The Audit-Intervention-Reaudit Cycle Can Improve Diagnostic Standards for Chronic Obstructive Pulmonary Disease (COPD).
The audit-intervention-reaudit cycle can improve diagnostic standards for chronic obstructive pulmonary disease (COPD).
Intern Emerg Med. 2013 May 1;
Lusuardi M, Garuti G, Massobrio M, Spagnolatti L, Borciani N
The Financial Burden of Reexcising Incompletely Excised Soft Tissue Sarcomas: A Cost Analysis.
Ann Surg Oncol. 2013 Apr 30;
Alamanda VK, Delisca GO, Mathis SL, Archer KR, Ehrenfeld JM, Miller MW, Homlar KC, Halpern JL, Schwartz HS, Holt GE
BACKGROUND: Although survival outcomes have been evaluated between those undergoing a planned primary excision and those undergoing a reexcision following an unplanned resection, the financial implications associated with a reexcision have yet to be elucidated. METHODS: A query for financial data (professional, technical, indirect charges) for soft tissue sarcoma excisions from 2005 to 2008 was performed. A total of 304 patients (200 primary excisions and 104 reexcisions) were identified. Wilcoxon rank sum tests and ? (2) or Fisher’s exact tests were used to compare differences in demographics and tumor characteristics. Multivariable linear regression analyses were performed with bootstrapping techniques. RESULTS: The average professional charge for a primary excision was $ 9,694 and $ 12,896 for a reexcision (p < .001). After adjusting for tumor size, American Society of Anesthesiologists status, grade, and site, patients undergoing reexcision saw an increase of $ 3,699 in professional charges more than those with a primary excision (p < .001). Although every 1-cm increase in size of the tumor results in an increase of $ 148 for a primary excision (p = .006), size was not an independent factor in affecting reexcision charges. The grade of the tumor was positively associated with professional charges of both groups such that higher-grade tumors resulted in higher charges compared to lower-grade tumors (p < .05). CONCLUSIONS: Reexcision of an incompletely excised sarcoma results in significantly higher professional charges when compared to a single, planned complete excision. Additionally, when the cost of the primary unplanned surgery is considered, the financial burden nearly doubles. HubMed – rehab
Ex vivo water exchange performance and short-term clinical feasibility assessment of newly developed heat and moisture exchangers for pulmonary rehabilitation after total laryngectomy.
Eur Arch Otorhinolaryngol. 2013 May 1;
van den Boer C, Muller SH, Vincent AD, Züchner K, van den Brekel MW, Hilgers FJ
Laryngectomized patients suffer from respiratory complaints due to insufficient warming and humidification of inspired air in the upper respiratory tract. Improvement of pulmonary humidification with significant reduction of pulmonary complaints is achieved by the application of a heat and moisture exchanger (HME) over the tracheostoma. The aim of this study was to determine whether the new Provox HMEs (XM-HME and XF-HME) have a better water exchange performance than their predecessors (R-HME and L-HME, respectively; Atos Medical, Hörby, Sweden). The other aim was to assess the short-term clinical feasibility of these HMEs. The XM-HME and XF-HME were weighed at the end of inspiration and at the end of expiration at different breathing volumes produced by a healthy volunteer. The associations between weight changes, breathing volume and absolute humidity were determined using both linear and non-linear mixed effects models. Study-specific questionnaires and tally sheets were used in the clinical feasibility study. The weight change of the XM-HME is 3.6 mg, this is significantly higher than that of the R-HME (2.0 mg). The weight change of the XF-HME (2.0 mg) was not significantly higher than that of the L-HME (1.8 mg). The absolute humidity values of both XM- and XF-HME were significantly higher than that of their predecessors. The clinical feasibility study did not reveal any practical problems over the course of 3 weeks. The XM-HME has a significantly better water exchange performance than its predecessor (R-HME). Both newly designed HMEs did succeed in the clinical feasibility study. HubMed – rehab