Resource utilisation and costs of palliative cancer care in an interdisciplinary health care model

This paper presents a detailed description of health care resource utilisation and costs of a pilot interdisciplinary health care model of palliative home care in Ontario, Canada. The descriptive evaluation entailed examining the use of services and costs of the pilot program: patient demographics, length of stay broken down by disposition (discharged, alive, death), access to services/resources, use of family physician and specialist services, and drug use. There were 434 patients included in the pilot program. Total costs were approximately CAN$2.4 million, and the cost per person amounted to approximately CAN$5586.33 with average length of stay equal to over 2 months (64.22 days). One may assume that length of stay would be influenced by the amount of service and support available. Future research might investigate whether in-home palliative home care is the most cost effective and suitable care setting for those patients requiring home care services for expected periods of time. © 2009 SAGE Publications.

Product standardisation as a tool to control prescribing costs a case study of alginate liquid preparations

Introduction Product standardisation involves promoting the prescribing of pre-selected products within a particular category across a healthcare region and is designed to improve patient safety by promoting continuity of medicine use across the primary/secondary care interface, in addition to cost containment without compromising clinical care (i.e. maintaining safety and efficacy). Objectives To examine the impact of product standardisation on the prescribing of compound alginate preparations within primary care in Northern Ireland. Methods Data were obtained on alginate prescribing from the Northern Ireland Central Services Agency (Prescription Pricing Branch), covering a period of 43 months. Two standardisation promotion interventions were carried out at months 18 and 33. In addition to conventional statistical analyses, a simple interrupted time series analysis approach, using graphical interpretation, was used to facilitate interpretation of the data. Results There was a significant increase in the prescribed share of the preferred alginate product in each of the four health boards in Northern Ireland and a decrease in the cost per Defined Daily Dose for alginate liquid preparations overall. Compliance with the standardisation policy was, however, incomplete and was influenced to a marked degree by the activities of the pharmaceutical industry. The overall economic impact of the prescribing changes during the study was small (3.1%). Conclusion The findings suggested that product standardisation significantly influenced the prescribing pattern for compound alginate liquid preparations within primary care across Northern Ireland. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

Developing mRNA-based biomarkers from formalin-fixed paraffin-embedded tissue

Cancer is a complex and heterogeneous disease which is one of the leading causes of death in Western civilisations. Thus, oncology is viewed as a primary focus for personalized medicine. It is recognised that cancer treatment needs to be better tailored in order to improve patient outcome. Patient tumor samples will be required to characterize cancer at a molecular level and identify where there may be disease subgroups that should be treated differently. The use of formalin-fixed paraffin-embedded tissue is important for enabling such studies. In this report, we focus on the challenges that have been faced to date along with the technological developments that have now made this possible. We also highlight the impact this may have on drug and diagnostic development.

An in situ spatially resolved method to probe gas phase reactions through a fixed bed catalyst

A new method to spatially probe heterogeneous catalysed reactions within a packed bed of catalyst has been developed. The spatial resolution is achieved using a stationary perforated capillary coupled to a mass spectrometer while the catalyst bed is moved. The oxidation of CO promoted by H-2 over a Pd catalyst has been used to demonstrate the technique.

Late-stage, primary open-angle glaucoma in Europe:Social and health care maintenance costs and quality of life of patients from 4 countries

Objective: The purpose of this study was to estimate costs and quality of life (QoL) of late-stage glaucoma patients in 4 European countries. Methods: Retrospective review of medical charts of patients with POAG who were followed in a low-vision or vision rehabilitation center in one of 4 countries for at least 1 year was used to determine patient characteristics, health status, and health care resource use. Visual impairment was measured by best-corrected visual acuity (Snellen score). Patients were also interviewed over the telephone in order to assess their health-related QoL (using EuroQol EQ-5D) and use of resources including: the number of visits to rehabilitation centers, visits to hospital and non-hospital specialists, the use of low-vision devices, medication, tests, and the use of hired home help. The costs associated with resource use were calculated from the perspective of a third-party payer of health and social care based on resource usage and unit costs in each country. Results: Patients undergoing visual rehabilitation in France (n=21), Denmark (n=59), Germany (n=60), and the United Kingdom (n=22) were identified, interviewed and had their medical charts reviewed. Annual maintenance costs of late-stage glaucoma amounted to €830 (±445) on average. Average home help costs were more than 3 times higher. QoL, on average, was 0.65 (±0.28). QoL was positively correlated with the level of visual acuity in the patients' best eye. On the other hand, visual acuity was also positively correlated to health care costs, but negatively correlated to costs of home help. Conclusions: The study was limited by its observational, uncontrolled design. The finding that late-stage glaucoma is associated with higher home help costs than health care maintenance costs suggests that potential savings from a better preventive treatment are to be found for social care payers rather than health care payers. © 2008 Informa UK Ltd All rights reserved.

Direct costs of glaucoma and severity of the disease:A multinational long term study of resource utilisation in Europe

Background: Resource utilisation and direct costs associated with glaucoma progression in Europe are unknown. As population progressively ages, the economic impact of the disease will increase. Methods: From a total of 1655 consecutive cases, the records of 194 patients were selected and stratified by disease severity. Record selection was based on diagnoses of primary open angle glaucoma, glaucoma suspect, ocular hypertension, or normal tension glaucoma; 5 years minimum follow up were required. Glaucoma severity was assessed using a six stage glaucoma staging system based on static threshold visual field parameters. Resource utilisation data were abstracted from the charts and unit costs were applied to estimate direct costs to the payer. Resource utilisation and estimated direct cost of treatment, per person year, were calculated. Results: A statistically significant increasing linear trend (p = 0.018) in direct cost as disease severity worsened was demonstrated. The direct cost of treatment increased by an estimated €86 for each incremental step ranging from €455 per person year for stage 0 to €969 per person year for stage 4 disease. Medication costs ranged from 42% to 56% of total direct cost for all stages of disease. Conclusions: These results demonstrate for the first time in Europe that resource utilisation and direct medical costs of glaucoma management increase with worsening disease severity. Based on these findings, managing glaucoma and effectively delaying disease progression would be expected to significantly reduce the economic burden of this disease. These data are relevant to general practitioners and healthcare administrators who have a direct influence on the distribution of resources.

Generic Ergodic Capacity Bounds for Fixed-Gain AF Dual-Hop Relaying Systems

This paper elaborates on the ergodic capacity of fixed-gain amplify-and-forward (AF) dual-hop systems, which have recently attracted considerable research and industry interest. In particular, two novel capacity bounds that allow for fast and efficient computation and apply for nonidentically distributed hops are derived. More importantly, they are generic since they apply to a wide range of popular fading channel models. Specifically, the proposed upper bound applies to Nakagami-m, Weibull, and generalized-K fading channels, whereas the proposed lower bound is more general and applies to Rician fading channels. Moreover, it is explicitly demonstrated that the proposed lower and upper bounds become asymptotically exact in the high signal-to-noise ratio (SNR) regime. Based on our analytical expressions and numerical results, we gain valuable insights into the impact of model parameters on the capacity of fixed-gain AF dual-hop relaying systems. © 2011 IEEE.

Fixed Bed Study of Ammonia Removal from Aqueous Solutions Using Natural Zeolite

Purpose
– The purpose of this paper is to investigate the performance of natural Jordanian zeolite tuff to remove ammonia from aqueous solutions using a laboratory batch method and fixed-bed column apparatus. Equilibrium data were fitted to Langmuir and Freundlich models.

Design/methodology/approach
– Column experiments were conducted in packed bed column. The used apparatus consisted of a bench-mounted glass column of 2.5 cm inside diameter and 100 cm height (column volume = 490 cm3). The column was packed with a certain amount of zeolite to give the desired bed height. The feeding solution was supplied from a 30 liter plastic container at the beginning of each experiment and fed to the column down-flow through a glass flow meter having a working range of 10-280ml/min.

Findings
– Ammonium ion exchange by natural Jordanian zeolite data were fitted by Langmuir and Freundlich isotherms. Continuous sorption of ammonium ions by natural Jordanian zeolite tuff has proven to be effective in decreasing concentrations ranging from 15-50 mg NH4-N/L down to levels below 1 mg/l. Breakthrough time increased by increasing the bed depth as well as decreasing zeolite particle size, solution flow-rate, initial NH4+ concentration and pH. Sorption of ammonium by the zeolite under the tested conditions gave the sorption capacity of 28 mg NH4-N/L at 20°C, and 32 mg NH4-N/L at 30°C.

Originality/value
– This research investigates the performance of natural Jordanian zeolite tuff to remove ammonia from aqueous solutions using a laboratory batch method and fixed-bed column apparatus. The equilibrium data of the sorption of Ammonia were plotted by using the Langmuir and Freundlich isotherms, then the experimental data were compared to the predictions of the above equilibrium isotherm models. It is clear that the NH4+ ion exchange data fitted better with Langmuir isotherm than with Freundlich model and gave an adequate correlation coefficient value.

Analysis of Fixed-Speed Wind Farm Low-Frequency Power Pulsations using a Wavelet-Prony Method

The increasing penetration of wind generation on the Island of Ireland has been accompanied by close investigation of low-frequency periodic pulsations contained within the active power flow from different wind farms. A primary concern is excitation of existing low-frequency oscillation modes already present on the system, particularly the 0.75 Hz mode as a consequence of the interconnected Northern and Southern power system networks. Recently grid code requirements on the Northern Ireland power system have been updated stipulating that wind farms connected after 2005 must be able to control the magnitude of oscillations in the range of 0.25 - 1.75 Hz to within 1% of the wind farm's registered output. In order to determine whether wind farm low-frequency oscillations have a negative effect (excite other modes) or possibly a positive impact (damping of existing modes) on the power system, the oscillations at the point of connection must be measured and characterised. Using time - frequency methods, research presented in this paper has been conducted to extract signal features from measured low-frequency active power pulsations produced by wind farms to determine the effective composition of possible oscillatory modes which may have a detrimental effect on system dynamic stability. The paper proposes a combined wavelet-Prony method to extract modal components and determine damping factors. The method is exemplified using real data obtained from wind farm measurements.

A Study of Tower Shadow Effect on Fixed-Speed Wind Turbines

This paper studies the impact of tower shadow effect on the power output of a fixed-speed wind farm. A data acquisition unit was placed at a wind farm in Northern Ireland which consists of ten fixed-speed wind turbines. The recording equipment logged the wind farmpsilas electrical data, which was time stamped using the global positioning network. Video footage of the wind farm was recorded and from it the blade angle of each turbine was determined with respect to time. Using the blade angle data and the wind farmpsilas power output, studies where performed to ascertain the extent of tower shadow effect on power fluctuation. This paper presents evidence that suggests that tower shadow effect has a significant impact on power fluctuation and that this effect is increased due to the synchronising of turbine blades around the tower region.

Description and predictors of hospital costs of oesophageal cancer during the first year following diagnosis in Northern Ireland

The cost-effectiveness of novel interventions in the treatment of cancer is well researched; however, relatively little attention is paid to the cost of many aspects of routine care. Oesophageal cancer is the ninth most common cancer in the UK and sixth most common cause of cancer death. It usually presents late and has a poor prognosis. The hospital costs incurred by oesophageal cancer patients diagnosed in Northern Ireland in 2005 (n = 198) were determined by review of medical records. The average cost of hospital care per patient in the 12 months from presentation was £7847. Variations in total hospital costs by age at diagnosis, gender, cancer stage, histological type, mortality at 1 year, co-morbidity count and socio-economic status were analysed using multiple regression analyses. Higher costs were associated with earlier stages of cancer and cancer stage remained a significant predictor of costs after controlling for cancer type, patient age and mortality at 1 year. Thus, although early detection of cancer usually improves survival, this would mean increased costs in the first year. Deprivation achieved borderline significance with those from more deprived areas having lower resource consumption relative to the more affluent. © 2013 John Wiley & Sons Ltd.