enhancements and attitudes toward people with disabilities did not change. CONCLUSIONS Universal design coupled with a social ecological approach improves accessibility in fitness facilities and results in a reasonable payback time. Attitudes toward people with disabilities did not change in a YMCA designed to accommodate people with disabilities.
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Affiliation(s)
- John F Butzer
- John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI, USA; Division of Rehabilitation, Michigan State University College of Human Medicine, 235 Wealthy St SE, Grand Rapids, MI, USA.
| | - Roberta Virva
- John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI, USA; Division of Rehabilitation, Michigan State University College of Human Medicine, 235 Wealthy St SE, Grand Rapids, MI, USA
| | - Allan J Kozlowski
- John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI, USA; Division of Rehabilitation, Michigan State University College of Human Medicine, 235 Wealthy St SE, Grand Rapids, MI, USA; Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, 235 Wealthy St SE, Grand Rapids, MI, USA
| | - Rebecca Cistaro
- John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, 235 Wealthy St SE, Grand Rapids, MI, USA; Division of Rehabilitation, Michigan State University College of Human Medicine, 235 Wealthy St SE, Grand Rapids, MI, USA
| | - Michael L Perry
- Universal Design Consulting, 1811 4, Mile Rd NE, Grand Rapids, MI, USA
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Moore W, Doshi A, Gyftopoulos S, Bhattacharji P, Rosenkrantz AB, Kang SK, Recht M. Enhancing communication in radiology using a hybrid computer-human based system. Clin Imaging 2020; 61:95-98. [PMID: 32004954 DOI: 10.1016/j.clinimag.2019.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Communication and physician burn out are major issues within Radiology. This study is designed to determine the utilization and cost benefit of a hybrid computer/human communication tool to aid in relay of clinically important imaging findings. MATERIAL AND METHODS Analysis of the total number of tickets, (requests for assistance) placed, the type of ticket and the turn-around time was performed. Cost analysis of a hybrid computer/human communication tool over a one-year period was based on human costs as a multiple of the time to close the ticket. Additionally, we surveyed a cohort of radiologists to determine their use of and satisfaction with this system. RESULTS 14,911 tickets were placed in the 6-month period, of which 11,401 (76.4%) were requests to "Get the Referring clinician on the phone." The mean time to resolution (TTR) of these tickets was 35.3 (±17.4) minutes. Ninety percent (72/80) of radiologists reported being able to interpret a new imaging study instead of waiting to communicate results for the earlier study, compared to 50% previously. 87.5% of radiologists reported being able to read more cases after this system was introduced. The cost analysis showed a cost savings of up to $101.12 per ticket based on the length of time that the ticket took to close and the total number of placed tickets. CONCLUSIONS A computer/human communication tool can be translated to significant time savings and potentially increasing productivity of radiologists. Additionally, the system may have a cost savings by freeing the radiologist from tracking down referring clinicians prior to communicating findings.
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Affiliation(s)
- William Moore
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America.
| | - Ankur Doshi
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Soterios Gyftopoulos
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Priya Bhattacharji
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Andrew B Rosenkrantz
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Stella K Kang
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
| | - Michael Recht
- NYU Langone Health, Department of Radiology, 660 1st Avenue, 3rd Floor, New York, NY 10016, United States of America
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10
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Medina-de Chazal HA, Cohen F, Pallavicini F, Fernández AD, Agatiello CR, Berrocal DH. Economic benefits of fractional flow reserve utilization on intermediate lesions and its clinical impact after one year-follow up. Arch Cardiol Mex 2019; 89:308-314. [PMID: 31834322 DOI: 10.24875/acm.m19000037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Fractional flow reserve (FFR) is a proven technology for guiding percutaneous coronary intervention, but it is not reimbursed despite the fact that it frequently allows to defer revascularization. Our goal was to determine the economic benefit of FFR on intermediate lesions, as well as the clinical endpoints at 1 year follow up. Methods Observational prospective study that included consecutive patients with intermediate lesions evaluated with FFR between April 2013 and March 2016. For the economic analysis we evaluated the specific resources used during the procedure. Clinical endpoints including cardiovascular death, target lesion revascularization and acute myocardial infarction, were followed up over a one-year period. Results FFR was performed on 222 lesions in 151 consecutive patients. FFR was positive in 26.1% of the assessed lesions. The estimated total cost using FFR was US$ 891,290.08 while cost estimate without FFR was US$ 1,557,352, meaning 43% in cost savings. There was one cardiovascular death and two readmissions during follow up in the positive FFR group. Conclusions FFR guided revascularization on intermediate coronary lesions resulted in an economic benefit by reducing overall costs without harming clinical outcomes.
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Affiliation(s)
| | - Fernando Cohen
- Servicio de Hemodinamia y Cardiología Intervencionista. Hospital Italiano, Buenos Aires, Argentina
| | - Franco Pallavicini
- Servicio de Hemodinamia y Cardiología Intervencionista. Hospital Italiano, Buenos Aires, Argentina
| | - Alejandro D Fernández
- Servicio de Hemodinamia y Cardiología Intervencionista. Hospital Italiano, Buenos Aires, Argentina
| | - Carla R Agatiello
- Servicio de Hemodinamia y Cardiología Intervencionista. Hospital Italiano, Buenos Aires, Argentina
| | - Daniel H Berrocal
- Servicio de Hemodinamia y Cardiología Intervencionista. Hospital Italiano, Buenos Aires, Argentina
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Cloete L, Mitchell BG, Morton D. Protocol: investigating the effectiveness and cost benefit of a lifestyle intervention targeting type 2 diabetes in Australia. BMC Endocr Disord 2019; 19:74. [PMID: 31307434 PMCID: PMC6631877 DOI: 10.1186/s12902-019-0396-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/12/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Type 2 Diabetes Mellitus (T2DM) has become an endemic disease. A number of interrelated factors increase the risk of the onset of T2DM, however much of the pathogenesis of the disease is associated with lifestyle. A number of studies have indicated that adopting positive lifestyle changes can successfully prevent or delay the onset of T2DM in a number of different population groups. The CHIP intervention is a lifestyle program that has been shown in over more than 30 published papers have indicated that the CHIP intervention leads to dramatic improvement in the indicators of T2DM these diseases of lifestyle. METHODS A randomized control trial will be conducted involving 150 individuals with an established diagnosis of T2DM. All participants will continue to receive usual ongoing diabetes care, however, the intervention group (75 individuals) will in addition participate in a 12-week CHIP lifestyle intervention programme followed by a further 9 months of monthly follow-up appointments. Approval for funding was obtained on 30 June 2017. DISCUSSION The outcomes of this study have the potential to inform decisions about patient treatment and potentially provide incentive for the provision of funded lifestyle-based preventive and restorative programs for patients diagnosed with T2DM. TRIAL REGISTRATION This trial is registered as an initial version with the Australia New Zealand Clinical Trials Registry ( http://www.anzctr.org.au/ ), registration number ACTRN12617001233314. Registered on 23/08/2017. No enrollments in the study to date.
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Affiliation(s)
- Linda Cloete
- Faculty of Arts Nursing and Theology, Avondale College of Higher Education, 185 Fox Valley Road, Wahroonga, Sydney, NSW, 2076, Australia.
| | - Brett G Mitchell
- School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, Q-10 Loop Road & The Boulevarde, Ourimbah, NSW, Australia
| | - Darren Morton
- Faculty of Education and Business, Avondale College of Higher Education, 582 Freemans Drive, Cooranbong, NSW, Australia
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Batumalai V, Wong K, Shafiq J, Hanna TP, Gabriel G, Heberle J, Koprivic I, Kaadan N, King O, Tran T, Cassapi L, Forstner D, Delaney GP, Barton M. Estimating the cost of radiotherapy for 5-year local control and overall survival benefit. Radiother Oncol 2019; 136:154-160. [PMID: 31015119 DOI: 10.1016/j.radonc.2019.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 03/31/2019] [Accepted: 04/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Escalating health care costs have led to greater efforts directed at measuring the cost and benefits of medical treatments. The aim of this study was to estimate the costs of 5-year local control and overall survival benefits of radiotherapy for the cancer population in Australia. MATERIALS AND METHODS The local control and overall survival benefits of radiotherapy at 5-years and optimal number of fractions per course have been estimated for 26 tumour sites for which radiotherapy is indicated. For this study, a hybrid approach that merges features from activity based costing (ABC) and relative value units costing (RVU) were used to provide cost estimates. ABC methodology was used to allocate costs to all radiotherapy activities associated with each patient's treatment course, while the RVUs represent the cost of each radiotherapy activity relative to the average cost of all activities and were used to achieve a weighted cost allocation. A patient's journey for the financial year was constructed by consolidating all the radiotherapy activities and their associated costs, and the average cost per activity (fraction) was determined. The cost of radiotherapy per 5-year overall survival and local control was then estimated. RESULTS The estimated population 5-year local control and overall survival benefits of radiotherapy for all cancer were 23% and 6%, respectively. The optimal number of fractions per treatment course if guidelines were followed was 19.4 fractions. The average cost per fraction for all cancer was AU$276. The estimated cost of radiotherapy was AU$23,585 per 5-year local control and AU$86,480 per 5-year overall survival (equivalent to 5 life years) for all cancer. CONCLUSION The cost of AU$86,480 per 5-year overall survival would translate to AU$17,296 1-year overall survival. Therefore, the cost of radiotherapy is inexpensive if delivered optimally. Policy implications from this study include knowledge about cost to deliver radiotherapy to allow one to quantify the expected benefit at a population level.
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Affiliation(s)
- Vikneswary Batumalai
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Australia; South Western Clinical School, University of New South Wales, Australia.
| | - Karen Wong
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Australia; South Western Clinical School, University of New South Wales, Australia
| | - Jesmin Shafiq
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Australia; South Western Clinical School, University of New South Wales, Australia
| | - Timothy P Hanna
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Australia; Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Canada
| | - Gabriel Gabriel
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Australia; South Western Clinical School, University of New South Wales, Australia
| | - Julia Heberle
- Activity Based Management, New South Wales Health, Australia
| | - Ivan Koprivic
- Activity Based Management, New South Wales Health, Australia
| | - Nasreen Kaadan
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia; Sydney and South West Sydney Clinical Cancer Registry, Ingham Institute for Applied Medical Research, Australia
| | - Odette King
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia
| | - Thomas Tran
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia
| | - Lynette Cassapi
- Department of Radiation Oncology, Calvary Mater Newcastle, Australia
| | - Dion Forstner
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia; Genesis Care Radiation Oncology, St Vincent's Hospital Sydney, Australia; School of Medicine, Western Sydney University, Australia
| | - Geoff P Delaney
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Australia; South Western Clinical School, University of New South Wales, Australia
| | - Michael Barton
- Department of Radiation Oncology, South Western Sydney Local Health District, Australia; Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Australia; South Western Clinical School, University of New South Wales, Australia
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Mery B, Rowinski E, Vallard A, Jacquin JP, Simoens X, Magné N, Doucey P. Advocacy for a New Oncology Research Paradigm: The Model of Bevacizumab in Triple-Negative Breast Cancer in a French Cohort Study. Oncology 2019; 97:1-6. [PMID: 30939479 DOI: 10.1159/000499583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Triple-negative breast cancer remains a disease with poor prognosis and few treatment options, due to the lack of therapeutic targets. Bevacizumab, the first anti-VEGF agent approved in the treatment of cancer, has demonstrated efficacy in breast cancer in combination with paclitaxel for the first-line treatment of HER2-negative metastatic breast cancer. Despite the fact that the benefit was particularly significant for triple-negative breast cancer with its approval in 2008 by the FDA, this decision was later reversed as there was no improvement in overall survival in addition to significant costs. OBJECTIVES The scope of the present study is to focus on the role of bevacizumab in triple-negative breast cancer through the analysis of overall survival, progression-free survival, and cost benefit among 45 patients in a French monocentric study and to discuss new paradigms of endpoints. METHODS All patients diagnosed with metastatic triple-negative breast cancer, for whom first-line treatment was bevacizumab in combination with paclitaxel between January 2011 and April 2018 were included in this single-center retrospective study, and a chart review of all recruited subjects was performed from medical records. RESULTS In this real-life study among 45 patients with metastatic triple-negative breast cancer, bevacizumab provided a significant benefit for a category of patients, with longer median progression-free survival and the ability of maintenance therapy associated to limited side effects. CONCLUSIONS Beyond being the phoenix of breast oncology and a magnet of controversy, the case of bevacizumab in metastatic breast cancer highlights one of the greatest challenges in oncology, namely to balance modest clinical benefits with exponential costs. A balance needs to be found between health care affordability, high price of progress, and the best medical decision for the patients, in order to avoid the "unbreathable tipping point" we are actually dealing with.
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Affiliation(s)
- Benoîte Mery
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France,
| | - Elise Rowinski
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Alexis Vallard
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Jean-Phillipe Jacquin
- Department of Medical Oncology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Xavier Simoens
- Department of Pharmacology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Nicolas Magné
- Radiotherapy Department, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
| | - Pauline Doucey
- Department of Pharmacology, Lucien Neuwirth Cancer Institute, Saint-Priest-en-Jarez, France
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Wang X, Guo G, Zheng J, Lu L. Programmes for the prevention of mother-to-child HIV infection transmission have made progress in Yunnan Province, China, from 2006 to 2015: a cost effective and cost-benefit evaluation. BMC Infect Dis 2019; 19:64. [PMID: 30654744 PMCID: PMC6337853 DOI: 10.1186/s12879-019-3708-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/10/2019] [Indexed: 11/16/2022] Open
Abstract
Background Prevention of mother-to-child transmission (PMTCT) of HIV programmes have substantially reduced HIV infections among infants in Yunnan Province, China. We conducted a macro-level economic evaluation of Yunnan’s PMTCT programmes over the 10 years from 2006 to 2015 from a policymaker perspective. Methods The study methodology was in accordance with the guidelines from the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. We quantified the output from the Yunnan’s PMTCT programmes by estimating the number of paediatric HIV infections averted and the relative savings to both the health care system and society. The return-on-investment ratio (ROI) was calculated as the output (numerator) divided by the input (denominator). Results We have found that the US$ 49 million investment in Yunnan’s PMTCT programmes over the period from 2006 to 2015 averted an estimated 2725 new paediatric HIV infections and resulted in an estimated 134,008 QALY acquired. It saved an estimated US$ 0.5 billion in treatment expenditures for Yunnan’s healthcare system and nearly US$ 3.9 billion in productivity. The ROI was 88.4, meaning every US$ 1 invested brought about US$ 88.4 in benefits. Conclusions Our results support the ongoing investment in PMTCT programmes in Yunnan Province. The PMTCT strategy is a cost effective and cost-benefit strategy in the periods from 2006 to 2015. Despite higher investments in the future, the overall investment in the PMTCT programmes in Yunnan province could be offset by averting more paediatric infections.
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Affiliation(s)
- Xiaowen Wang
- Yunnan Center for Disease Control and Prevention, No.158, Dongsi Street, Xishan District, Kunming, 650022, Yunnan Province, China.,Department of Public Health, Kunming Medical University, No. 1168, West Chunrong Road, Yuhua Street, Chenggong District, Kunming, 650599, Yunnan Province, China
| | - Guangping Guo
- Yunnan Maternal and Child Health Care hospital, No. 200, Gulou Road, Wuhua District, Kunming, 650032, Yunnan Province, China
| | - Jiarui Zheng
- Yunnan Maternal and Child Health Care hospital, No. 200, Gulou Road, Wuhua District, Kunming, 650032, Yunnan Province, China
| | - Lin Lu
- Department of Public Health, Kunming Medical University, No. 1168, West Chunrong Road, Yuhua Street, Chenggong District, Kunming, 650599, Yunnan Province, China. .,Health and Family Planning Commission of Yunnan Province, No. 309, Guomao Street, Kunming, 650299, Yunnan Province, China.
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Verma B, Singh A, Saxena AK, Kumar M. Deflated Balloon-Facilitated Direct Stenting in Primary Angioplasty (The DBDS Technique): A Pilot Study. Cardiol Res 2018; 9:284-292. [PMID: 30344826 PMCID: PMC6188044 DOI: 10.14740/cr770w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/27/2018] [Indexed: 01/06/2023] Open
Abstract
Background Several studies and meta-analyses have shown that direct stenting (DS) may improve clinical outcomes in patients with acute ST-elevation myocardial infarction (STEMI). But in most cases, the thrombolysis in myocardial infarction (TIMI) flow remains ≤ 1 after wire placement. We used deflated balloon to facilitate DS in patients with totally occluded culprit arteries. The aim of this study was to evaluate the feasibility, safety and outcomes of this novel technique in patients with STEMI in real-world clinical practice. Methods This was a prospective, observational, single-center pilot study. From September 2016 to June 2018, 454 patients were enrolled in the study. DS was performed when the culprit vessel was visualized with at least TIMI flow grade 1. Patients with complete occlusion of the vessel after wire placement were subjected to deflated balloon-facilitated DS technique (DBDS technique) and DS was done wherever possible. Results DS was done in 74% (n = 336) of the patients and 26% (n = 118) patients received stenting after pre-dilatation (PD). DBDS technique to facilitate DS was successful in 68% patients (211/309). Final TIMI 3 flow was achieved more frequently in the DS group as compared to PD group (96.7% versus 92.3%, P = 0.04). The procedural complications were also significantly lower in DS group (0.6% versus 7.6%, P < 0.001). DS group had significantly lower procedure time (33 ± 19 min versus 41 ± 17 min, P < 0.001), fluoroscopy time (6.2 ± 3.4 min versus 7.8 ± 32 min, P < 0.001), required lesser contrast volume (112 ± 16 mL versus 123 ± 18 mL, P < 0.001) and had lower procedural cost (310 ± 45$ versus 402 ± 56$, P < 0.001). ST-segment resolution > 50% after percutaneous coronary intervention (PCI) were significantly higher in the DS group (85.7% versus 71.1%, P < 0.001). At 30 days, the major adverse cardiac event (MACE) rate was significantly lower in the DS group (2.4% versus 9.3%, P = 0.02), mainly driven by lower rates of target lesion revascularization (TLR) (0.9% versus 4.2%, P = 0.01). Conclusion This cost-effective technique appears to be simple, feasible and safe and is associated with superior clinical outcomes. It helps in maximizing DS and could offer an alternative to PD and aspiration thrombectomy in total occlusion. However, larger studies with longer follow up are required before a wider application of this technique.
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Affiliation(s)
- Bhupendra Verma
- Department of Cardiology, Shree Krishna Hospital, Kashipur, UK, India
| | - Amrita Singh
- Department of Cardiology, Shree Krishna Hospital, Kashipur, UK, India
| | - Ashwani K Saxena
- Department of Cardiology, Shree Krishna Hospital, Kashipur, UK, India
| | - Manu Kumar
- Department of Cardiology, Shree Krishna Hospital, Kashipur, UK, India
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Coindre JP, Crochette R, Breuer C, Piccoli GB. Why are hospitalisations too long? A simple checklist for identifying the main social barriers to hospital discharge from a nephrology ward. BMC Nephrol 2018; 19:227. [PMID: 30208851 PMCID: PMC6134783 DOI: 10.1186/s12882-018-1023-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 08/28/2018] [Indexed: 12/14/2022] Open
Abstract
The present increase in life span has been accompanied by an even higher increase in the burden of comorbidity. The challenges to healthcare systems are enormous and performance measures have been introduced to make the provision of healthcare more cost-efficient. Performance of hospitalisation is basically defined by the relationship between hospital stay, use of hospital resources, and main diagnosis/diagnoses and complication(s), adjusted for case mix. These factors, combined in different indexes, are compared with the performance of similar hospitals in the same and other countries. The reasons why an approach like this is being employed are clear.Cutting costs cannot be the only criteria, in particular in elderly, high-comorbidity patients: in this population, although social issues are important determinants of hospital stay, they are rarely taken into account or quantified in evaluations. Quantifying the impact of the "social barriers" to care can serve as a marker of the overall quality of treatment a network provides, and point to specific out-of-hospital needs, necessary to improve in-hospital performance. We therefore propose a simple, empiric medico-social checklist that can be used in nephrology wards to assess the presence of social barriers to hospital discharge and quantify their weight.Using the checklist should allow: identifying patients with social frailty that could complicate hospitalisation and/or discharge; evaluating the social needs of patient and entourage at the beginning of hospitalisation, adopting timely procedures, within the partnership with out-of-hospital teams; facilitating prioritization of interventions by social workers.The following ten items were empirically identified: reason for hospitalisation; hospitalisation in relation to the caregiver's problems; recurrent unplanned hospitalisations or early re-hospitalisation; social/family isolation; presence of a dependent relative in the patient's household; lack of housing or unsuitable housing/accommodation; loss of autonomy; lack of economic resources; lack of a safe environment; evidence of physical or psychological abuse.The simple tool here described needs validation; the present proposal is aimed at raising attention on the importance of non-medical issues in medical organisation in our specialty, and is open to discussion, to allow its refinement.
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Affiliation(s)
- Jean Philippe Coindre
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
| | - Romain Crochette
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
| | - Conrad Breuer
- Direction des Finances, du Système d’Information et du Contrôle de Gestion, Centre Hospitalier Le Mans, 72000 le Mans, France
| | - Giorgina Barbara Piccoli
- Néphrologie, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72000 le Mans, France
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Turin, Italy
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Kanozawa K, Noguchi Y, Sugahara S, Nakamura S, Yamamoto H, Kaneko K, Kono R, Sato S, Ogawa T, Hasegawa H, Katayama S. The renoprotective effect and safety of a DPP-4 inhibitor, sitagliptin, at a small dose in type 2 diabetic patients with a renal dysfunction when changed from other DPP-4 inhibitors: REAL trial. Clin Exp Nephrol 2017; 22:825-834. [PMID: 29275488 DOI: 10.1007/s10157-017-1521-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 12/06/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND We conducted the multicenter, prospective, open-label study in type 2 diabetic (T2DM) patients with renal dysfunction, to clarify the efficacy and the safety in relation to renal function and glycemic control, and the economic effect when other dipeptidyl peptidase-4 (DPP-4) inhibitors were switched to a small dose of sitagliptin depending on their renal function. METHODS Vildagliptin, alogliptin, or linagliptin received for more than 2 months were changed to sitagliptin at 25 or 12.5 mg/day depending on their renal function in 49 T2DMs. Renal function and glycemic control, and the drug cost were assessed during 6 months. RESULTS Estimated glomerular filtration rate was not changed in patients not on hemodialysis (n = 29). The HbA1c levels were not altered in all of the patients including those on hemodialysis (n = 20). The active glucagon-like peptide-1 levels or other renal parameters were not altered significantly. There were no adverse events to be related to the drugs. The daily drug expense was reduced by 88.1 yen per patient. CONCLUSION Switching to a small dose of sitagliptin according to the renal function in T2DM patients with renal dysfunction demonstrated the same efficacy and safety as those with other full-dose DPP-4 inhibitors, indicating a therapeutic option with a high cost performance.
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Affiliation(s)
- Koichi Kanozawa
- Division of Nephrology and Hypertension, Blood Purification Center, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan.
| | - Yuichi Noguchi
- Department of Endocrinology and Diabetes, Saitama Medical University, 38, Morohongo, Moroyama-machi Iruma-gun, Saitama, 350-0451, Japan
| | - Souichi Sugahara
- Shingashi Kidney Centre, 39-1, Shimoshingashi, Kawagoe-shi, Saitama, 350-1136, Japan
| | - Satoko Nakamura
- Sekishin Health Care Clinic, 25-18, Wakita Honcho, Kawagoe-shi, Saitama, 350-1123, Japan
| | - Hirohisa Yamamoto
- Kawagoe Ekimae Clinic, Ishikawa Kinenkai Medical Group, Kawagoe Ekimae Bld. 2F, 16-23, Wakita Honcho, Kawagoe-shi, Saitama, 350-1123, Japan
| | - Keiko Kaneko
- Higashi-Hannou Ekimae Clinic, Takahasi Bld.2, 3F, 3-5, Yanagicho, Hanno-shi, Saitama, 357-0035, Japan
| | - Rika Kono
- Iruma Ekimae Clinic, Yokota Square Bld.4, 5F, 1-2-30, Toyooka, Iruma-shi, Saitama, 358-0003, Japan
| | - Saeko Sato
- Division of Nephrology and Hypertension, Blood Purification Center, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Tomonari Ogawa
- Division of Nephrology and Hypertension, Blood Purification Center, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Hajime Hasegawa
- Division of Nephrology and Hypertension, Blood Purification Center, Saitama Medical Center, Saitama Medical University, 1981, Kamoda, Kawagoe, Saitama, 350-8550, Japan
| | - Shigehiro Katayama
- Kawagoe Clinic, Saitama Medical University, 21-7 Wakita Honcho, Kawagoe-shi, Saitama, 350-1123, Japan
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Teh BW, Brown C, Joyce T, Worth LJ, Slavin MA, Thursky KA. Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre. Support Care Cancer 2018; 26:997-1003. [PMID: 29018966 DOI: 10.1007/s00520-017-3921-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/02/2017] [Indexed: 01/27/2023]
Abstract
BACKGROUND Neutropenic fever (NF) is a common complication of cancer chemotherapy. Patients at low risk of medical complications from NF can be identified using a validated risk assessment and managed in an outpatient setting. This is a new model of care for Australia. This study described the implementation of a sustainable ambulatory program for NF at a tertiary cancer centre over a 12-month period. METHODS Peter MacCallum Cancer Centre introduced an ambulatory care program in 2014, which identified low-risk NF patients, promoted early de-escalation to oral antibiotics, and early discharge to a nurse-led ambulatory program. Patients prospectively enrolled in the ambulatory program were compared with a historical-matched cohort of patients from 2011 for analysis. Patient demographics, clinical variables (cancer type, recent chemotherapy, treatment intent, site of presentation) and outcomes were collected and compared. Total cost of inpatient admissions was determined from diagnosis-related group (DRG) codes and applied to both the prospective and historical cohorts to allow comparisons. RESULTS Twenty-five patients were managed in the first year of this program with a reduction in hospital median length of stay from 4.0 to 1.1 days and admission cost from Australian dollars ($AUD) 8580 to $AUD2360 compared to the historical cohort. Offsetting salary costs, the ambulatory program had a net cost benefit of $AUD 71895. Readmission for fever was infrequent (8.0%), and no deaths were reported. CONCLUSION Of relevance to hospitals providing cancer care, feasibility, safety, and cost benefits of an ambulatory program for low-risk NF patients have been demonstrated.
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Hutchison K, Carter D, Johnson J. Robotic prostatectomy took off, despite a lack of evidence and risks of inequity. Med J Aust 2017; 207:89-90. [PMID: 28701133 DOI: 10.5694/mja16.00916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022]
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Schiavon M, Francescon M, Drigo D, Salloum G, Baraziol R, Tesei J, Fraccalanza E, Barbone F. The Use of Integra Dermal Regeneration Template Versus Flaps for Reconstruction of Full-Thickness Scalp Defects Involving the Calvaria: A Cost-Benefit Analysis. Aesthetic Plast Surg 2016; 40:901-907. [PMID: 27699461 PMCID: PMC5133275 DOI: 10.1007/s00266-016-0703-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/13/2016] [Indexed: 11/20/2022]
Abstract
Background INTEGRA® Dermal Regeneration Template is a well-known and widely used acellular dermal matrix. Although it helps to solve many challenging problems in reconstructive surgery, the product cost may make it an expensive alternative compared to other reconstruction procedures. This retrospective study aims at comparing INTEGRA-based treatment to flap surgery in terms of cost and benefit. Patients and Methods We considered only patients treated for scalp defects with bone exposure in order to obtain two groups as homogeneous as possible. We identified two groups of patients: 17 patients treated with INTEGRA and 18 patients treated with flaps. All patients were admitted in our institution between 2004 and 2010, and presented a defect of the scalp following trauma or surgery for cancer, causing a loss of the soft tissues of the scalp with bone exposure without pericranium. To calculate the cost in constant euros of each treatment, three parameters were evaluated for each patient: cost of the surgical procedure (number of doctors and nurses involved, surgery duration, anesthesia, material used for surgery), hospitalization cost (hospitalization duration, dressings, drugs, topical agents), and outpatient cost (number of dressing changes, personnel cost, dressings type, anti-infective agents). The statistical test used in this study was the Wilcoxon Mann–Whitney (α = 0.05). Results No significant difference was characterized between the two groups for gender, age, presence of diabetes, mean defect size, and number of surgical procedures. All patients healed with good quality and durable closure. The median total cost per patient was €11,121 (interquartile range (IQR) 8327–15,571) for the INTEGRA group and €7259 (IQR 1852–24,443) for the flap group (p = 0.34). A subgroup of patients (six patients in the INTEGRA group and five patients in the flap group) showing defects larger than 100 cm2 were considered in a second analysis. Median total cost was €11,825 (IQR 10,695–15,751) for the INTEGRA group and €23,244 (IQR 17,348–26,942) for the flap group. Conclusion Both treatments led to a good healing of the lesions with formation of soft and resistant tissue. No significant difference was characterized between the two groups for days of hospitalization and costs. In cases of patients with defects larger than 100 cm2 for whom major surgery is needed, the treatment with INTEGRA seemed to be less expensive than the treatment with free flaps or pedicle flaps. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the A5 online Instructions to Authors.www.springer.com/00266.
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Dalton BGA, Gonzalez KW, Keirsy MC, Rivard DC, St Peter SD. Chest radiograph after fluoroscopic guided line placement: No longer necessary. J Pediatr Surg 2016; 51:1490-1. [PMID: 26949145 DOI: 10.1016/j.jpedsurg.2016.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Historically, a chest radiograph was obtained after central line placement in the operating room. Recent retrospective studies have questioned the need for this radiograph. The prevailing current practice at our center is to order chest radiograph only for symptomatic patients. This study examines the outcomes of selective chest radiography after fluoroscopic guided central line placement. METHODS After obtaining institutional review board approval, a single institution retrospective chart review of patients undergoing central venous catheter placement by the pediatric surgery or interventional radiology service between January 2010 and July 2014 was performed. Outcome measures included CXR within 24h of catheter placement, reason for chest radiograph, complication, and complication requiring intervention. RESULTS In the study population 622 catheters were placed under fluoroscopy. A chest radiograph was performed in 118 (19%) patients within 24h of the line placement with 25 (4%) of these patients being symptomatic in the recovery room. One patient required chest tube for shortness of breath and pleural effusion. Four symptomatic patients (0.6%) were found to have a pneumothorax, none of which required chest tube placement. There were no re-operations because of mal-position of the catheter. In the 504 patients with no postoperative chest x-ray, there were no adverse outcomes. At our institution the current average charge of a chest radiograph is $283, thus we produced savings of $142,632 for the study period without adverse events. CONCLUSION After placement of central venous catheter under fluoroscopic guidance, a chest radiograph is unlikely to be helpful in an asymptomatic patient.
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Affiliation(s)
- Brian G A Dalton
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO
| | | | - Michael C Keirsy
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO
| | - Douglas C Rivard
- Department of Radiology, Children's Mercy Hospital, Kansas City, MO
| | - Shawn D St Peter
- Department of Pediatric Surgery, Children's Mercy Hospital, Kansas City, MO.
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Copp MV, Barrett TF. Sugammadex: Role in current anaesthetic practice and its safety benefits for patients. World J Anesthesiol 2015; 4:66-72. [DOI: 10.5313/wja.v4.i3.66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 07/20/2015] [Accepted: 08/21/2015] [Indexed: 02/06/2023] Open
Abstract
Sugammadex has revolutionized anaesthetic management of reversal of neuromuscular block (NMB) by way of its unique mechanism of action encapsulating the amino steroid neuromuscular blocking drugs rocuronium and vecuronium. The cholinesterase inhibitors have significant pharmacological and clinical limitations whereas sugammadex allows predictable, safe and rapid reversal from any depth of blockade. The financial cost of sugammadex is significant. Many hospitals in the United Kingdom use clinical guidelines to direct best use of sugammadex in their institutions. Auditing the use of sugammadex provides useful information on which patients are benefiting from sugammadex. The clinical benefits of sugammadex are well understood. No patient should now be subjected to the danger of post-operative residual curarization. Versatility in the ability to reverse NMB has brought opportunities to the anaesthetist in the management of rapid sequence induction using high dose rocuronium with the knowledge that safe reversal of NMB is now possible in the unlikely event of a “can’t intubate can’t ventilate” situation. Do we still need suxamethonium to be available? The nature of surgery continues to evolve with ever-increasing enthusiasm for minimally invasive laparoscopic techniques. There is evidence to support using a deeper level of NMB to improve the working space and operating conditions in laparoscopic surgery. It is now possible to maintain a deep level of NMB right up until the end of surgery with no concerns about the ability to effect safe reversal of NMB. Vigilance about the possibility of allergic sensitivity to sugammadex needs to be maintained. The increased usage of rocuronium has the potential for rocuronium-induced anaphylaxis. Conversely, there is a potential role for sugammadex in the treatment of rocuronium anaphylaxis. Clinicians who have used sugammadex are struck with the quality of recovery seen in their patients. It is important that the economic implications of the use of sugammadex are fully understood. This article considers the current role of sugammadex in clinical practice outside of routine reversal of NMB and discusses how the addition of sugammadex to the anaesthetic armamentarium brings safety benefits for patients.
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Galvis B, Bergin M, Boylan J, Huang Y, Bergin M, Russell AG. Air quality impacts and health-benefit valuation of a low-emission technology for rail yard locomotives in Atlanta Georgia. Sci Total Environ 2015; 533:156-164. [PMID: 26151659 DOI: 10.1016/j.scitotenv.2015.06.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/04/2015] [Accepted: 06/17/2015] [Indexed: 06/04/2023]
Abstract
One of the largest rail yard facilities in the Southeastern US, the Inman and Tilford yards, is located in the northwestern section of Atlanta, Georgia alongside other industries, schools, businesses, and dwellings. It is a significant source of fine particulate (PM2.5) and black carbon (BC) (Galvis, Bergin, & Russell, 2013). We calculate 2011 PM2.5 and BC emissions from the rail yards and primary industrial and on-road mobile sources in the area and determine their impact on local air quality using Gaussian dispersion modeling. We determine the change in PM2.5 and BC concentrations that could be accomplished by upgrading traditional switcher locomotives used in these rail yards to a lower emitting technology and evaluate the health benefits for comparison with upgrade costs. Emissions from the rail yards were estimated using reported fuel consumption data (GAEPD, 2012b) and emission factors previously measured in the rail yards (Galvis et al., 2013). Model evaluation against 2011 monitoring data found agreement between measured and simulated concentrations. Model outputs indicate that the line-haul and switcher activities are responsible for increments in annual average concentrations of approximately 0.5±0.03 μg/m(3) (39%) and 0.7±0.04 μg/m(3) (56%) of BC, and for 1.0±0.1 μg/m(3) (7%) and 1.6±0.2 μg/m(3) (14%) of PM2.5 at two monitoring sites located north and south of the rail yards respectively. Upgrading the switcher locomotives at the yards with a lower emitting technology in this case "mother slug" units could decrease PM2.5 and BC emissions by about 9 and 3 t/year respectively. This will lower annual average PM2.5 concentrations between 0.3±0.1 μg/m(3) and 0.6±0.1 μg/m(3) and BC concentrations between 0.1±0.02 μg/m(3) and 0.2±0.03 μg/m(3) at monitoring sites north and south of the rail yards respectively, and would facilitate PM2.5 NAAQS attainment in the area. We estimate that health benefits of approximately 20 million dollars per year could be gained.
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Affiliation(s)
- Boris Galvis
- Georgia Institute of Technology, Atlanta, GA, United States; Universidad de La Salle, Bogotá, Colombia.
| | - Michael Bergin
- Georgia Institute of Technology, Atlanta, GA, United States
| | - James Boylan
- Environmental Protection Division - Air Protection Branch - Georgia Department of Natural Resources, Atlanta, GA, United States
| | - Yan Huang
- Environmental Protection Division - Air Protection Branch - Georgia Department of Natural Resources, Atlanta, GA, United States
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Hong J, Xu C, Hong J, Tan X, Chen W. Life cycle assessment of sewage sludge co-incineration in a coal-based power station. Waste Manag 2013; 33:1843-1852. [PMID: 23777667 DOI: 10.1016/j.wasman.2013.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 04/15/2013] [Accepted: 05/07/2013] [Indexed: 06/02/2023]
Abstract
A life cycle assessment was conducted to evaluate the environmental and economic effects of sewage sludge co-incineration in a coal-fired power plant. The general approach employed by a coal-fired power plant was also assessed as control. Sewage sludge co-incineration technology causes greater environmental burden than does coal-based energy production technology because of the additional electricity consumption and wastewater treatment required for the pretreatment of sewage sludge, direct emissions from sludge incineration, and incinerated ash disposal processes. However, sewage sludge co-incineration presents higher economic benefits because of electricity subsidies and the income generating potential of sludge. Environmental assessment results indicate that sewage sludge co-incineration is unsuitable for mitigating the increasing pressure brought on by sewage sludge pollution. Reducing the overall environmental effect of sludge co-incineration power stations necessitates increasing net coal consumption efficiency, incinerated ash reuse rate, dedust system efficiency, and sludge water content rate.
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Affiliation(s)
- Jingmin Hong
- School of Economics and Management, Liaoning University of Petroleum & Chemical Technology, No. 1, West Dandong Road, Wanghua District, Fushun, Liaoning Province 113001, PR China
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Cokkinos DD, Blomley MJ, Harvey CJ, Lim A, Cunningham C, Cosgrove DO. Can contrast-enhanced ultrasonography characterize focal liver lesions and differentiate between benign and malignant, thus providing a one-stop imaging service for patients?(). J Ultrasound 2007; 10:186-93. [PMID: 23396623 DOI: 10.1016/j.jus.2007.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Contrast-enhanced ultrasonography (CEUS) displays high sensitivity and specificity in characterizing focal liver lesions (FLLs). We attempted to determine how often CEUS provides an unequivocal diagnosis of FLLs that does not require additional imaging studies. MATERIALS AND METHODS Seventy-three patients with 146 FLLs were scanned with B-mode, Doppler, and contrast-enhanced US (2 × 2.4 ml SonoVue, low MI, 4-6 MHz curved array transducer, Toshiba Aplio/Siemens-Acuson Sequoia). Data were digitally stored and transferred to a work station with the GE PACS system. Images were reviewed by a consultant radiologist experienced in CEUS and interpreted in accordance with the criteria for characterizing FLLs published by the European Federation of Societies for Ultrasound in Medicine and Biology. Diagnoses were compared with those based on computed tomography (CT) and/or magnetic resonance (MR) findings if these were available. However, our aim was to assess the frequency with which CEUS provided diagnoses that were considered reliable enough to exclude the need for other imaging studies. Therefore, the CEUS diagnoses were not necessarily confirmed by other methods. RESULTS Based on CEUS findings alone, 130/146 (89.0%) FLLs could be classified as benign or malignant, and in 118/146 (80.8%) cases, the lesion could be specifically identified. The other 28/146 (19.2%) FLLs could not be characterized based on CEUS data alone. In 58 (80.8%) of the 73 patients with multiple FLLs, CEUS findings were sufficient to establish the benign vs. malignant nature of all the patient's lesions; in 51/73 (69.9%) patients, all the lesions could also be characterized with CEUS. In the remaining cases, at least one lesion required additional imaging to determine whether it was malignant (14/73, 19.2%) or to establish its identity (22/73, 30.1%). In 4/73 (5.5%) patients, CEUS revealed additional lesions not detected on B-mode US. CONCLUSIONS CEUS alone was sufficient to classify 89.0% of the FLLs as benign or malignant, and in 80.8% it was also regarded as sufficient to identify the lesion. It served as a one-stop diagnostic test for 80.8% of the patients, reducing the need for CT-MR scans and providing savings in terms of radiation exposure, time, and money.
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Affiliation(s)
- D D Cokkinos
- Imaging Sciences Department, Hammersmith Hospital, Imperial College, London, UK
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De Wals P. Should university students be vaccinated against meningococcal disease in Canada? Can J Infect Dis 2004; 15:25-8. [PMID: 18159440 PMCID: PMC2094918 DOI: 10.1155/2004/740537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Accepted: 11/28/2003] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the benefit and costs of vaccination of university students against invasive meningococcal disease (IMD) in Canada. METHODS Published studies were reviewed and a simulation model was used. RESULTS IMD risk seems to be of low magnitude, but consequences can be dramatic. Over a 10-year period, IMD risk reduction would be slightly greater using a monovalent C conjugate vaccine than a quadrivalent polysaccharide vaccine. From a societal perspective, costs per quality-adjusted life-years gained would be between $135,000 and $698,000, according to epidemiological scenarios and with vaccine purchase prices between $35 and $50 per dose. CONCLUSIONS Economic indices exceed proposed criteria for cost effective public health programs, but from the perspective of students and parents, the cost of vaccination might be worth the benefit.
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Affiliation(s)
- Philippe De Wals
- Department of Social and Preventive Medicine, Laval University and National Institute of Public Health, Quebec City, Quebec
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