Economic evaluation comparing From Home To Operation same day admission and preoperative admission one day prior to the surgery process : a randomized,controlled trial of laparoscopic cholecystectomy

ABSTRACT

Objective: A novel preoperative procedure From Home To Operation (FHTO) seeks to combat increasing operation and infection rates. This is the first prospective randomized controlled trial (RCT) comparing the cost-effectiveness and cost-utility of FHTO and conventional ward procedures for standardized Laparoscopic Cholecystectomy (LC).

Research design and methods: During 12/2004–7/2005, 47 patients with symptomatic gallstones were randomized to receive LC in the FHTO (28 patients) or in a conventional manner (19 patients) in a Finnish hospital setting. The 15D quality of life tool was administered at the baseline and 1 month after.

Main outcome measures: A stochastic approach over a month interval for hospital costs, length of postoperative stay, infection rate and Quality-Adjusted Life Years (QALY) was employed.

Results: Baseline group characteristics were similar. The mean health care costs with FHTO (1695 EUR) were significantly lower (?p < 0.001) than in the conventional arm (2234 EUR). The number of patients discharged on the first postoperative day was 27 (96.4%) and 15 (78.9%) with two (7.1%) infections in the FHTO and four (21.1%) in the conventional arm. A difference in QALYs gained (0.0174; p = 0.030) favouring FHTO was observed. According to a cost-effectiveness acceptability curve, the probability of FHTO being cost-effective was 99%. The results were robust to probabilistic sensitivity analyses.

Conclusions: FHTO can introduce substantial cost savings and have a positive impact on both clinical measures and quality of life. Studies with larger numbers of patients are needed to assess whether conventional ward procedure can be a source of infections, which can be avoided with FHTO.

Clinical Trial Registry: ICJME-qualified registry of the Hospital District of Helsinki and Uusimaa (number 217849).     

The effectiveness of simulation activities on the cognitive abilities of undergraduate third‐year nursing students: a randomised control trial

Aims and objectives. To provide evidence on the effectiveness of simulation activities on the clinical decision‐making abilities of undergraduate nursing students. Based on previous research, it was hypothesised that the higher the cognitive score, the greater the ability a nursing student would have to make informed valid decisions in their clinical practice. Background. Globally, simulation is being espoused as an education method that increases the competence of health professionals. At present, there is very little evidence to support current investment in time and resources. Methods. Following ethical approval, fifty‐eight third‐year undergraduate nursing students were randomised in a pretest–post‐test group‐parallel controlled trial. The learning environment preferences (LEP) inventory was used to test cognitive abilities in order to refute the null hypothesis that activities in computer‐based simulated learning environments have a negative effect on cognitive abilities when compared with activities in skills laboratory simulated learning environments. Results. There was no significant difference in cognitive development following two cycles of simulation activities. Therefore, it is reasonable to assume that two simulation tasks, either computer‐based or laboratory‐based, have no effect on an undergraduate student’s ability to make clinical decisions in practice. However, there was a significant finding for non‐English first‐language students, which requires further investigation. Conclusions. More longitudinal studies that quantify the education effects of simulation on the cognitive, affective and psychomotor attributes of health science students and professionals from both English‐speaking and non‐English‐speaking backgrounds are urgently required. It is also recommended that to achieve increased participant numbers and prevent non‐participation owing to absenteeism, further studies need to be imbedded directly into curricula. Relevance to clinical practice. This investigation confirms the effect of simulation activities on real‐life clinical practice, and the comparative learning benefits with traditional clinical practice and university education remain unknown.     

Decision analysis for the genotype designation in low-template-DNA profiles

What genotype should the scientist specify for conducting a database search to try to find the source of a low-template-DNA (lt-DNA) trace? When the scientist answers this question, he or she makes a decision. Here, we approach this decision problem from a normative point of view by defining a decision-theoretic framework for answering this question for one locus. This framework combines the probability distribution describing the uncertainty over the trace's donor's possible genotypes with a loss function describing the scientist's preferences concerning false exclusions and false inclusions that may result from the database search. According to this approach, the scientist should choose the genotype designation that minimizes the expected loss. To illustrate the results produced by this approach, we apply it to two hypothetical cases: (1) the case of observing one peak for allele x_i on a single electropherogram, and (2) the case of observing one peak for allele x_i on one replicate, and a pair of peaks for alleles x_i and x_j, i ≠ j, on a second replicate. Given that the probabilities of allele drop-out are defined as functions of the observed peak heights, the threshold values marking the turning points when the scientist should switch from one designation to another are derived in terms of the observed peak heights. For each case, sensitivity analyses show the impact of the model's parameters on these threshold values. The results support the conclusion that the procedure should not focus on a single threshold value for making this decision for all alleles, all loci and in all laboratories.     

医院管理决策中统计信息的应用

医院决策层的决策及其对医院工作的指导和改进建议,都是在对医院以往各项统计数据进行认真分析总结的基础上进行的。实际上医院的统计工作的目的和意义,在一定程度上也正是为医院决策层的科学决策提供有价值的参考。医院决策层通过医院的统计数据,能够对上年度计划的执行情况进行监督和检查;掌握医疗设备及床位的配置和使用的真实情况,能够通过对住院患者疾病种类、死亡率、死因、住院费用对患者的影响等一系列信息的统计分析,制定有效的管理政策、充分利用医疗设备、降低死亡率,把握医疗市场的新动向,实现优质高效管理。     

Neuroimaging of valence decisions in children and adults

To date, the neural underpinnings of affective components in language processing in children remain largely unknown. To fill this gap, the present study examined behavioural and neural correlates of children and adults performing the same auditory valence decision task with an event-related fMRI paradigm. Based on previous findings in adults, activations in anterior and posterior cingulate cortex, orbitofrontal cortex and left inferior frontal gyrus were expected for both positive and negative valence categories. Recent behavioural findings on valence decisions showed similar ratings and reaction time patterns in children and adults. This finding was successfully replicated in the present study. On a neural level, our analysis of affective language processing showed activations in regions associated with both semantic (superior and middle temporal and frontal) and affective (anterior and posterior cingulate, orbitofrontal and inferior frontal, insula and amygdala) processing. Neural activations in children and adults were systematically different in explicit affective word processing. In particular, adults showed a more distributed semantic network activation while children recruited additional subcortical structures.