Intensive care unit (ICU) costs account for up to 20% of a hospital's costs. We aimed to analyse the individual patient-related cost of intensive care at various hospital levels and for different ...groups of disease.
Data from 51 ICUs all over Germany (15 primary care hospitals and 14 general care hospitals, 10 maximal care hospitals and 12 focused care hospitals) were collected in an observational, cross-sectional, one-day point prevalence study by two external study physicians (January-October 2003). All ICU patients (length of stay > 24 hours) treated on the study day were included. The reason for admission, severity of illness, surgical/diagnostic procedures, resource consumption, ICU/hospital length of stay, outcome and ICU staffing structure were documented.
Altogether 453 patients were included. ICU (hospital) mortality was 12.1% (15.7%). The reason for admission and the severity of illness differed between the hospital levels of care, with a higher amount of unscheduled surgical procedures and patients needing mechanical ventilation in maximal care hospital and focused care hospital facilities. The mean total costs per day were euro 791 +/- 305 (primary care hospitals, euro 685 +/- 234; general care hospitals, euro 672 +/- 199; focused care hospitals, euro 816 +/- 363; maximal care hospitals, euro 923 +/- 306), with the highest cost in septic patients (euro 1,090 +/- 422). Differences were associated with staffing, the amount of prescribed drugs/blood products and diagnostic procedures.
The reason for admission, the severity of illness and the occurrence of severe sepsis are directly related to the level of ICU cost. A high fraction of costs result from staffing (up to 62%). Specialized and maximum care hospitals treat a higher proportion of the more severely ill and most expensive patients.
: Experimental data suggest that melatonin decreases inflammatory changes after major liver resection, thus positively influencing the postoperative course. To assess the safety of a preoperative ...single dose of melatonin in patients undergoing major liver resection, a randomized controlled double‐blind pilot clinical trial with two parallel study arms was designed at the Department of General and Transplantation Surgery, Ruprecht‐Karls‐University, Heidelberg. A total of 307 patients, who were referred for liver surgery, were screened. One hundred and thirteen patients, for whom a major liver resection (≥3 segments) was scheduled, were eligible. Sixty‐three eligible patients refused to participate, and therefore, 50 patients were randomized. A preoperative single dose of melatonin (50 mg/kg BW) dissolved in 250 mL of milk was administered through the gastric tube after the intubation for general anesthesia. Controls were given the same amount of microcrystalline cellulose. Primary endpoint was safety. Secondary endpoints were postoperative complications. Melatonin was effectively absorbed with serum concentrations of 1142.8 ± 7.2 ng/mL (mean ± S.E.M.) versus 0.3 ± 7.8 ng/mL in controls (P < 0.0001). Melatonin treatment resulted in lower postoperative transaminases over the study period (P = 0.6). There was no serious adverse event in patients after melatonin treatment. A total of three infectious complications occurred in either group. A total of eight noninfectious complications occurred in five control patients, whereas three noninfectious complications occurred in three patients receiving preoperative melatonin (P = 0.3). There was a trend toward shorter ICU stay and total hospital stay after melatonin treatment. Therefore, a single preoperative enteral dose of melatonin is effectively absorbed and is safe and well tolerated in patients undergoing major liver surgery.
: Reactive oxygen species (ROS) are involved in pathophysiology of ischemia/reperfusion injury. Melatonin is a potent scavenger of ROS. Thus, this study was designed to elucidate its effects in a ...combined hepatic warm ischemia and resection model. The right lateral and caudate lobes (32% of liver volume) of Sprague–Dawley rats underwent warm ischemia for 30 min followed by reperfusion and subsequent resection of the nonischemic liver tissue. Some rats were gavaged with 50 mg/kg melatonin 2 hr before the onset of experiments. Controls received the same volume of microcrystalline cellulose. Survival, transaminases, histology, flow cytometry, inducible nitric oxide synthase (iNOS) expression, and activation of signal transduction pathways c‐Jun N‐terminal kinase (JNK), cJUN, IκB kinase α (IKKα), proliferating cell nuclear antigen (PCNA), and Ki67 were assessed for hepatic injury, oxidative stress, and cell proliferation. Melatonin significantly improved animal survival and decreased transaminase levels, the indices for necrosis, liver damage, leukocyte infiltration, and iNOS expression. In parallel, the expression of IKKα, JNK1, and cJUN decreased by 35–50% after melatonin (P < 0.05). At the same time, melatonin reduced the expression of both PCNA and Ki67 in liver (P < 0.05). Melatonin is hepatoprotective most likely via mechanisms including inhibition of IKK and JNK pathways and regulation of cell proliferation.
To determine the direct costs of severe sepsis patients in German intensive care units (ICUs).
Retrospective electronic data analysis.
Three adult intensive care units (surgical/medical) in three ...university hospitals in Germany.
385 patients identified by standard definitions as suffering from severe sepsis.
A bottom-up approach was used to determine the direct ICU cost on actual resource use (medication, laboratory tests, microbiological analysis, disposables, and clinical procedures) for patients with severe sepsis. To determine the total direct costs, center-specific personnel and basic bed ("hotel") costs were added to total resources consumed. Average hospital mortality of severely septic patients was 42.6%. Mean ICU length of stay (LOS) was 16.6 days. Survivors stayed on average 4 days longer than nonsurvivors. The mean direct ICU costs of care were 23,297+/-18,631 euros per patient and 1,318 euros per day. In comparison, average daily charges being paid for an ICU patient by the health care system in Germany are 851 euros (based on official statistics). Nonsurvivors were more expensive than survivors in total direct costs (25,446 vs. 21,984 euros) and in per day direct cost (1,649 vs. 1,162 euros). Medication makes up the largest part of the direct costs, followed by expenses for personnel. CONCLUSIONS. Patients with severe sepsis have a high ICU mortality rate and long ICU LOS and are substantially expensive to treat. Nonsurviving septic patients are more costly than survivors despite shorter ICU LOS. This is due to higher medication costs indicating increased efforts to keep patients alive.
To assess the mid- to long-term effectiveness of lifestyle interventions in the prevention and treatment of obesity.
A systematic literature review with meta-analysis was performed. Electronic ...databases, reference lists, books and reports covering topic of obesity were searched. The included studies were randomized clinical trials of lifestyle interventions in overweight and obese subjects that had a minimum observation period of one year. Outcomes evaluated were measurements of body weight, body mass index, waist circumference, systolic and diastolic blood pressure, blood lipids: total cholesterol, low density lipoprotein, high density lipoprotein, triglyceride, blood glucose control: two-hour plasma glucose, fasting plasma glucose, and glycosylated haemoglobin.
Thirteen studies have been selected in the prevention and seventeen in the treatment of obesity. Compared with standard care, lifestyle intervention reduced significantly body weight, body mass index, waist circumference, blood pressure, blood lipids and blood glucose in overweight and obese people. The favorable effects were maintained up to three years.
Lifestyle interventions were efficacious in the mid- to long-term prevention and treatment of obesity leading to a significant reduction in body weight and cardiovascular risk factors.
Abstract Background: Although nonprescription oral phenylephrine 10 mg has been judged “generally recognized as safe and effective” by the US Food and Drug Administration (FDA), its efficacy as a ...nasal decongestant has been questioned. Objective: This study assessed available data on the efficacy of oral phenylephrine 10 mg as a nasal decongestant. Methods: Three sources were used to identify potentially relevant publications—the bibliography of the phenylephrine section of the 1976 FDA monograph on over-the-counter cold, cough, allergy, bronchodilator, and antiasthmatic products; a 2004 Cochrane Review of nasal decongestants for the common cold; and a search of MEDLINE from 1966 through January 2007 using the term phenylephrine nasal . To be included in the analyses, studies had to have a single-dose, randomized, placebo-controlled design; involve an orally administered product in which phenylephrine 10 mg was the sole active ingredient; enroll patients with acute nasal congestion due to the common cold; evaluate nasal airway resistance (NAR) as the efficacy end point; and have sufficient data in the study report to allow reanalysis and/or meta-analysis of phenylephrine 10 mg versus placebo. Reanalysis of individual studies and fixed-effects and random-effects meta-analyses were performed. Statistical significance at 30 and 60 minutes after dosing (the primary time points) and a ≥20% reduction in NAR from baseline were considered indicative of a clinically meaningful difference. Results: Fifteen potentially relevant studies were identified, of which 8 met the inclusion criteria. Data from 7 crossover studies involving a total of 113 subjects were reanalyzed and then pooled for meta-analysis; results from the initial phase of the eighth study, a parallel-group trial involving 50 subjects, were included in the reanalysis of individual studies but not in the meta-analyses. Significant differences in favor of phenylephrine were seen in 4 of the 8 studies ( P ≤ 0.05). Phenylephrine 10 mg was significantly more effective than placebo at the primary time points and at 90 minutes after dosing in the meta-analyses using both the fixed-effects and random-effects models ( P ≤ 0.05). At 45, 120, and 180 minutes after dosing, phenylephrine 10 mg was also significantly more effective than placebo in the fixed-effects model ( P ≤ 0.05). Between 30 and 90 minutes after dosing, percent reductions from baseline in NAR ranged from 6.0 percentage points higher with phenylephrine than with placebo (at 30 and 45 minutes after dosing) to 16.6 percentage points higher (at 60 minutes after dosing). From 60 to 180 minutes after dosing, the percent reductions from baseline were generally ≥20% with phenylephrine. Conclusion: These meta-analyses of 7 crossover studies and the reanalysis of a parallel-group study support the effectiveness of a single oral dose of phenylephrine 10 mg as a decongestant in adults with acute nasal congestion associated with the common cold.
To estimate the total annual economic costs caused by overweight and obesity in Switzerland.
Top-down estimation of direct treatment costs for obesity including medication, nutritional counselling, ...and surgical interventions was carried out. Using Swiss prevalence data (2002) and literature-based estimates of the relative risks the population attributable fraction (PAF) was calculated for 18 overweight- and obesity-related diseases. PAF was then used in combination with estimates of the total (direct and indirect) health care costs of these diseases to estimate the economic burden of obesity for Switzerland.
The estimated total costs in Switzerland amounted to CHF 2691 million per year (on cost basis 2001). Allowance for uncertainty in parameter assumptions and values in the published literature used applying a sensitivity range of +/- 20% gave a cost range of between CHF 2153 and 3 229 millions, representing approx. 2.3-3.5% of total health care expenditures. Overweight and obesity contribute each approx. 50% to these costs.
Overweight and obesity represent a considerable financial burden to the Swiss society. According to their present trends, this economic burden is expected to grow over the coming years.
Summary Background & aims Strategies to treat malnutrition lack practicability in the hospital setting. The present study aimed at developing and evaluating a routinely manageable concept for an ...improved nutritional care of malnourished in-hospital patients. Methods A randomized controlled intervention study was conducted. 132 risk patients defined by Nutritional Risk Screening 2002, were randomized to individualised nutrition support (intervention group n = 66) or standard hospital care (control group n = 66). Body weight, plasma vitamin levels, quality of life, complications, antibiotic therapies, readmissions and mortality were assessed. Results Nutrition interventions led to higher intakes (mean standard deviation) in energy (1553 341 kcal vs. 1115 381 kcal, p < 0.001) and protein (65.4 16.4 g vs. 43.9 17.2 g, p < 0.001). Intervention patients ( n = 66) kept their body weight in comparison to control patients ( n = 66; 0.0 2.9 kg vs. −1.4 3.2 kg, p = 0.008). Positive effects on plasma ascorbic acid level (46.7 26.7 μmol/l vs. 34.1 24.2 μmol/l, p = 0.010), SF-36 function summary scale (37 11 % vs. 32 9 %, p = 0.030), number of complications (4/66 vs. 13/66, p = 0.035), antibiotic therapies (1/66 vs. 8/66, p = 0.033) and readmissions (17/64 vs. 28/61, p = 0.027) were recorded. Conclusions Malnourished patients profit from nutrition support regarding nutrition status and quality of life. They have fewer complications, need fewer antibiotics and are less often re-hospitalised.
Pentaerithrityl tetranitrate (PETN) is a long-acting donor of nitric oxide (NO) and has recently been characterized as an antianginal agent that, in contrast with other nitric acid esters, does not ...induce oxidative stress and is therefore free of tolerance. Moreover, animal experiments have revealed that PETN actively reduces oxygen radical formation in vivoand specifically prevents atherogenesis and endothelial dysfunction. Because heme oxygenase-1 (HO-1) has been described as an antiatherogenic and cytoprotective gene in the endothelium, our aim was to investigate the effect of the active PETN metabolite pentaerithrityl trinitrate (PETriN) on HO-1 expression and catalytic activity in endothelial cells. Endothelial cells derived from human umbilical vein were incubated with PETriN (0.01-1 mM) for 8 hr. PETriN increased HO-1 mRNA and protein levels in a concentration-dependent fashion up to 3-fold over basal levels. Elevation of HO-1 protein was accompanied by a marked increase in catalytic activity of the enzyme as reflected by enhanced formation of both carbon monoxide and the endogenous antioxidant, bilirubin. Pretreatment of endothelial cells with PETriN or bilirubin at low micromolar concentrations protected endothelial cells from hydrogen peroxide-mediated toxicity. HO-1 induction and endothelial protection by PETriN were not mimicked by isosorbide dinitrate, another long-acting nitrate. The present study demonstrates that the active PETN metabolite, PETriN, stimulates mRNA and protein expression as well as enzymatic activity of the antioxidant defense protein, HO-1, in endothelial cells. Increased HO-1 expression and ensuing formation of bilirubin and carbon monoxide may contribute to and explain the specific antioxidant and antiatherogenic actions of PETN.
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