Cost-effective Prevention of Pulmonary Embolus in High-risk Trauma Patients

1997 ◽  
Vol 42 (3) ◽  
pp. 456-462 ◽  
Author(s):  
Karen J. Brasel ◽  
David C. Borgstrom ◽  
John A. Weigelt
Keyword(s):  
High Risk ◽  
Pulmonary Embolus ◽  
Cost Effective ◽  
Trauma Patients ◽  
Effective Prevention

scholarly journals Consequences of Exposure to Violence, Aggression, and Sexual Harassment in Private Security Work: A Mediation Model

2020 ◽  
pp. 088626052098443
Author(s):  
Alexander Herrmann ◽  
Christian Seubert ◽  
Jürgen Glaser
Keyword(s):  
High Risk ◽  
Sexual Harassment ◽  
Workplace Violence ◽  
Turnover Intention ◽  
Exposure To Violence ◽  
Private Security ◽  
Equation Modeling ◽  
Negative Consequences ◽  
Effective Prevention ◽  
Psychosomatic Complaints

While exposure to violence and aggression is well known for its detrimental effects on employees’ health as well as organizational outcomes, certain high-risk work domains have scarcely been researched. Thus, this study set out to determine negative consequences of work-related exposure to four forms of harmful behaviors in private security. In a sample of 487 German-speaking security guards, 23% had experienced outsider-initiated violence, 56% aggressive acts, 30% vicarious violent acts, and 3% were sexually harassed over the past 12 months. Additionally, 19% reported substantial to extreme worries about violence. By presenting an integrated model of negative consequences to outsider-initiated violent, aggressive as well as sexual harassing acts, we strived to extend previous research by showing that turnover intention (as an ultimate negative behavioral outcome) is only indirectly related to these experiences via worries about violence and psychosomatic complaints. Structural equation modeling provided support for the model and plausibility for a sequential “two-step” prediction of turnover intention. Further, we provided support that worries about violence are not solely triggered by directly experiencing physical violence but also vicarious violence, aggressive acts, and sexual harassment. Consistent with previous studies, worries about violence were identified as a central mediator in the transmission process from exposure to harmful behaviors at work to negative consequences, that is, psychosomatic complaints and turnover intention. Our findings have implications for the detailed understanding of consequences emerging from exposure to workplace violence and aggression as well as the development of effective prevention strategies especially in high-risk occupations such as private security.

scholarly journals A preliminary study of intensivist-performed DVT ultrasound screening in trauma ICU patients (APSIT Study)

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Lloyd Roberts ◽  
Tom Rozen ◽  
Deirdre Murphy ◽  
Adam Lawler ◽  
Mark Fitzgerald ◽  
...  
Keyword(s):  
Intensive Care ◽  
Deep Vein Thrombosis ◽  
High Risk ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Major Trauma ◽  
Intraclass Correlation ◽  
Trauma Patients ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background Multiple screening Duplex ultrasound scans (DUS) are performed in trauma patients at high risk of deep vein thrombosis (DVT) in the intensive care unit (ICU). Intensive care physician performed compression ultrasound (IP-CUS) has shown promise as a diagnostic test for DVT in a non-trauma setting. Whether IP-CUS can be used as a screening test in trauma patients is unknown. Our study aimed to assess the agreement between IP-CUS and vascular sonographer performed DUS for proximal lower extremity deep vein thrombosis (PLEDVT) screening in high-risk trauma patients in ICU. Methods A prospective observational study was conducted at the ICU of Alfred Hospital, a major trauma center in Melbourne, Australia, between Feb and Nov 2015. All adult major trauma patients admitted with high risk for DVT were eligible for inclusion. IP-CUS was performed immediately before or after DUS for PLEDVT screening. The paired studies were repeated twice weekly until the DVT diagnosis, death or ICU discharge. Written informed consent from the patient, or person responsible, or procedural authorisation, was obtained. The individuals performing the scans were blinded to the others’ results. The agreement analysis was performed using Cohen’s Kappa statistics and intraclass correlation coefficient for repeated binary measurements. Results During the study period, 117 patients had 193 pairs of scans, and 45 (39%) patients had more than one pair of scans. The median age (IQR) was 47 (28–68) years with 77% males, mean (SD) injury severity score 27.5 (9.53), and a median (IQR) ICU length of stay 7 (3.2–11.6) days. There were 16 cases (13.6%) of PLEDVT with an incidence rate of 2.6 (1.6–4.2) cases per 100 patient-days in ICU. The overall agreement was 96.7% (95% CI 94.15–99.33). The Cohen’s Kappa between the IP-CUS and DUS was 0.77 (95% CI 0.59–0.95), and the intraclass correlation coefficient for repeated binary measures was 0.75 (95% CI 0.67–0.81). Conclusions There is a substantial agreement between IP-CUS and DUS for PLEDVT screening in trauma patients in ICU with high risk for DVT. Large multicentre studies are needed to confirm this finding.

scholarly journals Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Emergency Room ◽  
Healthcare Costs ◽  
Cost Effective ◽  
Severe Trauma ◽  
Third Party ◽  
Trauma Patients ◽  
Short Term ◽  
The Third

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.

Doing More With Less: Pragmatic Implementation of Vancomycin Area-Under-the-Curve (AUC) Monitoring

2021 ◽  
pp. 089719002110272
Author(s):  
Joanne Huang ◽  
Jeannie D. Chan ◽  
Thu Nguyen ◽  
Rupali Jain ◽  
Zahra Kassamali Escobar
Keyword(s):  
Quality Improvement ◽  
High Risk ◽  
Therapeutic Drug Monitoring ◽  
Paradigm Shift ◽  
Area Under The Curve ◽  
Cost Effective ◽  
Practical Method ◽  
Therapeutic Drug ◽  
Short Term ◽  
Quality Improvement Process

Universal area-under-the-curve (AUC) guided vancomycin therapeutic drug monitoring (TDM) is resource-intensive, cost-prohibitive, and presents a paradigm shift that leaves institutions with the quandary of defining the preferred and most practical method for TDM. We report a step-by-step quality improvement process using 4 plan-do-study-act (PDSA) cycles to provide a framework for development of a hybrid model of trough and AUC-based vancomycin monitoring. We found trough-based monitoring a pragmatic strategy as a first-tier approach when anticipated use is short-term. AUC-guided monitoring was most impactful and cost-effective when reserved for patients with high-risk for nephrotoxicity. We encourage others to consider quality improvement tools to locally adopt AUC-based monitoring.

An Untapped Resource: Characteristics of Thrombus Recovered from Intermediate or High Risk Pulmonary Embolus Patients

2021 ◽  
pp. 107392
Author(s):  
Geoffrey Newcomb ◽  
Bennett L. Wilson ◽  
R. James White ◽  
Bruce Goldman ◽  
Neil A. Lachant ◽  
...  
Keyword(s):  
High Risk ◽  
Pulmonary Embolus ◽  
Resource Characteristics ◽  
Untapped Resource
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