Search

What is known and objective:Drug-related problems (DRPs) are common inhospitalized patients in intensive care unit (ICU). The aim of the study is to reduceDRPs and associated costs with clinical pharmacist's (CP) recommendations.Methods:The study is a prospective, non-randomized controlled study conducted inthe ICU for a total of 6 months (1 January 2021–30 June 2021) in 2-month con-trol, 2-month study, and 2-month control periods. Patients who were hospitalizedfor more than 24 h and used more than one medication were included in thestudy. The PCNE V9.1 Classification system was used in the classification ofDRPs. During the intervention period, CP recommendations for DRPs wereproposed to the healthcare team.Results and discussion:A total of 146 patients were included in the study. A total of1061 DRPs from all periods were detected. The most common causes of DRPs werepotential drug–drug interactions (31.76%), high dose (12.44%), and dose timinginstruction errors (9.24%). For 347 DRPs identified during the study period, 259 inter-ventions (74.63%) were recommended, and 238 (91.89%) were accepted by physi-cians. Interventions were mostly made as interrupting/discontinuing the drug(28.02%), changing the dose (25.27%), changing the instructions for use (20.32%),and starting a new drug (15.93%). Cost savings were achieved with CP recommenda-tions applied.What is new and conclusion:The CP's recommendations were highly accepted bythe healthcare team. With the CP's participation in routine patient rounds in thehealthcare team of the ICU, drug-related costs would also decrease.

INTRODUCTION Identification of residual disease after neuroendocrine tumor (NET) resection is critical for management. Post-surgery imaging is insensitive, expensive, and current biomarkers ineffective. We evaluated whether the NETest, a multigene liquid biopsy blood biomarker, correlated with surgical resection and could predict recurrence. METHODS Multicenter evaluation of NET resections over 24 months (n = 103): 47 pancreas, 26 small bowel, 26 lung, 2 appendix, 1 duodenum, 1 stomach. Surgery: R0 (83), R1/R2 (20). One millilitre of blood was collected at D0 and posroperative day (POD) 30. Transcript quantification by polymerase chain reaction (normal: ≤20), CgA by NEOLISA (normal ≤108 ng/mL). Standard-of-care (SoC) follow-up costs were calculated and compared to POD30 NETest-stratification approach. Analyses: Wilcoxon-paired test, Chi-square test. RESULTS D BIOMARKERS NETest: 103 of 103 (100%)-positive, whereas 23 of 103 (22%) were CgA-positive (Chi-square = 78, P < 0.0001).In the R0 group, the NETest decreased 59 ± 28 to 26 ± 23 (P < 0.0001); 36% (30/83) remained elevated. No significant decrease was evident for CgA. In the R1/R2 group the NETest decreased but 100% remained elevated. CgA levels did not decrease.An elevated POD30 NETest was present in R0 and 25 (83%) developed radiological recurrences. Normal score R0 s (n = 53) did not develop recurrence (Chi-square = 56, P < 0.0001). Recurrence prediction was 94% accurate with the NETest. COST EVALUATION Using the NETest to stratify postoperative imaging resulted in a cost-savings of 42%. CONCLUSION NETest diagnosis is more accurate than CgA (100% vs 22%). Surgery significantly decreased NETest. An elevated POD30 NETest predicted recurrence with 94% accuracy and post-surgical POD30 NETest follow-up stratification decreased costs by 42%. CgA had no surgical utility. Further studies would define the accuracy and cost-effectiveness of the NETest in the detection of postoperative recurrent disease.

Introduction Pooled testing is a potentially efficient alternative strategy for COVID‐19 testing in congregate settings. We evaluated the utility and cost‐savings of pooled testing based on imperfect test performance and potential dilution effect due to pooling and created a practical calculator for online use. Methods We developed a 2‐stage pooled testing model accounting for dilution. The model was applied to hypothetical scenarios of 100 specimens collected during a one‐week time‐horizon cycle for varying levels of COVID‐19 prevalence and test sensitivity and specificity, and to 338 skilled nursing facilities (SNFs) in Los Angeles County (Los Angeles) (data collected and analyzed in 2020). Results Optimal pool sizes ranged from 1 to 12 in instances where there is a least one case in the batch of specimens. 40% of Los Angeles SNFs had more than one case triggering a response‐testing strategy. The median number (minimum; maximum) of tests performed per facility were 56 (14; 356) for a pool size of 4, 64 (13; 429) for a pool size of 10, and 52 (11; 352) for an optimal pool size strategy among response‐testing facilities. The median costs of tests in response‐testing facilities were $8250 ($1100; $46,100), $6000 ($1340; $37,700), $6820 ($1260; $43,540), and $5960 ($1100; $37,380) when adopting individual testing, a pooled testing strategy using pool sizes of 4, 10, and optimal pool size, respectively. Conclusions Pooled testing is an efficient strategy for congregate settings with a low prevalence of COVID‐19. Dilution as a result of pooling can lead to erroneous false‐negative results.

Background In the area where there is a lack of medical experts, telemedicine gives a lot of benefits to deal with the distance and limited public infrastructure. Objective This study aimed to review the literature on the cost-effectiveness of telemedicine in Asian countries and possibly to provide recommendations on implementing telemedicine in this region. Methods Articles were independently screened in two selected databases (PubMed and EBSCO). The framework of patient, intervention, comparison, and outcome (PICO) was applied by considering Asian population, the intervention of telemedicine, current situation (without telemedicine) as the comparator, and cost per QALY gained as the major outcome. Results A total of 870 articles were identified from two databases: PubMed (n = 689 articles) and EBSCO (n = 181 articles). After removing 181 duplicates, 689 articles were screened by title and abstract, excluding 665 records. After the full-text screening on 24 articles, 8 articles were selected for further analysis. Various perspectives were applied in the included studies, such as societal, healthcare, and program perspectives. All studies applied different time horizons, such as 3-month, 25-year, 40-year, and lifetime. Among all included studies, several studies applied mathematical modeling. Conclusion The implementation of telemedicine in Asia can be a promising intervention since it can enhance the effectiveness of health services by saving time and travel costs. It also can reduce the overall costs of treatment, improve patients’ quality of life, and expand access to essential health services.

SETTING: Early diagnosis of latent tuberculous infection (LTBI) should be pursued in healthcare workers (HCWs). While HCWs in hospitals are screened for LTBI, HCWs in outpatient settings are usually not. In 2017, in Italy, a tuberculosis (TB) infected paediatrician working in an outpatient vaccination service infected 15 adults and nine children. The investigation involved 2490 children and 151 adults. Among children, nine were tuberculin skin test-positive, and four developed active TB. Among 123 adult contacts with longer exposure, seven were interferon-gamma release assay (IGRA) positive and none had active TB. Among 28 close contacts, eight had a positive IGRA, and three had pulmonary TB. The total outbreak cost €1 017 903.OBJECTIVE: To compare the outbreak cost with those of potential screening programme strategies.RESULTS: Regular screening of paediatric outpatient HCWs would have cost between €2592 and €11 373. Extending the screening to all outpatient HCWs (caring for adults and children) would have cost between €66 384 and €155 043. Investigating only close contacts would have cost €42 857.CONCLUSION: Each of these screening strategies would have been cost-effective compared with the outbreak investigation occurring in real life with a cut-off of 474 for the maximum number of tested outpatient HCWs needed for the screening strategy to be cost-saving.

Laleh Mahmoudi,1 Mehrdad Ghouchani,1 Motahareh Mahi-Birjand,2 Alimohammad Bananzadeh,3 Ali Akbari41Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 2Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran; 3Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 4Department of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, IranBackground: Antibiotic prophylaxis is one of the major approaches to prevent surgical site infection. Despite the availability of international guidelines on it, the practice of antibiotic prophylaxis is still far from optimal. This study aimed to assess the impact of guideline implementation on the rational use of prophylactic antibiotics and its cost-saving effect in gastrointestinal surgery by clinical pharmacist intervention.Methods: A pre and post intervention study was carried out between October 2017 and June 2018 on patients who underwent gastrointestinal surgery in a major referral teaching hospital in Shiraz, southern Iran. The intervention phase consisted of revising the institutional guidelines for surgical antimicrobial prophylaxis, assigning a clinical pharmacist to the surgical department, and arranging several meetings with the surgical department regarding the appropriate utilization of antibiotics. Differences in antibiotic utilization in patients before and after the intervention phase were compared. Exposures were surgical antimicrobial prophylaxis timing and agents, and main outcomes were incidence of surgical site infection and length of hospital stay.Results: A total of 430 patients were included in the post intervention phase, while 445 patients were included in the baseline evaluation. Promoting appropriate antibiotic use in the post intervention group had the potential to decrease medication costs by reducing unnecessary prescriptions and duration of antibiotic usage (P

Background Identification and treatment of malnutrition across the care continuum can help prevent illness onset or relapse and maximize the effectiveness of other medical treatments. This study aimed to evaluate the effect of a nutrition‐focused quality improvement program (QIP) conducted in a home health agency (HHA) on hospitalization rates and healthcare costs incurred over 90 days. Methods This was a multisite, pre‐post QIP implemented at 2 branches of an Illinois‐based HHA. The QIP included 1546 patients who were (1) at‐risk or malnourished hospitalized patients discharged to the HHA, (2) referred by a physician during an outpatient visit, or (3) enrolled in the HHA through a skilled nursing facility. A historic (n = 7413 patients) and concurrent group (n = 5235) of patients were used for comparisons. Propensity score matching was used to account for imbalances in patient characteristics. Results The QIP led to reduced relative risk of hospitalization post‐enrollment to the QIP by 24.3%, 22.8%, and 18.3% at 30, 60, and 90 days, respectively, when compared with the historic group, and by 18.2%, 16.2%, and 12.1% when compared with the concurrent group. Total cost savings from reduced 90‐day healthcare resource utilization was $2,318,894, or $1500 per patient treated. Conclusions Rates of hospitalization and healthcare resources can be significantly reduced through the implementation of a nutrition‐focused QIP delivering oral nutritional supplements in home health settings for adults at‐risk/malnourished. These results highlight the importance of nutrition as a strategy for HHAs and other post‐acute care institutions to improve patients' health outcomes and generate cost savings.

Enhanced quadrivalent influenza vaccines that include an adjuvant (aQIV) or a high dose of antigen (QIV-HD), which stimulate a stronger immune response in older adults than the standard vaccine (QIVe), are now approved. The objective of this research is to compare available vaccines and determine the cost-effectiveness of immunizing persons aged 65 years and above with aQIV compared to QIVe and QIV-HD in Germany. A compartmental transmission model calibrated to outpatient visits for influenza in Germany was used to predict the number of medically attended infections using the three vaccines. The rates of hospitalizations, deaths, and other economic consequences were estimated with a decision tree using German data where available. Based on meta-analysis, the rVE of −2.5% to 8.9% for aQIV versus QIV-HD, the vaccines are similar clinically, but aQIV is cost saving compared to QIV-HD (unit cost of EUR 40.55). All results were most sensitive to changes in vaccine effectiveness. aQIV may be cost-effective compared to QIVe depending on the willingness to pay for additional benefits in Germany. As aQIV and QIV-HD are similar in terms of effectiveness, aQIV is cost saving compared to QIV-HD at current unit prices.

Background Given that China has encouraged EHR usage in hospitals for more than a decade, patients’ access to their own EHR data is still not as widely utilized as expected. Methods We cultivated a survey with four categories and field interviews of measures to identify whether hospitals have already released EHR data to patients, inpatients or outpatients, the top EHR release contents and the most popular release software. Results Of the 1344 responding hospitals from 30 provinces nationwide, 41.37% of hospitals have already released their EHR data to patients, of which 97.12% are through smart apps. More than 91% of hospitals use WeChat, and 32.37% of hospitals developed their own standalone apps or use vendors’ apps. A total of 54.63% were released to both outpatients and inpatients, and the top release contents were all objective. A rough estimation is made that releasing EHR data to patients via smart apps may save the hospital 15.9 million RMB per year and patients 9.4 million RMB altogether. Conclusions EHR data release is believed to bring both patient and hospital cost savings and efficiency gains but is still considered spontaneous and requires legal support and government regulation.

BACKGROUND: The use of generic medicines instead of branded, is one of the main policies to decrease the expenditures and provide access to affordable and essential medicines in low and middle-income countries. The present study aims to systematically create a comprehensive synthesis of demand-side policies, encouraging the use of generic medicines.METHODS: The study systematically searched and reviewed the articles in Medline, Scopus, Web of Science, and Embase from 1.1.2000 to 12.5.2019. A total of 6435 records were identified during this period of time (Medline (n=315), Scopus (n=4323), Web of Science (n=71) and Embase (n=1726)). All stages are conducted according to the Preferred Reporting Item for Systematic Reviews and Meta-Analyzed (PRISMA).RESULTS: The encouraging policies and practices were classified into four categories from 44 articles analyzed, including; Prescribing, Dispensing, Patients/consumers, and healthcare organizations. Subthemes were also explored in relation to each category as; education, financial incentives, generic substitution, advertising approaches, and enforcement.CONCLUSION: Various policies should be taken into consideration to encourage successful generic medication prescribing, dispensing, and consumption in both supply and demand-side. Economic, political, socio-cultural, technological, legal, and structural factors could as such accelerate the policies’ effect. Studying the experience of successful countries can be helpful for policymakers.

Continuous increases in electrical energy demand and the deregulation of power systems have forced utility companies to provide high-quality and reliable services to maintain a sustainable operation and reduce electricity price. One way to continue providing the required services while simultaneously reducing operational costs is through minimizing power losses and voltage deviation in the distribution network. For this purpose, Network Reconfiguration (NR) is commonly adopted by employing the switching operation to enhance overall system performance. In the past, work proposed by researchers to attain switching sequence operation was based on hamming distance approach. This approach caused the search space to grow with the increase in total Hamming distance between the initial and the final configuration. Therefore, a method is proposed in this paper utilizing a Mixed Integer Second Order Cone Programming (MISOCP) to attain optimal NR to address this issue. The Hamming dataset approach is opted to reduce search space by considering only radial configuration solutions to achieve an optimal switching sequence. In addition, a detailed economic analysis has been performed to determine the saving after the implementation of the proposed switching sequence. The effectiveness of the proposed technique is validated through simulations on IEEE 33-bus distribution network and a practical 71-bus network in Malaysia. The result shows that the proposed method determined the optimal network configuration by minimizing the power losses for the 33 bus and 71-bus system by 34.14% and 25.5% from their initial configuration, respectively to maintain sustainable operation.

Nowadays, the rotating motor is the most demoralized machine for the global Motor industry. Comfort of practice, start-up, small, weightiness, Increased efficiency, low maintenance and inexpensive for each power rating that generally meets the necessary features for industries. Efficient improvements are inspected with copper for the rotor bars slot. Usually, the copper loss in the induction motor Rotor division contributes to the loss of energy. The research work was planned a new rotor design, by improved rotor bars type slot, size and design. These tasks were inspected using two approaches, in particular, MotorSolve (IM) and calculations in theory. One set of simulation has shown a significant increase in energy efficiency for a new rotor frame design. Calculations in theory are used MATLAB. As a result, these new designs have improved energy efficiency by 77% as compared to its 74% existing design. The results proved to be using MATLAB. For energy, cost savings and emission reduction (ER), new design rotor frame has been saved 154KWH/year, utility bill RM 60.20/Year and 0.113 CO2 tons/years intended for individually motor. Finally, the estimated cost aimed at 100,000 pieces of new rotor bars pattern induction motor and indicates this price was kept almost RM6 million.

The PRediction of short-term Outcomes in preGNant wOmen with Suspected preeclampsIa Study (PROGNOSIS) Asia validated the use of the soluble fms-like tyrosine 1/placental growth factor (sFlt-1/PlGF) ratio cutoff value of ≤38 to rule out the occurrence of preeclampsia in the short term in Asian women. We assessed the economic impact of the introduction of the sFlt-1/PlGF ratio test for predicting preeclampsia in Japan using data from the Japanese cohort of PROGNOSIS Asia. The cost analysis was developed with estimates in either a no-test scenario, with clinical decisions based on standard diagnostic procedures alone, or a test scenario, in which the sFlt-1/PlGF ratio test was used in addition to standard diagnostic procedures. For both scenarios, rates of hospitalization and other test characteristics were obtained from the results for the Japanese cohort in PROGNOSIS Asia. The total cost per patient was the main outcome of this cost analysis model. Introduction of the sFlt-1/PlGF ratio test using a cutoff value of 38 resulted in a reduced hospitalization rate compared with the rate in the no-test scenario (14.4% versus 8.7%). The reduction in the rate of hospitalizations led to an estimated 16 373 JPY reduction in healthcare costs per patient. The sFlt-1/PlGF ratio test is likely to reduce the unnecessary hospitalization of women at low risk of developing preeclampsia in the short term while also identifying high-risk individuals requiring appropriate management. Reducing unnecessary hospitalizations would result in significant cost savings in the Japanese healthcare system.

Background Preoperative antibiotic prophylaxis is essential for preventing surgical site infection (SSI). The aim of this study was to evaluate compliance with international and local recommendations in caesarean deliveries carried out at the Obstetrics and Gynaecology Service of the Ambato General Hospital, as well as any related health and economic consequences. Methods A retrospective indication-prescription drug utilization study was conducted using data from caesarean deliveries occurred in 2018. A clinical pharmacist assessed guidelines compliance based on the following criteria: administration of antibiotic prophylaxis, antibiotic selection, dose, time of administration and duration. The relationship between the frequency of SSI and other variables, including guideline compliance, was analysed. The cost associated with the antibiotic used was compared with the theoretical cost considering total compliance with recommendations. Descriptive statistics, Odds Ratio and Pearson Chi Square were used for data analysis by IBM SPSS Statistics version 25. Results The study included 814 patients with an average age of 30.87 ± 5.50 years old. Among the caesarean sections, 68.67% were emergency interventions; 3.44% lasted longer than four hours and in 0.25% of the deliveries blood loss was greater than 1.5 L. Only 69.90% of patients received preoperative antibiotic prophylaxis; however, 100% received postoperative antibiotic treatment despite disagreement with guideline recommendations (duration: 6.75 ± 1.39 days). The use of antibiotic prophylaxis was more frequent in scheduled than in emergency caesarean sections (OR = 2.79, P = 0.000). Nevertheless, the timing of administration, antibiotic selection and dose were more closely adhered to guideline recommendations. The incidence of surgical site infection was 1.35%, but tended to increase in patients who had not received preoperative antibiotic prophylaxis (OR = 1.33, P = 0.649). Also, a significant relationship was found between SSI and patient age (χ2 = 8.08, P = 0.036). The mean expenditure on antibiotics per patient was 5.7 times greater than that the cost derived from compliance with international recommendations. Conclusions Surgical antibiotic prophylaxis compliance was far below guideline recommendations, especially with respect to implementation and duration. This not only poses a risk to patients but leads to unnecessary expenditure on medicines. Therefore, this justifies the need for educational interventions and the implementation of institutional protocols involving pharmacists.

Introduction: The clinical pharmacist in the intensive care unit is involved in the aspects of patient safety, technical guidance for the team care and cost saving with rational use of medicines. Objective: This study aims to estimate the cost saving with of the clinical pharmacist interventions in the pediatric intensive care unit (PICU). Methods: This was a retrospective, observational study. The cost saving was measured over three months based on (1) Clinical pharmacist interventions from the prescriptions analysis. (2) Individualized doses of four antibiotics. (3) Comparison of drugs dispensing system between the period before and after the decentralization of pharmacy services. The main outcome measure is costs saving with strategic planning for the rational use of medicines, based on local reality. Results: 173 clinical pharmacist interventions were carried out, from 13 interventions we could calculated the economic impact, resulting in an estimate cost saving of the US$ 633.38/year. Cost saving from individualized doses of four antimicrobials was US$ 8,754.46/year. The decentralization of the pharmacy service resulted in a cost saving of US$ 28,770.52/year. Conclusion: The clinical pharmacist in the pediatric intensive care unit results in cost saving. Clinical pharmacist interventions, antimicrobials individualized doses and decentralization of pharmacy services reduce costs in the hospital.

Purpose. The research aims at the analysis of the possibility of using in the development of one-group train formation plan the criterion, which allows to consider the costs associated with the movement of cars and locomotives. Methodology. The existing methods for development of train formation plan and current directions of its optimization are analyzed. The formulas for calculating the cost-saving criterion for running cars and locomotives in through-trains have been developed. Findings. The dependence between the service speed and the category of train was analyzed on the examples of railway sections of the Belarusian Railways. The obtained results allowed to conclude that, in general, the service speed of through-trains is higher than that of local trains. At the same time, the traffic intensity and section capacity affect the difference between the service speeds of trains belonging to the different categories. The one-group train formation plan was developed using the traditional methods and the proposed criterion on the example of the railway direction, where four marshalling yards are located. The use of the proposed methodology for the development of train formation plan can provide significant savings in operating costs due to the acceleration of the passing of the car through the railway sections. Originality. The use of the additional parameter in the development of train formation plan – «the criterion of cost saving when running of rolling stock in through-trains» – is proposed. It is shown that the application of this criterion makes it possible to substantiate the creation of separate assignments of some car-streams, while these car-streams would be considered as unprofitable, when using traditional methods of the calculation of train formation plan. The authors analyzed the influence of such factors as the train composition, the length of the railway section and the car traffic volume on the cost savings by using the proposed criterion. Practical value. The obtained results can be used in the development of the train formation plan, which will save the operating costs connected with the movement of cars and locomotives.

Bangladesh has an agrarian economy in which paddy is the dominant crop. A significant amount of field losses of paddy occurs every year due to natural calamities and a shortage of time during the harvesting period. During this study, a modification was done on locally developed BAU self-propelled reaper and its performance was compared with manual harvesting system of paddy. Several experiments were conducted in Boro paddy (April–May 2017) and Aman paddy harvesting (November–December 2017) at BAU farm of Bangladesh Agricultural University after necessary modification works in the workshop. An experiment was also conducted on Aman paddy in 2017 at BAU farm for determining manual harvesting cost. The technical and economic performances of the modified BAU self-propelled reaper were determined based on the field experiments. Results reveal that average fuel consumption, effective field capacity and field efficiency were 2.71 L/ha, 0.255 ha/h and 77.27%, respectively for the modified BAU self-propelled reaper and 2.88 L/ha, 0.25 ha/h and 75.76%, respectively for the existing BAU self-propelled reaper. These results indicated that field performances of modified BAU self-propelled reaper were better than that of the existing BAU reaper. Paddy harvesting cost was found 916 Tk/ha for modified BAU self-propelled reaper and 9200 Tk/ha for manual harvesting system. The benefit-cost ratio of the modified BAU self-propelled reaper was 2.18. Considering the technical and economic performances, modified BAU self-propelled reaper was found suitable than the existing BAU reaper. So, the modified BAU self-propelled reaper may be introduced in Bangladesh in the commercial basis.J. Bangladesh Agril. Univ. 16(2): 171-177, August 2018

Cristina Lucidi,1 Vincenza Di Gregorio,1 Giancarlo Ceccarelli,2 Mario Venditti,2 Oliviero Riggio,1 Manuela Merli1 1Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy; 2Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome,Italy Background: Early diagnosis and appropriate treatment of infections in cirrhosis are crucial. As new guidelines in this context, particularly for health care-associated (HCA) infections, would be needed, we performed a trial documenting whether an empirical broad-spectrum antibiotic therapy is more effective than the standard one for these infections. Because of the higher daily cost of broad-spectrum than standard antibiotics, we performed a cost analysis to compare: 1) total drug costs, 2) profitability of hospital admissions. Methods: This retrospective observational analysis was performed on patients enrolled in the trial NCT01820026, in which consecutive cirrhotic patients with HCA infections were randomly assigned to a standard vs a broad-spectrum treatment. Antibiotic daily doses, days of treatment, length of hospital stay, and DRG (diagnosis-related group) were recorded from the clinical trial medical records. The profitability of hospitalizations was calculated considering DRG tariffs divided by length of hospital stay.Results: We considered 84 patients (42 for each group). The standard therapy allowed to obtain a first-line treatment cost lower than in the broad-spectrum therapy. Anyway, the latter, being related to a lower failure rate (19% vs 57.1%), resulted in cost saving in terms of cumulative antibiotic costs (first- and second-line treatments). The mean cost saving per patient for the broad-spectrum arm was €44.18 (–37.6%), with a total cost saving of about €2,000. Compared to standard group, we observed a statistically significant reduction in hospital stay from 17.8 to 11.8 days (p

Some projects are often performed by many subcontractors that cooperate with each other and some of them are conducted by outsourcing them to several firms; so subcontractors carry out activities in competition. Appropriate trade-off between time and cost and achieving more benefit and cost saving are objectives of both models. In this paper, it is investigated that how different subcontractors of a project can cooperate to achieve more advantages if possible and how sub-contractors can compete to make the results better and find the optimum cost to minimize the time for each of them. The competition here does not mean eliminating a competitor, but the aim is to challenge the contractors in order to choose the best decision. The purpose of this study is to address the challenges in time and cost management and to find more profit allocation among subcontractors and fair competition for fair allocation as well. A model based on cooperative game theory in time/cost trade-off problem of projects is suggested and then a competition model among subcontractors based on non-cooperative game theory is proposed. A case study is rep-resented to comprehensively illustrate the problem, the cooperative techniques of cooperative game theory, and the payoff matrix of non-cooperative model among subcontractors. Results of the proposed model reveal that subcontractors can obtain higher profit from cooperation if pos-sible. When they outsource the project and compete with each other, they must consider the in-teraction activities and choose the best strategies for cost saving and gain more reward from the client. Moreover, it is found that some techniques such as Shapley value, Core, Max-Min Core, or Equal Profit Method (EPM) are able to fairly assign extra profit of cooperation, and using the payoff matrix, Nash equilibrium, and Nash bargaining helps to find the optimum point to mini-mize time and cost for interaction activities state.

Introducao Ha 8 anos, A.C, um simpatico italiano, recebeu stents coronarios. Ha mais ou menos 3 meses passou a ter dificuldade respiratoria progressiva com sensacao de aperto no peito; perda de apetite e emagreceu 4 kg, mas continuou trabalhando com boa disposicao. Estivera em duas consultas hospitalares previas, nas quais foi informado de que o pulmao estava normal, com base na radiografia. Nao haviam chegado a diagnostico definitivo, e por isso veio ao consultorio. Sua aparencia geral era normal; nada [...]

Introduction: Clinical pharmacists have become an integral part of multidisciplinary medical teams, including in the area of psychiatry. Previous studies have shown that having pharmacists in multidisciplinary medical teams has led to improved medication use, reduction of adverse drug events, and improved patient outcomes. The purpose of this study is to conduct a quantitative and economic analysis of the impact of clinical pharmacist interventions during hospital rounds in an acute care psychiatric hospital setting. Methods: This is a retrospective analysis of 200 clinical pharmacist interventions documented between September 2013 and September 2014. Clinical pharmacist interventions were classified into several categories and types. Only clinical pharmacist interventions made during multidisciplinary team rounds were included in the study. Descriptive statistics were used for the quantitative analysis of clinical pharmacist interventions. The acceptance rate was calculated. Only the accepted clinical interventions were included in the economic analysis. Economic outcome involved an assessment of cost saving and cost avoidance. Results: The most frequent types of clinical pharmacist interventions were discontinuation of medications (38.5%), laboratory monitoring (26%), and medication order modification (13.5%). The most common reason for drug discontinuation was polypharmacy. Clinical pharmacist interventions were associated with a 92.5% acceptance rate. Two hundred clinical pharmacist interventions were associated with $6760.19 medication cost saving and $62 806.67 cost avoidance. Discussion: Clinical pharmacist interventions during rounds in an acute care psychiatric hospital setting mostly involve medication order modification and laboratory monitoring. They are also associated with significant cost saving and cost avoidance.

The evolution of resistant pathogens is a worldwide health crisis and adherence to European Association of Urology (EAU) guidelines on antibiotic prophylaxis may be an important way to improve antibiotic stewardship and reduce patient harm and costs.To evaluate the prevalence of antibiotic-resistant bacterial strains and health care costs during a period of adherence to EAU guidelines in a tertiary referral urologic institution.A protocol for adherence to EAU guidelines for antibiotic prophylaxis for all urologic procedures was introduced in January 2011. Data for 3529 urologic procedures performed between January 2011 and December 2013 after protocol introduction were compared with data for 2619 procedures performed between January 2008 and December 2010 before protocol implementation. The prevalence of bacterial resistance and health care costs were compared between the two periods.The outcome measures were the proportion of resistant uropathogens and costs related to antibiotic consumption and symptomatic postoperative infection. We used χ2 and Fisher's exact tests to test the significance of differences.The proportion of patients with symptomatic postoperative infection did not differ (180/3529 [5.1%] vs. 117/2619 [4.5%]; p=0.27). A total of 342 isolates from all patients with symptomatic postoperative infections were analysed. The rate of resistance of Escherichia coli to piperacillin/tazobactam (9.1% vs. 5.4%; p=0.03), gentamicin (18.3% vs. 11.2%; p=0.02), and ciprofloxacin (32.3% vs. 19.1%; p=0.03) decreased significantly after protocol introduction. The defined daily dose (DDD) use of ciprofloxacin fell from 4.2 to 0.2 DDD per 100 patient-days after implementation (p0.001). Antibiotic drug costs (€76,980 vs. €36,700) and costs related to postoperative infections (€45,870 vs. €29,560) decreased following introduction of the protocol (p0.001).Adherence to EAU guidelines on antibiotic prophylaxis reduced antibiotic usage without increasing post-operative infection rate and lowered the prevalence of resistant uropathogens.We analysed the impact of adherence to European Association of Urology guidelines on antibiotic prophylaxis for all surgical urologic procedures on the prevalence of infections and resistant bacterial strains and on costs. We found that adherence to the guidelines reduced the rate of bacterial resistance, in particular against piperacillin/tazobactam, gentamicin, and ciprofloxacin, and reduced costs without increasing the risk of postoperative infection after urologic procedures. We recommend adherence to the guidelines as an important part of antibiotic stewardship programmes.

PurposeTo compare post-operative recovery of prosthetic hip surgery patients with or without the implementation of iron supplementation with a new highly absorbable oral iron formulation.MethodsObservational retrospective quality improvement assessment conducted on patients who had undergone elective prosthetic hip surgery (first implant) with ferritin 100mcg/dl but C-reactive protein (CRP) >3mg/l and transferrin saturation (TSAT) 100mcg/l to two groups of patients with iron deficiency, of which only one received iron supplementation. Measurements included haemoglobin levels, length of hospital stay, and number of transfused patients/blood units.ResultsPatients with iron deficiency supplemented with Sideral (R) Forte compared to non-supplemented patients showed a smaller decline in post-operative Hb (9.71.24g/dl vs 8.4 +/- 0.6g/dl), required shorter hospital stay (4 vs 6.5days) and less blood transfusions (0 in the iron-supplemented group vs 7units in the non-iron-supplemented group), yielding an overall savings of 1763.25 Euro/patient.Conclusions p id=Par4 Pre-operative sucrosomial iron supplementation at least 4weeks prior to elective surgery in non-anaemic patients limits the drop in post-operative Hb levels, determining higher post-operative haemoglobin, quicker post-surgical recovery, shorter hospitalisation, and decreased surgery-related costs.

© Copyright 2018, Mary Ann Liebert, Inc. Background: Telemedicine in the intensive care unit (tele-ICU) is expected to address geographic health disparities through more efficient resource allocation. Our previous economic evaluation demonstrated tele-ICU to be cost-effective in most cases and cost saving in some cases, compared to conventional intensive care unit (ICU) care without adequate intensivist coverage. Introduction: This study's objective is to examine how to optimize the cost-effectiveness of tele-ICU use by selecting highest risk (i.e., both highest mortality and highest cost) subpopulations. We also explore potential cost savings. Materials and Methods: We conducted simulation analyses among a hypothetical adult ICU patient cohort defined by the literature, distinguishing four types of hospitals: urban tertiary (primary analysis), urban community, rural tertiary, and rural community. The selected tele-ICU use was assumed to affect per-patient ICU cost and hospital mortality among highest risk subpopulations (10-100% of all ICU patients), defined by an established illness-severity measure. Results: We found a U-shaped relationship between the economic efficiency and selected tele-ICU use among all 4 hospital types. Optimal cost-effectiveness was achieved when tele-ICU was applied to the 30-40% highest risk patients among all ICU patients (incremental cost-effectiveness ratio = $25,392 [2014 U.S. dollars] per extending a quality-adjusted life year) in urban tertiary hospitals (primary analysis). Our break-even analyses indicated that cost saving seems more feasible when reducing ICU medical care cost, rather than lowering the cost to operate telemedicine alone. Discussion and Conclusions: A selected use of tele-ICU based on severity of illness is likely to improve tele-ICU cost-effectiveness. To achieve cost saving, tele-ICU must reduce more than just telemedicine-related cost.

INTRODUCTION: Biosimilar products play an important role in improving the access to biological medicines for an increased number of patients and enhancing the financial sustainability of the health systems. AIM: To assess the cost saving potential associated with the introduction of two biosimilars (Benepali ® and Flixabi ® ) vs. their respective reference biological products on the European and Italian markets. METHODS: A budget impact model was developed to estimate the cost saving of the hypothetical introduction of Benepali ® and Flixabi ® vs. Enbrel ® and Remicade ® , respectively, in three European countries. The analysis was conducted from the payer perspective, over a 3-year period. In addition, the same model was used to assess the impact of Benepali ® vs. Enbrel ® in three Italian regions over a 2-year period. The model compares the costs associated with the current treatment patterns, used to manage patients with all the conditions which Benepali ® and Flixabi ® are authorized for, with that of a hypothetical treatment pattern in which biosimilar products have been introduced. Only direct costs associated with the drug acquisition were considered. The model was constructed using published country- or region-specific data, where available. Annual drug acquisition costs were calculated using the dosing information from SPCs and country-/region-specific price lists. RESULTS: The introduction of Benepali ® and Flixabi ® in the biologic therapeutic setting of three European countries resulted in substantial cost savings across the entire scenario, with different penetration over a 3-year period. Similarly, over a 2-year horizon, the introduction of Benepali ® in the biologic therapeutic setting of three Italian regions resulted in significant cost savings. In all cases, the greater savings were observed in the scenario where the biosimilars’ penetration was higher. CONCLUSIONS: The introduction of Benepali ® and Flixabi ® has a substantial cost saving potential for the Italian and European health systems, and the budget impact is sensitive to the uptake rates of the biosimilars market.

Currently, education has become a business sector that provides service to students. This service is developing standards more similar to consumer goods marketing. As a higher education organization, Durham University aims to top education and research across all disciplines in 2020 in UK, which needs the support of the most able and motivated students, academic staff and sufficient money. During the past two years China was the top international students sending country to UK, who pay highly tuition fees. Chinese shows high academic capabilities in variety academic field as well. In this situation, DU should enhance its current strategies to exploit this most talent market with implementing Business-to-Cusiness (B2C), IT outsourcing (ITO) and Workflow Management System (WfMS). These initiatives, significantly achieving customer satisfaction (CS), long-term development, flexible risk management, cost saving, short develop timescales and effective organizational management. Importance-Performance Analysis tool and decision value theory will be introduced to evaluate these initiatives.

With an incidence of 68 new cases per 100,000 people per year, an estimated total number of up to 350,000 new non-small-cell lung cancer (NSCLC) cases are diagnosed each year in the European Union. Up to 10% of NSCLC patients are eligible for therapy with novel ALK (anaplastic lymphoma kinase) inhibitors, as they have been diagnosed with a mutation in the gene coding for ALK. The ALK inhibitor therapy costs add up to approx. 9,000 € per patient per month, with treatment durations of up to one year. Recent studies have shown that up to 10% of ALK cases are misdiagnosed by nearly 40% of pathologic investigations. The current state-of-the-art ALK diagnostic procedure comprises a Fluorescent in situ Hybridization (FISH) assay accompanied by ALK inhibitor therapy (Crizotinib). The therapy success ranges between a full therapy failure and the complete remission of the tumor (i.e., healing), but the biomedical and systemic reasons for this range remain unknown so far. It appears that the variety of different ALK mutations and variants contributes to the discrepancy in therapy results. Although the major known fusion partner for ALK in NSCLC is the Echinoderm microtubule-associated protein-like 4 (EML4), of which a minimum of 15 variants have been described, an additional 20 further ALK fusion variants with other genes are known, of which three have already been found in NSCLC. We hypothesize that the wide variety of known (and unknown) ALK mutations is associated with a variable therapy success, thus rendering current companion diagnostic procedures (FISH) and therapy (Crizotinib) only partly applicable in ALK-related NSCLC treatment. In cell culture, differing sensitivity to Crizotinib has been shown for some fusion variants, but it is as yet unknown which of them are really biologically active in cancer patients, and how the respective variants affect the response to Crizotinib treatment. Moreover, it has been demonstrated that translocated ALK genes can also be observed in healthy tissues and are not compulsorily associated with tumors. Therefore, it is important to keep in mind that even for the known variants of ALK fusion genes, the biological function is not known for all variants, and that no information is available on the homogeneity of ALK fusion variants within a single tumor. These facts, in concert with data for ALK mutation prevalence and therapy outcomes of a German cohort of NSCLC patients, support the hypothesis that, by using novel companion diagnostic tools in combination with therapy outcome predictions, massive cost savings could be possible in European Health Care systems without a loss of patient care.

Financial toxicity of cancer treatment is now a well-recognised problem in cancer medicine leading to patient bankruptcy and even poor survival, including in high-income countries and countries with public health care systems. Many oncologists, despite acknowledging the severity of financial toxicity as a problem, resign the responsibility of reducing the costs of cancer treatment to the government, industry, and oncology societies. However, an oncologist can play an important role in reducing the costs of cancer treatment because all cancer treatment decisions are made between the oncologist and the patient. In this article, I point out a few examples of low value practices from various oncology disciplines that we oncologists can easily replace or abandon in our practice and contribute to lessening the financial toxicities to patients and society. As these examples suggest, reducing cost does not necessarily mean compromising efficacy. We should continuously keep looking for other similar cost-saving strategies in our practice.

Background Timely availability of blood sample results for interpretation affects planning and delivery of patient care from initial assessment in Accident and Emergency (A&E) departments. Materials and methods Rates of, and reasons for, rejected blood samples submitted from all clinical areas over one month were evaluated. Haemoglobin (Hb) represented haematology and potassium (K+), biochemistry. A prospective observational study evaluated the methodology of sample collection and impact on utility. Results 16,061 haematology and 16,209 biochemistry samples were evaluated; 1.4% (n = 229, range 0.5–7.3%) and 4.7% (n = 762, range 0.9–14%) respectively were rejected, with 14% (n = 248/1808) K+ rejection rate in A&E. Patients with rejected K+ and Hb had a longer median in-hospital stay of 9 and 76 h respectively and additional stay fixed costs of £26,824.74 excluding treatment. The rejection rate with Vacutainer and butterfly (4.0%) was lower than Vacutainer and cannula (28%). Conclusion Sample rejection rate is high and is associated with increased in-hospital stay and cost. Blood sampling technique impacts on rejection rates. Reduction in sample rejection rates in emergency care areas in acute hospitals has the potential to impact on patient flow and reduce cost., Highlights Conclusion • Blood sample rejection rate in a single large NHS Foundation Trust is high. • The highest rate of blood sample rejection is in the Accident and Emergency department. • Blood sample rejection is associated with increased in-hospital stay. • Blood sampling technique impacts on rejection rates. • Reduction in sample rejection rates in emergency care areas in acute hospitals has the potential to impact on patient flow and cost.

There is still a debate as to whether radiological guidance is needed for intra-articular hip injections. The aim of this study was to evaluate correct needle positioning for the hip joint performed with a non-radiological method and confirmed on arthrogram under image intensifier. Patients listed for diagnostic and therapeutic hip joint injections were included in our study. Eighty seven patients (100 hips) underwent injections with the non-radiological method using anatomical landmarks. Fluoroscopy and arthrogram were then used to confirm the needle position. The primary outcome measure was the success rate of correct positioning of the needle in hip joint by the non-radiological method, as confirmed on arthrogram under image intensifier. The secondary outcome measures were relationship between the grade of the surgeon and patient BMI to success rate of hip injections by the non-radiological method. Overall success rate with the non-radiological method was 67%. Consultants were 77.1% successful and registrars 57.7% (P = 0.039). The average body mass index (BMI) in the successful group was 28.45 (SD = 5.21) and 32.03 (SD = 4.84) in the unsuccessful group (p=0.001). Success was further improved to 88% when performed by a consultant in low BMI (< 30) patients. This prospective study shows that hip injections can be performed with reasonable success without radiological guidance. Experienced surgeons may be able to perform this procedure in outpatient clinics in normal BMI patients; thereby reducing costs and the need for bed space.

As an attractive alternative to the traditional plug-in charged electric vehicles (EVs), wireless-charged EVs have recently been in the spotlight. Opportunistically charged utilizing the wireless-charging infrastructure installed under the road at bus stops, an electric bus can have a smaller and lighter battery pack. In this paper, an improved opportunistic wireless-charging system (OWCS) for electric bus is introduced, which includes the opportunistic stationary wireless-charging system (OSWCS) and opportunistic hybrid wireless-charging system (OHWCS) consisting of stationary wireless-charging and dynamic wireless-charging. A general battery reduction model is established for the opportunistic wireless-charged electric bus (OWCEB). Two different battery-reduction models are built separately for OWCEB on account of the characteristics of OSWCS and OHWCS. Additionally, the cost saving models including the production cost saving, the operation cost saving and total cost saving are established. Then, the mathematical models are demonstrated with a numerical example intuitively. Furthermore, we analyze several parameters that influence the effectiveness of battery reduction due to the application of an opportunistic wireless-charging system on an electric bus. Finally, some points worth discussing in this work are performed.

Blockchain technology has been recommended for the sustainability in the manufacturing industry, owing to its benefits in terms of real-time transparency and cost savings. To verify this, we first examine how firms can employ distributed ledger technology by adopting blockchain technology to achieve real-time transparency and cost savings. We also review the current blockchain technology applications in the financial industry and supply chains to explain this technology&rsquo, s mechanisms for enabling real-time transparency and cost savings in the manufacturing industry. Finally, we theoretically compare the profits of manufacturing firms in two managerial delegation games under a duopoly situation. This theoretical model suggests that the real-time transparency and cost savings secured by blockchain technology improve the profitability and competitiveness of manufacturing firms, which, in turn, assure the sustainability in the manufacturing industry.

RACIONAL: A execução de bypass gástrico laparoscópico em hospital universitário público tem sido difícil devido ao elevado custo dos grampeadores cirúrgicos que prejudica o treinamento de médicos residentes e tem motivado a busca por técnicas alternativas, de baixo custo, mantendo a eficácia. OBJETIVO: Apresentar a viabilidade de um método com menor uso de suturas mecânicas. MÉTODOS: Foram operados 63 pacientes em 2 hospitais universitários, sendo 12 homens e 51 mulheres (81%), com média de 33,5 anos de idade e IMC médio de 43. Aplicou-se a seguinte padronização técnica: Secção da alça com bisturi elétrico a 50 cm do ângulo duodeno-jejunal, anastomose término-lateral, passagem da alça retrocólica e retrogástrica, confecção da parede lateral da bolsa gástrica com 1 carga azul de 45 e outra de 60 mm após a secção horizontal com bisturi elétrico, sutura do estômago excluso e anastomose gastrojejunal. As anastomoses foram manuais e contínuas com fio absorvível. RESULTADOS: O tempo operatório médio foi de 5,5 horas. As complicações precoces foram: fístula no ângulo de esôfago-gástrico (1,6%), estenose (1,6%) e fístula na anastomose gastrojejunal (1,6%) e torção da anastomose intestinal (1,6%). A estenose foi tratada por dilatação endoscópica e as outras complicações através de 3 re-operações (2 laparoscópicas e 1 laparotômica). O tempo de internação variou de 2 a 20 dias, com média de 4 dias, não havendo óbito. CONCLUSÃO: Este método é viável e com baixo custo operacional; todavia, é complexo e requer habilidade principalmente em suturas laparoscópicas. BACKGROUND: To perform laparoscopic gastric bypass in public university hospital has been difficult due to the high cost of the surgical staplers. This fact induced to look for different technical options, with low cost, maintaining the efficacy. AIM: To present the viability of a new method with the use of a low number of stapler devices. METHODS: Sixty three patients were operated in two university hospitals, 12 men and 51 women (81%), with mean age of 33.5y and average BMI of 43. The surgical technique used followed this sequence: loop section with electrical scalpel 50 cm of the duodenojejunal angle; termino-lateral anastomosis; retrogastric-retrocolic passage of the Roux limb; construction of the lateral wall of the pouch using 1 blue load of 45 and other of 60 mm after horizontal section with electrical scalpel; suture of the excluded stomach and gastrojejunal anastomosis. The anastomoses were hand-sewn made and a single-layer continuous absorble suture was performed. RESULTS: The average surgical time was 5.5 hours. The early complications were: fistula in the esophago-gastric angle (1.6%), stenosis (1.6%); fistula in the gastro-jejunal anastomosis (1.6%); obstruction of the intestinal anastomosis (1.6%). The stenosis was treated by endoscopic dilation. The remaining complications, with 3 re-operations (2 with laparoscopic and 1 with laparotomic approaches). The length of hospital stay was in average 4 days. CONCLUSION: This method is viable with low cost; however, it is complex and requires ability mainly in laparoscopic handsewn sutures.

Introduction: The balance between revenue and cost of an organization/system is essential to maintain its survival and quality of services. Emergency departments (ED) are one of the most important parts of health care delivery system. Financial discipline of EDs, by increasing the efficiency and profitability, can directly affect the quality of care and subsequently patient satisfaction. Accordingly, the present study attempts to investigate failure mode and effects analysis (FMEA) method in identifying the problems leading to the loss of ED revenue and offer solutions to help fix these problems. Methods: This prospective cohort study investigated the financial records of ED patients and evaluated the effective errors in reducing the revenue in ED of Imam Hossein hospital, Tehran, Iran, from October 2007 to November 2009. The whole department was divided based on FMEA into one main system and six subsystems. The study was divided in two phases. In the first phase, the problems leading to the loss in the revenue in each subsystem were identified and weighted to four groups using risk priority number (RPN), and the solutions for fixing them were planned. Then, at the second phase discovered defects in the first phase were fixed according to their priority. Finally, the impact of each solution was compared before and after interventions using the repeated measure ANOVA test. Results: At last, 100 financial records of ED patients were evaluated during the first phase of the study. The average of ED revenue in the six months of the first phase was 73.1±3.65 thousands US dollar/month. 12 types of errors were detected in the predefined subsystems. ED revenue rose from 73.1 to 153.1, 207.06, 240, and 320 thousands US dollar/month after solving of first, second, third, and fourth priority problems, respectively (337.75% increase in two years) (pConclusion: The findings of the present study revealed that FMEA could be considered as an efficient model for increasing the revenue of emergency department. According to this model, not recording the services by nursing unit and lack of specific identifying code for the patients' files, moving from ED to any other department, were the two first priority problems in decreasing our ED revenue.

Background Type 2 diabetes mellitus (T2DM) has gained pandemic proportions becoming a global threat within the last few decades. In parallel to the increasing prevalence, healthcare costs have become a huge economic burden for the hospital and governments. Bariatric surgery has been proven to induce glycemic control in obese type 2 diabetics. However, the cost effectiveness of metabolic surgery in overweight, obese and morbidly obese individuals has not been documented. We aimed to demonstrate the efficacy and reduced diabetic-medication cost after diverted sleeve gastrectomy with ileal interposition (DSIT) in type 2 diabetic individuals followed more than 1 year. Methods Records of 116 type 2 diabetic patients operated by DSIT at a dedicated metabolic surgery clinic between October 2011 and April 2013 were retrospectively reviewed. A comparison was made between the annual diabetic medication cost before and after surgery using the paired t test. The alterations in BMI and HbA1c were recorded and analyzed. Results Diverted sleeve gastrectomy with ileal interposition led to a marked reduction in BMI and improved glycemic control after 1 year follow-up. Mean HbA1c levels decreased from a mean of 8.9 ± 1.7 to 6.6 ± 1.1 1 year after surgery (p

Background : The use of pharmacokinetics is associated with cost savings in anti-tumor necrosis factor (anti-TNF) therapy, but the long-term cost savings in a large cohort of Crohn’s disease (CD) patients are unknown. Aim : The goal of this study was to compare the cost of anti-TNF therapy in two cohorts of CD patients losing response to infliximab, one using a test-based strategy and one an empirical dose escalation. Methods : We used a selected mathematical model to describe the trajectories of CD patients based on a discrete event system. This design allowed us to track over a given period a double cohort of patients who moved randomly and asynchronously from one state to another, while keeping all the information on their entire trajectory. Both cohorts were modeled using state diagram parameters where transition probabilities from one state to another are derived from literature data. Costs were estimated based on the French health care system. Results : Cost savings among the 10,000 CD patients using a test-based strategy were €131,300,293 at 5 years. At 5 years the mean cost saving was €13,130 per patient. The direct cost of the test had no impact on the results until the cost per test reached €2,000. Conclusions : A test-based strategy leads to major cost savings related to anti-TNF therapy in CD. Keywords: infliximab; pharmacokinetics; adalimumab; Crohn’s disease; cost saving (Published: 30 October 2015) Citation: Journal of Market Access & Health Policy 2015, 3 : 29229 - http://dx.doi.org/10.3402/jmahp.v3.29229

The aim of this paper is to study both the private and the social desirability of a mixed bundling strategy that generates a cost savings effect. We confirm that mixed bundling is the dominant strategy for multiproduct firms, although it may give rise to a prisoner’s dilemma. Moreover, we show that mixed bundling may maximise social welfare, provided that cost savings are sufficiently high. Finally, we highlight the parametric regions where the social and the private interests coincide, and those where they do not. The recent evolution of broadband telecommunications services provides an ideal framework to apply our theoretical predictions.

Medication errors may lead to adverse drug events (ADEs), which endangers patient safety and increases healthcare-related costs. The on-ward deployment of clinical pharmacists has been shown to reduce preventable ADEs, and save costs. The purpose of this study was to evaluate the ADEs prevention and cost-saving effects by clinical pharmacist deployment in a nephrology ward. This was a retrospective study, which compared the number of pharmacist interventions 1 year before and after a clinical pharmacist was deployed in a nephrology ward. The clinical pharmacist attended ward rounds, reviewed and revised all medication orders, and gave active recommendations of medication use. For intervention analysis, the numbers and types of the pharmacist's interventions in medication orders and the active recommendations were compared. For cost analysis, both estimated cost saving and avoidance were calculated and compared. The total numbers of pharmacist interventions in medication orders were 824 in 2012 (preintervention), and 1977 in 2013 (postintervention). The numbers of active recommendation were 40 in 2012, and 253 in 2013. The estimated cost savings in 2012 and 2013 were NT$52,072 and NT$144,138, respectively. The estimated cost avoidances of preventable ADEs in 2012 and 2013 were NT$3,383,700 and NT$7,342,200, respectively. The benefit/cost ratio increased from 4.29 to 9.36, and average admission days decreased by 2 days after the on-ward deployment of a clinical pharmacist. The number of pharmacist's interventions increased dramatically after her on-ward deployment. This service could reduce medication errors, preventable ADEs, and costs of both medications and potential ADEs.

Background Many patients who suffer from bradycardia and need cardiac pacing also have atrial fibrillation (AF). New pacemaker algorithms, such as atrial preventive pacing and atrial antitachycardia pacing (DDDRP) and managed ventricular pacing (MVP), have been specifically designed to reduce AF occurrence and duration and to minimize the detrimental effects of right ventricular pacing. The randomized MINimizE Right Ventricular pacing to prevent Atrial fibrillation and heart failure trial established that DDDRP + MVP pacing modality reduced permanent AF in bradycardia patients as compared with standard dual-chamber pacing (DDDR). Objective The aim of this study was to estimate the cost savings due to lower AF-related health care utilization events based on health care costs from the United States and the European Union. Methods Dual-chamber pacemaker patients with a history of paroxysmal or persistent AF were randomly assigned to receive DDDR (n = 385) or the advanced features (DDDRP + MVP; n = 383). We used published health care costs from the United States and the European Union (Italy, Spain, and the United Kingdom) to estimate the costs associated with AF-related hospitalizations and emergency visits. Results The rate of AF-related hospitalizations was significantly lower in the DDDRP + MVP group than in the conventional pacemaker group (DDDR group; 42% reduction; incidence rate ratio 0.58). Similarly, a significant reduction of 68% was observed for AF-related emergency department visits (incidence rate ratio 0.32; P

In July 2011, Cyprus experienced an abrupt disruption of power supply as a result of an explosion that happened near the biggest conventional power station of the island, which destroyed about 60 % of the its power generating capacity. This was a major drawback for the Cypriot economy that could turn into an opportunity to restructure Cyprus's energy mix towards a more sustainable one by further promoting renewable energy sources. However, due to the time-consuming licensing procedures which exists in Cyprus nothing has materialised. This chapter searches for the reasons for this situation and examines the potential of the single stop principle for national renewable energy governance. Within this context, a simple numerical model is considered what-if scenarios employing the single stop rationale by means of time and cost savings are quantified and examined, and specific suggestions for the improvement of the licensing procedures are performed. © Springer-Verlag London 2013. 23 169 181 Cited By :2

Society is increasingly dependent on Information Security Management Systems (ISMS), and having these kind of systems has become vital for the development of Small and Medium-Sized Enterprises (SMEs). However, these companies require ISMS that have been adapted to their special features and have been optimized as regards the resources needed to deploy and maintain them, with very low costs and short implementation periods. This paper discusses the different cycles carried out using the ‘Action Research (AR)’ method, which have allowed the development of a security management methodology for SMEs that is able to automate processes and reduce the implementation time of the ISMS.

This paper aims to identify the critical dominant incidents and key instigators that influence on usage or lack of usage of e-ticketing by Kosovo Air Passengers.The research at hand utilizes the Grounded Theory of Barney Glaser and Anselm Strauss, and the Critical Incident Technique in order to identify the factors that influence on the (diss) satisfaction of the travellers in using e-ticketing. For the purpose of this paper, the empirical data were gathered through interviews by using open ended questions. Among 93 interviews with the random selected passengers, 13 interviews were deemed as invalid.The empirical results highlighted the need for raising the consciousness regarding the efficacy and the advantages of eticketing. On the other hand, many other passengers cannot conceive the possibility of travelling without use of e-ticketing, given that in the past they spent much time in finding the right agent, desired destination, purchase difficulties in making reservation, confirmation, changes, or they had to carry large amounts of cash money to buy tickets which raised insecurity concerns.Research is limited only to the description of critical incidents that occurred in Prishtina International Airport. Majority of the respondents were highly-educated with high income status. These characteristics create a bias and constrain our ability to extrapolate from the findings. Nevertheless, the study serves as a point for more in-depth analysis and discussion on e-ticketing behaviour in Airline industry.

xProjects is a cloud based collaboration and project management solution that resolves the interoperability issues associated with integrated project delivery (IPD) and electrifies the IPD process by enabling capital project owners to collaborate seamlessly with multiple project stakeholders. Using XML adapters to create connections between systems, CMiC Real Time Integration (RTI) tags data so it can be transferred bi-directionally between participants within the project ecosystem with no loss of information or the need for re-entry.

Victims of disasters such as floods, earthquakes and war have to seek shelter elsewhere. A need arises to rapidly construct houses on site and at minimal cost. This will eliminate the need to transport pre-fabricated shelters long distances, saving the time and costs associated with transportation. Since Contour Crafting is an automated process, labor needs are highly minimized allowing relief workers to allocate their time and effort to rebuilding local infrastructure such as water sanitation and distribution systems, roads, electrical and communication systems as well as irrigations systems.

The FieldManager® software is a construction management system jointly owned by the Michigan Department of Transportation (MDOT) and Info Tech, Inc. Designed for any size organization that manages construction projects, FieldManager software wraps up contract documentation and reporting, contract modifications, and pay estimates into one neat package for use on multiple hardware platforms, increasing productivity and accountability by implementing a standard business practice across the organization.

Wind energy has become the major renewable energy source in Germany with an installed capacity of more than 20 GW and an annual output of about 40 TWh in 2007. In this paper we analyze the extent to which wind energy can replace fossil capacities based on wind injection and demand data for 2006 through June 2008. The results indicate that the wind potential in Germany will not allow a significant reduction of fossil capacities. We also assess the potential savings due to wind energy. The German market is modeled with and without wind input to estimate the net savings of fossil fuels in the observation period. We find that the cost-saving potential for electricity production is quite significant in the study period and exceeds the subsidies.

This study describes the development and use of a mathematical model that will enable mine operators to minimise the costs of electricity consumed by the ventilation and refrigeration systems used for environmental control in deep mines. This model was calibrated and tested by using actual data from a gold mine near Welkom in South Africa. In a first simulation, the mine's current practice of controlling conditions to a wet bulb temperature (Twb) of 25S°C, was optimised. The model demonstrated that this environmental condition could be sustained at lower electricity consumption. In so doing, the mine realised a saving of 30 000 kWh per day. The energy saving and load management led to a cost saving of R 1.5 million per year. However, a better indicator of environmental conditions is the Air Cooling Power index, (ACP). Research has shown that for hard physical work in hot conditions workers need an ACP of 300 w/m2. It was found that the case study mine actually supplied their workplace with a cooling capacity of 422 w/m2. The new model optimised the refrigeration and ventilation systems in such a manner that the workers were supplied with exactly 300 w/m2, no more and no less. It was found that by doing this, an electricity saving of 57 600 kWh per day could be realised when compared with the current mine practices. The energy saving and load management led to a potential cost saving of R 2.55 million per year. (Certain capital costs, such as for variable speed drives may have to be incurred to realise these savings.) The new model could be further extended to take advantage of the new Real Time Price offerings from Eskom It will be able to identify an operating point for the refrigeration and ventilation systems to supply 300 w/m2 for the workers, in real time, at the lowest electricity cost. Thesis (Ph.D. (Mechanical Engineering))--North-West University, Potchefstroom Campus, 2004.

Sai-Ping Jiang,1 Zheng-Yi Zhu,2 Xiao-Liang Wu,3 Xiao-Yang Lu,1 Xing-Guo Zhang,1 Bao-Hua Wu1 1Department of Pharmacy, the First Affiliated Hospital, 2Department of Pharmacy, Children’s Hospital, College of Medicine, Zhejiang University, Hangzhou, 3Intensive Care Unit, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China Background: The impact of continuous renal replacement therapy (CRRT) on drug removal is complicated; pharmacist dosing adjustment for these patients may be advantageous. This study aims to describe the development and implementation of pharmacist dosing adjustment for critically ill patients receiving CRRT and to examine the effectiveness of pharmacist interventions. Methods: A comparative study was conducted in an intensive care unit (ICU) of a university-affiliated hospital. Patients receiving CRRT in the intervention group received specialized pharmacy dosing service from pharmacists, whereas patients in the no-intervention group received routine medical care without pharmacist involvement. The two phases were compared to evaluate the outcome of pharmacist dosing adjustment. Results: The pharmacist carried out 233 dosing adjustment recommendations for patients receiving CRRT, and 212 (90.98%) of the recommendations were well accepted by the physicians. Changes in CRRT-related variables (n=144, 61.81%) were the most common risk factors for dosing errors, whereas antibiotics (n=168, 72.10%) were the medications most commonly associated with dosing errors. Pharmacist dosing adjustment resulted in a US$2,345.98 ICU cost savings per critically ill patient receiving CRRT. Suspected adverse drug events in the intervention group were significantly lower than those in the preintervention group (35 in 27 patients versus [vs] 18 in eleven patients, P

Objectives: To analyse clinical pharmacists interventions in the ICU of the Penang General Hospital (Penang, Malaysia) and to assess the pharmaco-economic impact of these interventions. Methods: A clinical pharmacist reviewed drug prescriptions during one month. Drug-related problems were documented on a preprepared form including a suggestion for a change in prescribing. Such recommendations were submitted to the nursing/medical staff. Acceptance of the recommendation was entirely at the discretion of the medical staff. All recommendations were analysed with respect to potential pharmaco-economic impact: cost savings, cost avoidance or cost addition. Results: The ICU pharmacist made 57 recommendations, of which the medical staff rejected only 5%. The majority of detected drug-related problems referred to unnecessary drug therapy (37%). Recommendations resulted in net cost savings of RM 15,227 (USD 4,007). This corresponded with RM 634 per patient intervened by the pharmacist. Conclusion: Pharmacists interventions in the ICU of a Malaysian hospital resulted in significant cost savings in terms of drug expenses and can therefore be suggested as a routine practice in our hospital.

A hierarchical distributed telecom cloud architecture for live-TV distribution exploiting flexgrid networking and SBVTs is proposed. Its scalability is compared to that of a centralized architecture. Cost savings as high as 32 % are shown.