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Increased Cost (increased + cost)
Selected AbstractsFallacies of High-Speed HemodialysisHEMODIALYSIS INTERNATIONAL, Issue 2 2003Zbylut J. Twardowski Chronic hemodialysis sessions, as developed in Seattle in the 1960s, were long procedures with minimal intra- and interdialytic symptoms. Financial and logistical pressures related to the overwhelming number of patients requiring hemodialysis created an incentive to shorten dialysis time to four, three, and even two hours per session in a thrice weekly schedule. This method spread rapidly, particularly in the United States, after the National Cooperative Dialysis Study suggested that time of dialysis is of minor importance as long as urea clearance multiplied by dialysis time and scaled to total body water (Kt/Vurea) equals 0.95,1.0. This number was later increased to 1.3, but the assumption remained unchanged that hemodialysis time is of minimal importance as long as it is compensated by increased urea clearance. Patients accepted short dialysis as a godsend, believing that it would not be detrimental to their well-being and longevity. However, Kt/Vurea measures only removal of low molecular weight substances and does not consider removal of larger molecules. Besides, it does not correlate with the other important function of hemodialysis, namely ultrafiltration. Whereas patients with substantial residual renal function may tolerate short dialysis sessions, the patients with little or no urine output tolerate short dialyses poorly because the ultrafiltration rate at the same interdialytic weight gain is inversely proportional to dialysis time. Rapid ultrafiltration is associated with cramps, nausea, vomiting, headache, fatigue, hypotensive episodes during dialysis, and hangover after dialysis; patients remain fluid overloaded with subsequent poor blood pressure control, left ventricular hypertrophy, diastolic dysfunction, and high cardiovascular mortality. Short, high-efficiency dialysis requires high blood flow, which increases demands on blood access. The classic wrist arteriovenous fistula, the access with the best longevity and lowest complication rates, provides "insufficient" blood flow and is replaced with an arteriovenous graft fistula or an intravenous catheter. Moreover, to achieve high blood flows, large diameter intravenous catheters are used; these fit veins "too tightly," so predispose the patient to central-vein thrombosis. Longer hemodialysis sessions (5,8 hrs, thrice weekly), as practiced in some centers, are associated with lower complication rates and better outcomes. Frequent dialyses (four or more sessions per week) provide better clinical results, but are associated with increased cost. It is my strong belief that a wide acceptance of longer, gentler dialysis sessions, even in a thrice weekly schedule, would improve overall hemodialysis results and decrease access complications, hospitalizations, and mortality, particularly in anuric patients. [source] Complications of Methylprednisolone Sodium Succinate Therapy in Dachshunds with Surgically Treated Intervertebral Disc DiseaseJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2001Amanda K. Boag MA VetMB, MRCVS; Abstract Objective: To compare the incidence of clinically evident post-operative complications, financial cost and length of hospital stay for Dachshunds with acute intervertebral disc disease treated with decompressive surgery with and without the use of methylprednisolone sodium succinate (MPSS). Design: Retrospective clinical study Setting: Veterinary Teaching Hospital Animals: Dachshunds that presented to the Veterinary Hospital of the University of Pennsylvania between January 1994 and December 1999 with acute intervertebral disc disease that were treated with decompressive surgery. Intervention: None Measurements and Main Results: Dogs were divided into 2 groups dependent upon whether they had received MPSS. Medical records were examined for evidence of post-operative complications. Other parameters recorded included details of drugs administered (principally corticosteroids and gastrointestinal protectant drugs), length and cost of hospital stay and neurological status at 24 hours post-operatively and at suture removal. Compared to other corticosteroids, dogs receiving MPSS had a significantly higher incidence of clinically evident post-operative gastrointestinal complications, an increased use of gastrointestinal protectant drugs, and an increased cost for hospital stay (p<0.01). Conclusions: The use of MPSS inDachshunds with acute intervertebral disc disease is associated with an increased post-operative complication rate and an increased financial cost to the client. The use of MPSS should be carefully evaluated for each patient. [source] Infant carrying: The role of increased locomotory costs in early tool developmentAMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY, Issue 2 2007C.M. Wall-Scheffler Abstract Among the costs of reproduction, carrying one's infant incurs one of the greatest drains on maternal energy, simply because of the added mass alone. Because of the dearth of archaeological evidence, however, how early bipeds dealt with the additional cost of having to carry infants who were less able to support their body weight against gravity is not particularly well understood. This article presents evidence on the caloric drain of carrying an infant in one's arms versus having a tool with which to sling the infant and carry her passively. The burden of carrying an infant in one's arms is on average 16% greater than having a tool to support the baby's mass and seems to have the potential to be a greater energetic burden even than lactation. In addition, carrying a baby in one's arms shortens and quickens the stride. An anthropometric trait that seems to offset some of the increased cost of carrying a baby in the arms is a wider bi-trochanteric width. Am J Phys Anthropol, 2007. © 2007 Wiley-Liss, Inc. [source] Roentgen stereophotogrammetric analysis and clinical assessment of unipolar versus bipolar hemiarthroplasty for subcapital femur fracture: a randomized prospective studyANZ JOURNAL OF SURGERY, Issue 4 2010Benjamin Jeffcote Abstract Background:, Hemiarthroplasty is a well-established treatment for displaced subcapital fracture, but controversy exists about the optimal implant type. Bipolar hemiarthroplasty has proposed advantages over unipolar hemiarthroplasty in terms of better clinical results and decreased wear of acetabular cartilage. Methods:, This study is a randomized prospective study of 51 patients (52 hips) receiving either bipolar or unipolar hemiarthroplasty for displaced subcapital fractures. The outcome measurements were clinical scores and Roentgen stereophotogrammetric analysis (RSA) analysis to determine the rate of acetabular wear. Results:, Twenty-three patients completed 2-year follow-up. The RSA data demonstrated that there was slightly less acetabular wear by bipolar prostheses than by unipolar. The combined mean three-dimensional wear of the bipolar prostheses was 0.6 mm compared with 1.5 mm for the unipolar prostheses (P= 0.04). The bipolar group generally achieved higher scores in terms of the Harris Hip Score, Western Ontario and McMaster University Index of Osteoarthritis (WOMAC) questionnaire and 6-min walk test. These results were statistically significant at 3 months but not at 12 and 24 months. Conclusion:, This study suggests that while the bipolar prosthesis performs slightly better than the unipolar in terms of acetabular cartilage wear and clinical outcomes, it remains debatable whether the benefits are worth the increased cost of the prosthesis. [source] IS THERE STILL A ROLE FOR THE CLASSICAL COX-MAZE III?ANZ JOURNAL OF SURGERY, Issue 5 2006Cheng-Hon Yap Background: The incidence of surgery for atrial fibrillation (AF) is rising, paralleled by an increase in the types of lesion sets and energy sources used. These alternate energy sources have simplified the surgery at the expense of increased cost of consumables. The classical Cox-Maze III is the gold standard therapy with a proven efficacy in curing AF. Our complete experience with this procedure is presented. Methods: All 28 patients undergoing the classical Cox-Maze III procedure at our institution underwent preoperative assessment and were followed prospectively. Results: Twenty-eight patients underwent the Cox-Maze III procedure between January 2001 and May 2003. Their mean age was 65 years (range, 44,80 years). Twenty-five patients had concomitant cardiac procedures. Mean duration of AF was 8.3 years. Permanent AF was present in 82%. Mean follow-up time was 15 ± 8 months (range, 4,30 months). There were no perioperative or late deaths, or thromboembolic events. Sixty-one per cent had early (<3 months) atrial arrhythmia. Freedom from AF at most recent clinical follow up was 93%. Freedom from late atrial arrhythmia was 82%. Freedom from late AF or atrial flutter by pacemaker interrogation or Holter assessment was 77%. Anti-arrhythmic medication use was reduced. New York Heart Association class improved from an average of 2.8 preoperatively to 1.3 postoperatively. Conclusion: The result of the present study shows the safety and efficacy of the classical Cox-Maze III procedure. With the advantage of proven long-term efficacy, demonstrable safety and avoidance of costly technology, the Cox-Maze III should not be discounted as a treatment option in patients because of its perceived complexity. [source] A Note on Efficiency Wage Theory and Principal,Agent TheoryBULLETIN OF ECONOMIC RESEARCH, Issue 3 2006Uwe Jirjahn J41; J33; D82 Abstract Why are principal,agent models used in some circumstances and efficiency wage models in others? In this note, it is argued that efficiency wages provide incentives based on an evaluation of the agent's input, while the incentives analysed in principal,agent models rely on the agent's output. The choice between the two incentive schemes depends on the probability that the agent is caught shirking. Moreover, we demonstrate that a combination of input- and output-related elements provides stronger incentives than payment schemes based on merely one of these elements. However, the combination requires a more complex labour contract involving an increased cost of writing the contract. The interaction between this transaction cost and a hiring cost is analysed. [source] Laparoscopic colectomy is cheaper than conventional open resectionCOLORECTAL DISEASE, Issue 9 2007P. F. Ridgway Abstract Objective, International randomized trials have endorsed the routine use of laparoscopic techniques in colorectal surgery. The authors hypothesize that the overall care pathway in minimal access resection was cheaper than conventional open resection. Method, This was a case-matched study of consecutive patients undergoing laparoscopic resection between July 2005 and February 2006. Intraoperative (costs, duration, incision length) and postoperative [morbidity, length of stay (LOS), readmission] parameters were examined. Institutional retrospective open controls and national validated figures were used for costings. Results, Thirty-five laparoscopic and 53 open resections were evaluated. Median LOS was 5 days in the laparoscopic group vs 12 in the open group (P = 0.001). There were two conversions (5.7%) and two readmissions. Mean operative cost of laparoscopic resection was ,1557.08, therefore 2.4 bed days need to be saved to recoup the increased cost compared with open resection. The actual median save is 7 days (P = 0.031). A mean of ,4591.38 and 7 bed days per case is saved by performing the resection laparoscopically. Subgroup analysis of laparoscopic resections clearly demonstrates similar trends. Conclusion, The institutional saving is over ,150 000 and 245 bed days during the study period. Despite higher operative spending, laparoscopic colorectal resections are significantly cheaper than conventional open resections. [source] Female zebra finches compromise clutch temperature in energetically demanding incubation conditionsFUNCTIONAL ECOLOGY, Issue 5 2010Andreas Nord Summary 1.,Avian embryos depend on the incubating parent to provide a thermal environment suitable for embryogenesis, but as the maintenance of optimal incubation temperatures is energetically costly, an incubating bird often must trade off embryonic investment against self-maintenance. 2.,We manipulated the energetic cost of incubation in female zebra finches (Taeniopygia guttata Vieillot) by varying ambient temperature and clutch size during nocturnal incubation and recorded the corresponding effects on incubation metabolic rate and clutch temperature. 3.,Females increased their night-time incubation metabolic rate more than twofold when incubating at 10 °C compared to when incubating close to thermoneutrality (28 °C). Furthermore, clutch enlargement caused females to elevate their metabolic rate with 2·8% per additional egg added to the clutch. 4.,However, despite spending more energy, females did not fully cover the increased costs of incubation, because clutch temperature decreased with decreasing ambient temperature and increasing clutch size. 5.,These findings suggest that parental investment in incubation can be energetically constrained and sometimes result in clutch temperatures below the optimal level for embryonic development, at least during nocturnal incubation. [source] Cost-effectiveness of primary cytology and HPV DNA cervical screeningINTERNATIONAL JOURNAL OF CANCER, Issue 2 2008Peter Bistoletti Abstract Because cost-effectiveness of different cervical cytology screening strategies with and without human papillomavirus (HPV) DNA testing is unclear, we used a Markov model to estimate life expectancy and health care cost per woman during the remaining lifetime for 4 screening strategies: (i) cervical cytology screening at age 32, 35, 38, 41, 44, 47, 50, 55 and 60, (ii) same strategy with addition of testing for HPV DNA persistence at age 32, (iii) screening with combined cytology and testing for HPV DNA persistence at age 32, 41 and 50, iv) no screening. Input data were derived from population-based screening registries, health-service costs and from a population-based HPV screening trial. Impact of parameter uncertainty was addressed using probabilistic multivariate sensitivity analysis. Cytology screening between 32 and 60 years of age in 3,5 year intervals increased life expectancy and life-time costs were reduced from 533 to 248 US Dollars per woman compared to no screening. Addition of HPV DNA testing, at age 32 increased costs from 248 to 284 US Dollars without benefit on life expectancy. Screening with both cytology and HPV DNA testing, at ages 32, 41 and 50 reduced costs from 248 to 210 US Dollars with slightly increased life expectancy. In conclusion, population-based, organized cervical cytology screening between ages 32 to 60 is highly cost-efficient for cervical cancer prevention. If screening intervals are increased to at least 9 years, combined cytology and HPV DNA screening appeared to be still more effective and less costly. © 2007 Wiley-Liss, Inc. [source] Agrarian Transformation and Rural Diversity in Globalizing East AsiaINTERNATIONAL JOURNAL OF JAPANESE SOCIOLOGY, Issue 1 2004Atsushi Kitahara Abstract:, In East Asia the rural society is not a society based upon agricultural industry anymore and the peasant society with its long history has been disappearing. The occupation and income sources of rural inhabitants have diversified and among them those who specialized in farming are the minority. There is a shortage of rural labor, which used to be abundant in the past, and presently it is not as easy to hire the farm workers. The reason for the diversification of the rural occupations is, to put it simply, because people cannot live merely on farm income. Indeed the farm operation costs have become more expensive due to labor saving techniques, but the livelihood costs have become more expensive due the new uniform lifestyle standards from globalization. Electric machines and education are the typical of these increased costs. The background of this rural change is industrialization and urbanization in the context of globalization and its strong impact is penetrating into the rural society through the regional urban center as the relay point of the global mechanism. This change is different based upon the location of each rural society. Generally, rural societies around a big urban center enjoy opportunities for the younger generation, but remote areas have serious problems with few employment opportunities and a smaller youth population. To reproduce and sustain the regional society as a whole, it is necessary to attract younger people and make them stay. We should plan to develop a variety of industries and the resultant diversified work opportunities in the broader region beyond the narrowly demarcated village and community. Subsistence and commercial agriculture might merely be a part of such diversity. [source] How different provisioning strategies result in equal rates of food delivery: an experimental study of blue tits Parus caeruleusJOURNAL OF AVIAN BIOLOGY, Issue 4 2002Fabrizio Grieco Food provisioning in birds requires a considerable amount of time and usually has to be traded-off against other parental and non-parental activities. I investigated experimentally the rate at which blue tit Parus caeruleus parents deliver food to their brood after a change in food availability. The main argument behind this study is that parents enjoying an additional food source may use less time for self-feeding and therefore use more time for food provisioning. This could increase the rate at which food is brought to the nest. However, a prey choice model that takes the energetic needs of the parent into account allows for the possibility that the food-supplemented parents would deliver the same amount of food by increasing prey size (through an increase in prey selectivity) and reducing visit rate. The field data indicate that the parents changed provisioning strategy when food-supplemented: they fed the chicks natural food less frequently, but brought larger larvae. On the whole, delivery rate of natural food was the same or lower than in controls. The results suggest that food-supplemented parents used the time saved to increase their degree of food selectivity. When the gains from an increased delivery rate are not worth the increased costs (mainly resulting from an increased visiting rate), the parent with low energetic need may increase selectivity to provide the same amount of food to the brood as the unmanipulated parent, but at a lower cost. [source] Robotic-assisted single-incision right colectomy: early experienceTHE INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY, Issue 4 2009Matthew B. Ostrowitz Abstract Background Application of laparoendoscopic single-site surgery (LESS) is increasing across surgical disciplines. In addition to the possibility of decreased postoperative pain, LESS offers better cosmesis with virtually ,scarless' surgeries, while avoiding the increased costs and complexity of natural orifice surgery. Instrument conflict minimization often requires the crossing of articulating instruments, which we believe can be more intuitively facilitated using the daVinci-S® robotic system. We describe our early experience with three robotic single-incision right hemicolectomies. Methods Three robotic single-incision right hemicolectomies were performed using the daVinci-S robotic system, utilizing a single 4 cm incision through or around the umbilicus. The procedure was performed using three robotic arms, a 12 mm camera and two 8 mm robotic ports. A medial to lateral approach was used and an extracorporeal resection and anastomosis was performed after undocking the robot. Results There were no intraoperative or postoperative complications. Average operative time was 152 min. The first case was converted to non-robotic single-incision right hemicolectomy during mobilization of the ascending colon, due to uncontrollable air leakage around the ports. The second and third cases were successfully completed without air loss by purse-stringing sutures around each individual port and the use of the SILSÔ port, respectively. Conclusions Robotic-assisted single-incision right hemicolectomy can be successfully and safely performed using the daVinci-S robotic system. Several techniques may be employed to prevent the loss of pneumoperitoneum. We believe right hemicolectomy lends itself to single-site surgery because specimen extraction requires a 4 cm incision and may confer patient benefit, with decreased postoperative pain and improved cosmesis. By crossing the robotic instruments and reassigning control of the arms, the robot represents a means to help perform these procedures safely by allowing them to be performed in a more intuitive fashion. Copyright © 2009 John Wiley & Sons, Ltd. [source] | |||||||||||||