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In the healthcare field, the effective implementation of clinical protocols is crucial to ensuring patient safety and well-being. In this context, this study evaluates nurses' adherence to the maintenance and replacement protocol of peripheral venous catheters (PVCs) in a university hospital in Spain, examining the impact of compliance with the protocol on the loss of PVCs and on patient safety in addition to analyzing the related costs. A retrospective observational study was conducted with 590 patients who were admitted in 2018 and 2019. The chi-square test or Fisher's exact test, as appropriate, was used to see the association between the study variables; with the dependent variable being the loss of PVCs (including, as a dependent variable, the loss of PVCs before 48 h). The patients' electronic and physical medical records were reviewed to analyze nursing interventions related to the management of PVCs. A total of 24% of patients experienced PVC loss within the first 24 h after insertion. Failure to comply with the protocol resulted in 80% more catheter loss and increased the cost of cannulation by 46.84%. Low compliance with PVC care protocols significantly increases the risk of catheter loss, suggesting the need for increased training and strict protocol implementation. The findings emphasize the critical role of nursing in ensuring patient safety through adherence to evidence-based protocols. Continuing education and diligent protocol implementation are essential to reducing healthcare costs and improving patient outcomes.

Introduction: Complete surgical resection for locally advanced rectal cancer is the standard treatment after a clinical complete response following chemoradiotherapy. However, some novel clinical approaches could achieve better functional results, such as Robotic Resection, or avoiding surgical procedure and incrementing surveillance intensity, called Watch-and-Wait policy. We use computational techniques to compare these clinical approaches using quality adjusted life years (QALYs)., Methods: A Markov decision analytic model was used in order to perform a cost-utility analysis, comparing standard resection (SR), Robotic Rectal Resection (RRR) and Watch-and-Wait (WW) strategies, estimating the incremental cost-effectiveness ratio per QALY to be gained from patients reaching a clinical complete response to chemoradiotherapy. Model parameter estimates were informed by previously published studies comparing WW to SR and from our database of RRR versus SR. Lifetime incremental cost-utility ratio was calculated among approaches, and a sensitivity analysis were performed in order to estimate the model uncertainty. A willingness-to-pay of per one additional QALY gained was measured to determine which strategies would be most cost-effective., Results: WW is a dominating option over SR ( -75,486. 75 € and +2.04 QALYs) and RRR ( -75,486. 75 € and +0.41 QALYs). The cost-effectiveness plane shows that WW does not always dominate over RRR or SR. WW saves costs in 99.98% of the simulations when compared with either SR or RRR but only 86.9% and 55.38% (respectively) of these fall within the SR quadrant. WW is only more effective than SR 55% of the time which implies a significant uncertainty due to the high utility value assigned to cCR after chemoradiotherapy in the RRR alternative., Conclusion: This study provides data of cost-effectiveness differences among Standard Surgery, Watch-and-Wait and Robotic Resection approaches in clinical complete response in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy, showing a benefit for Watch-and-Wait policy., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: The aim of this study is to compare the clinical and cost-effective outcomes of the open Lichtenstein repair (OL) and laparoscopic trans-abdominal preperitoneal (TAPP) repair for bilateral inguinal hernias., Summary Background Data: A cost-effective analysis of laparoscopic versus open inguinal hernia repair is still not well addressed, especially regarding bilateral hernia., Methods: This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital.Cases of primary, reducible bilateral inguinal hernia were included and randomized using a simple randomization program.The outcome parameters included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio., Results: Between March 2013 and January 2017, 165 patients were enrolled in this study (81 of them underwent TAPP and 84 OL).The TAPP procedure had less early postoperative pain (P = 0.037), a shorter length of stay (P = 0.001), and fewer postoperative complications (P = 0.002) when compared with the OL approach. The overall cost of TAPP procedure was higher compared with the OL cost (1,683.93&OV0556; vs 1192.83&OV0556;, P = 0.027). The mean QALYs at 1 year for TAPP (0.8094) was higher than that associated with OL (0.6765) (P = 0.018). At a willingness-to-pay threshold of 20,000 &OV0556; and 30,000 &OV0556;, there was a 95.38% and 97.96% probability that TAPP was more cost-effective relative to OL., Conclusions: The TAPP procedure for bilateral inguinal hernia appears to be more cost-effective compared with OL.