Identification of Key Cost Generating Events for Idiopathic Pulmonary Fibrosis: A Systematic Review.

Background: Idiopathic pulmonary fibrosis (IPF) is an incurable, debilitating disease which impairs lung function and eventually leads to death. Currently, there is a lack of effective modifying therapies and treatments for IPF as the underlying epidemiological mechanism is not clearly understood. This leads to difficulty in diagnosing and managing IPF, which results in a high incurment of disease-associated cost.

Near-lethal acute kidney injury due to Goodpasture's syndrome: A case report.

We report a case of a 75-year-old patient who presented with severe acute kidney injury due to Goodpasture's syndrome. It is an uncommon autoimmune condition, requiring treatment with immunosuppressive drugs and plasma exchange. Prognosis depends largely on early diagnosis, so it is important to be aware of these rarer causes whenever anyone presents with acute kidney injury.

Randomised controlled trial and parallel economic evaluation of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR).

Objectives: To determine the comparative effectiveness and cost-effectiveness of conventional ventilatory support versus extracorporeal membrane oxygenation (ECMO) for severe adult respiratory failure.

Design: A multicentre, randomised controlled trial with two arms.

Setting: The ECMO centre at Glenfield Hospital, Leicester, and approved conventional treatment centres and referring hospitals throughout the UK.

Intensive care reimbursement practices: results from the ICUFUND survey.

Objective: To assess patterns of intensive care reimbursement practices.

Methods: A detailed questionnaire about basic intensive care unit (ICU) characteristics and ICU reimbursement practices was created, and then members of the European Society of Intensive Care (ESICM) were asked by e-mail to participate in the survey and complete the web-based questionnaire.

Results: There were a total of 447 responses analyzed.

Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicentre randomised controlled trial.

Background: Severe acute respiratory failure in adults causes high mortality despite improvements in ventilation techniques and other treatments (eg, steroids, prone positioning, bronchoscopy, and inhaled nitric oxide). We aimed to delineate the safety, clinical efficacy, and cost-effectiveness of extracorporeal membrane oxygenation (ECMO) compared with conventional ventilation support.

Methods: In this UK-based multicentre trial, we used an independent central randomisation service to randomly assign 180 adults in a 1:1 ratio to receive continued conventional management or referral to consideration for treatment by ECMO.

Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR).

Background: Extracorporeal Membrane Oxygenation (ECMO) is a technology used in treatment of patients with severe but potentially reversible respiratory failure. A multi-centre randomised controlled trial (CESAR) was funded in the UK to compare care including ECMO with conventional intensive care management. The protocol and funding for the CESAR trial included plans for economic data collection and analysis.

Cost-effectiveness of live-attenuated influenza vaccine, trivalent in preventing influenza in young children attending day-care centres.

Vaccinating children at day-care may be a cost-effective approach for improving influenza immunization rates in this high-risk group. This study uses influenza attack-rate data from a randomized, blinded, placebo-controlled clinical trial of live-attenuated influenza vaccine, trivalent in day-care centres from two consecutive influenza seasons, one with a moderate attack rate (H1N1 dominant) and one with a high attack rate (H3N2 dominant). Costs were measured in US dollars.

Selective and nonselective packaging of cellular RNAs in retrovirus particles.

Assembly of retrovirus particles normally entails the selective encapsidation of viral genomic RNA. However, in the absence of packageable viral RNA, assembly is still efficient, and the released virus-like particles (termed "Psi-" particles) still contain roughly normal amounts of RNA. We have proposed that cellular mRNAs replace the genome in Psi- particles.

CESAR: conventional ventilatory support vs extracorporeal membrane oxygenation for severe adult respiratory failure.

Background: An estimated 350 adults develop severe, but potentially reversible respiratory failure in the UK annually. Current management uses intermittent positive pressure ventilation, but barotrauma, volutrauma and oxygen toxicity can prevent lung recovery. An alternative treatment, extracorporeal membrane oxygenation, uses cardio-pulmonary bypass technology to temporarily provide gas exchange, allowing ventilator settings to be reduced.

Preliminary physical mapping of RNA-RNA linkages in the genomic RNA of Moloney murine leukemia virus.

Retrovirus particles contain two copies of their genomic RNA, held together in a dimer by linkages which presumably consist of a limited number of base pairs. In an effort to localize these linkages, we digested deproteinized RNA from Moloney murine leukemia virus (MLV) particles with RNase H in the presence of oligodeoxynucleotides complementary to specific sites in viral RNA. The cleaved RNAs were then characterized by nondenaturing gel electrophoresis.

Expanding student learning using patient pathways.

This article examines the first stages of a project to address problems in the quality of students' clinical experience after consultation with senior nurses at a large district general hospital. The term 'placement pathway' is defined and the use of these pathways is discussed. Several examples are given to demonstrate ways in which students can gain a wider understanding of the care of the patient throughout their stay and still achieve competence.

mRNA molecules containing murine leukemia virus packaging signals are encapsidated as dimers.

Prior work by others has shown that insertion of psi (i.e., leader) sequences from the Moloney murine leukemia virus (MLV) genome into the 3' untranslated region of a nonviral mRNA leads to the specific encapsidation of this RNA in MLV particles.

Definitions and methods of cost assessment: an intensivist's guide. ESICM section on health research and outcome working group on cost effectiveness.

Objective: To define the different types of costs incurred in the care of critically ill patients and to describe some of the most commonly used methods for measuring and allocating these costs.

Design: Literature review. Definitions for opportunity, direct and indirect, fixed, variable, marginal, and total costs are described and interpreted in the context of the critical care setting.

Retroviral splicing suppressor requires three nonconsensus uridines in a 5' splice site-like sequence.

Rous sarcoma virus RNA contains a negative regulator of splicing (NRS) element that aids in maintenance of unspliced RNA. The NRS binds U1 snRNA at a sequence that deviates from the 5' splice site consensus by substitution of U's for A's at three positions: -2, +3, and +4. All three of these U's are important for NRS-mediated splicing suppression.

Descriptive patient data as an explanation for the variation in average daily costs in intensive care.

Intensive care patients require therapy that can vary considerably in type, duration and cost, so making it extremely difficult to predict patient resource use. Few studies measure actual costs; usually average daily costs are calculated and these do not reflect the variation in resource use between individual patients. The aim of this study was to analyse a data set of 193 critically ill adult patients to look for associations between routinely collected descriptive data and patient-specific costs.

Variations in expenditure between adult general intensive care units in the UK.

This paper presents the findings from the second pilot study of the cost block method in 21 adult general intensive care units (ICUs). The aim of this study was to explore the possible reasons for the variation in cost identified in a previous pilot study of 11 ICUs. Data were collected for the six cost blocks for the financial year 1996/97.

Rous sarcoma virus DR posttranscriptional elements use a novel RNA export pathway.

Rous sarcoma virus (RSV), a simple retrovirus, needs to export unspliced viral RNA from the nucleus to the cytoplasm, circumventing the host cell restriction on cytoplasmic expression of intron-containing RNA. The cytoplasmic accumulation of full-length viral RNA is promoted by two cis-acting direct repeat (DR) elements that flank the src gene; at least one copy of the DR sequence is necessary for viral replication. We show here that the DR mediates export of a reporter construct from the nucleus, suggesting it is a constitutive transport element (CTE).

PH-metric log P 11. pKa determination of water-insoluble drugs in organic solvent-water mixtures.

The apparent acid dissociation constants (p(s)Ka) of two water-insoluble drugs, ibuprofen and quinine, were determined pH-metrically in acetonitrile water, dimethylformamide water, dimethylsulfoxide water, 1,4-dioxane-water, ethanol water, ethylene glycol-water, methanol water and tetrahydrofuran water mixtures. A glass electrode calibration procedure based on a four-parameter equation (pH = alpha + SpcH + jH[H+]+jOH[OH-]) was used to obtain pH readings based on the concentration scale (pcH). We have called this four-parameter method the Four-Plus technique.

Cost considerations for the use of low-air-loss bed therapy in adult intensive care.

The aim of this study was to consider the costs of low-air-loss bed therapy in the adult intensive care unit (ICU). A retrospective cost analysis was performed on 269 consecutive patients, 63 of whom had received low-air-loss bed therapy. Patients' APACHE II scores, length of stay (LOS), average daily TISS and ICU outcomes were also collected.

The patient-related costs of care for sepsis patients in a United Kingdom adult general intensive care unit.

Objective: To determine the patient-related costs of care for critically ill patients with severe sepsis or early septic shock.

Design: Retrospective, longitudinal, observational study during a 10-month period.

Setting: Adult general intensive care unit (ICU) in a university hospital located in the United Kingdom.

The development of a method for comparative costing of individual intensive care units. The Intensive Care Working Group on Costing.

Intensive care is one of the most costly areas of hospital care. Unfortunately, because of the diversity of case mix, costing intensive care is difficult. Many described costing methods previously are limited by being cumbersome, laborious to apply and expensive.

The role of overlapping U1 and U11 5' splice site sequences in a negative regulator of splicing.

Splicing of Rous sarcoma virus RNA is regulated in part by a cis-acting intronic RNA element called the negative regulator of splicing (NRS). An NRS mutant affecting nt 916-923 disrupts U11 snRNP binding and reduces NRS activity (Gontarek et al., 1993, Genes & Dev 7:1926-1936).

Evaluation of proposed casemix criteria as a basis for costing patients in the adult general intensive care unit.

This study analyses the relationship between the actual patient-related costs of care calculated for 145 patients admitted sequentially to an adult general intensive care unit and a number of factors obtained from a previously described consensus of opinion study. The factors identified in the study were suggested as potential descriptors for the casemix in an intensive care unit that could be used to predict the costs of care. Significant correlations between the costs of care and severity of illness, workload and length of stay were found but these failed to predict the costs of care with sufficient accuracy to be used in isolation to define isoresource groups in the intensive care unit.