Pursuing Elimination of Hepatitis C in Egypt: Cost-Effectiveness and Economic Evaluation of a Country-Wide Program.

Introduction: Hepatitis C virus (HCV) is a global public health crisis. Egypt presents the highest HCV global prevalence. Recently, three different HCV screening/testing/therapy programs were implemented: In 2014 (wave 1), major decisions on HCV therapy were enacted, accompanied by a 99% discount for the HCV therapy sofosbuvir.

Processes for Implementing Community Health Worker Workforce Development Initiatives.

The objective of this observational, cross-sectional study was to identify, document, and assess the progress made to date in implementing various processes involved in statewide community health worker (CHW) workforce development initiatives. From September 2017 to December 2020, we developed and applied a conceptual model of processes involved in implementing statewide CHW initiatives. One or more outputs were identified for each model process and assessed across the 50 states, D.

Robotic hysterectomy compared with laparoscopic hysterectomy: is it still more costly to perform?

To establish the economic value of simple robotic hysterectomy vs laparoscopic hysterectomy and assess the impact of surgeon's experience. Retrospective cohort study. University-affiliated US regional healthcare system.

Senhance surgical system in benign hysterectomy: A real-world comparative assessment of case times and instrument costs versus da Vinci robotics and laparoscopic-assisted vaginal hysterectomy procedures.

Objectives: Comparison of retrospective, learning curve benign hysterectomy cost and case time data from Senhance total laparoscopic hysterectomy (TLH) cases with similar da Vinci robot cases and laparoscopic-assisted vaginal hysterectomy (LAVH) cases.

Methods: Instrument costs, console time, and case time analysis from six surgeons at four U.S.

Achieving robotic program best practice performance and cost versus laparoscopy: Two case studies define a framework for optimization.

Background: Robotic surgery is seen by many hospital administrators and surgeons as slower and more expensive than laparoscopic surgery despite the implementation of commonly held robotic best practices. Multiple factors, including surgeon learning curves and program governance, are often overlooked, precluding optimal robotic program performance.

Methods: An assessment of several leading robotic surgery publications is presented followed by real-world case studies from two US hospitals: an existing robotic program in a mid-sized, regional hospital system and a small, rural hospital that launched a new program.

Assessing and responding to stress related to pulmonary function testing in cystic fibrosis through quality improvement.

Background: Pulmonary function tests (PFTs) are performed routinely to evaluate lung function in patients with cystic fibrosis (CF). Staff at the Cincinnati Children's Hospital Medical Center CF Center observed stress in patients before PFTs. An interdisciplinary quality improvement (QI) team was assembled to address this clinical issue.

Cost of ownership assessment for a da Vinci robot based on US real-world data.

Background: Despite growth of robotic surgery, published literature lacks assessment of the cost of ownership (CoO) of a da Vinci robot by surgical service line and the associated benefit such data provides.

Methods: Based on real-world data (RWD) from 14 US hospitals and ≈6000 da Vinci robotic cases, CoO was assessed using all relevant fixed and variable cost components, calculated by surgical service line.

Results: At a representative hospital with an efficient robotic program (n = 424 cases), the weighted average fixed cost per case was $984.

Budget Impact of a Comprehensive Nutrition-Focused Quality Improvement Program for Malnourished Hospitalized Patients.

Background: Nutrition interventions can alleviate the burden of malnutrition by improving patient outcomes; however, evidence on the economic impact of medical nutrition intervention remains limited. A previously published nutrition-focused quality improvement program targeting malnourished hospitalized patients showed that screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence result in significant reductions in 30-day unplanned readmissions and hospital length of stay.

Objectives: To assess the potential cost-savings associated with decreased 30-day readmissions and hospital length of stay in malnourished inpatients through a nutrition-focused quality improvement program using a web-based budget impact model, and to demonstrate the clinical and fiscal value of the intervention.

A Comprehensive Nutrition-Focused Quality Improvement Program Reduces 30-Day Readmissions and Length of Stay in Hospitalized Patients.

Background: Although screening patients for malnutrition risk on hospital admission is standard of care, nutrition shortfalls are undertreated. Nutrition interventions can improve outcomes. We tested effects of a nutrition-focused quality improvement program (QIP) on hospital readmission and length of stay (LOS).

Efficacy and safety of perindopril arginine + amlodipine in hypertension.

To study the efficacy and safety of a new combination of perindopril arginine and amlodipine besylate, 837 subjects were enrolled in a three-arm, prospective, 59-center, randomized clinical trial. For 42 days, subjects (average seated blood pressure [BP], 158 ± 12/101 ± 5 mm Hg; age, 52 ± 10 years; 52% male; 34% black; 20% diabetic) received amlodipine/perindopril arginine (10/14 mg/d), perindopril erbumine (16 mg/d), or amlodipine (10 mg/d). Goal BP was <140/90 or <130/80 mm Hg in diabetics, per JNC 7 guidelines.

Insurance companies' perspectives on the orphan drug pipeline.

Background: Rare diseases are of increasing concern to private and public healthcare insurance plans. Largely neglected by manufacturers before the 1983 passing of the Orphan Drug Act (ODA), orphan drugs have become a commercialization target of steadily increasing importance to the healthcare industry. The ODA mandates the coverage of rare diseases, which are defined in research communities as diseases that are so infrequent that there is no reasonable expectation of a drugmaker recovering the cost of developing that drug.

Evaluation of silent thrombus after the Fontan operation.

Background: Thromboembolic complications have been noted after the Fontan operation. However, the prevalence of silent events among an adult contemporary population is not known. Noninvasive screening by any method including computed tomography (CT) has been technically limited to date.

Health services utilization and cost of retinitis pigmentosa.

Objective: To estimate annual per-patient health services utilization and costs of retinitis pigmentosa (RP) in the United States.

Methods: A retrospective claims analysis of patients with RP (N = 2990) and a 1:1 exactly matched cohort of non-RP patients was conducted using the MarketScan Commercial and Medicare Supplemental Databases. Individuals were continuously enrolled in a commercial health plan or employer-sponsored health insurance for at least 1 year.

Narrowband ultraviolet B phototherapy for the treatment of steroid-refractory and steroid-dependent acute graft-versus-host disease of the skin.

Background: Acute graft-versus-host disease (aGvHD) is a common complication of allogeneic stem cell transplantation. It is usually treated with high doses of corticosteroids and other immunosuppressive agents. When cutaneous features are predominant, narrowband ultraviolet B (NB-UVB) phototherapy may be an attractive option for its steroid-sparing effect.

Optimizing medical device buying. Value analysis models can help you improve decision-making process.

Value Analysis Models (VAMs) are a burgeoning analytical tool that can help materials managers, operating room managers, CFOs and others to make comparative value assessments before reaching a critical purchasing decision. Although relatively new to the hospital field, more and more manufacturers are supporting these initiatives to bring critical information to their customers and the health care industry. VAMs aren't designed to conclude that one product is better than another but to be a tool that can help make the product acquisition process much easier.

Acceptability and repeatability of spirometry in children using updated ATS/ERS criteria.

Spirometry in pediatrics can be limited by the child's development which is usually related to age. In 2005 the American Thoracic Society (ATS) and European Respiratory Society (ERS) published updated quality control criteria for spirometry. In 2007 the ATS/ERS published specific criteria for spirometry in preschool children 6 years of age and younger.

A comparison of two sphygmomanometers that may replace the traditional mercury column in the healthcare workplace.

Objective: Alternatives to the traditional, but possibly toxic mercury sphygmomanometer are needed for accurate blood pressure measurements in the medical workplace. We compared the performance of two commercially available potential replacements for the mercury column; an anaeroid manometer (Baum & Co) and an automated oscillometric device (Omron HEM-907), using the mercury sphygmomanometer as a standard, in the same participants.

Methods: Two independent observers performed simultaneous triplicate blood pressure readings for 512 participants.

The occurrence of the alerting response is independent of the method of blood pressure measurement in hypertensive patients.

Objective: Current guidelines stress the need for more than one measurement of blood pressure in the hypertensive patient. The frequency with which the first blood pressure significantly exceeds subsequent blood pressures (alerting response) is unknown. Participants in a hypertension treatment trial before initiation of therapy were included in post-hoc analyses to investigate the alerting response separately for trained nurse blood pressure measurements with mercury sphygmomanometer and measurements taken by an Omron 705 CP automated device.

The trained observer better predicts daytime ABPM diastolic blood pressure in hypertensive patients than does an automated (Omron) device.

Objectives: Accurate blood pressure measurement is critical to successful clinical trials. Concerns about observer errors have led to the use of automated oscillometric devices without evidence that their performance is similar to that of trained observers. This study compares blood pressures obtained by trained observers and with an oscillometric device (Omron 705CP) to 24-h ambulatory blood pressure monitoring.

Persistent abnormal lung function after childhood empyema.

Objective: The purpose of this study was to examine pulmonary function tests in children at various time points in their recovery from empyema.

Design: Cross-sectional study.

Setting: Academic Children's Hospital.

A rational approach to psychological testing of adults with mental retardation.

Intelligence (IQ) tests and scales of adaptive behavior are typically used to evaluate adults with mental retardation. Personality tests and instruments designed to measure behavior problems and psychopathology are also used. Repeated IQ testing is common but not useful for adults.