Cost Of Procedure Research Articles

Simultaneous Symmetrizing Surgery on the Contralateral Breast in Unilateral Autologous Breast Reconstruction is Cost-Effective.

BACKGROUND Simultaneous symmetrizing surgery at the time of unilateral free flap reconstruction has been described as a method to facilitate single stage breast reconstruction. However, the impact on cost and number of additional procedures is not well described. METHODS Patients with unilateral free flap reconstruction were identified in national administrative data from 2017-2021 and followed for one year. Patients were stratified by immediate and delayed reconstruction, then further stratified into groups with simultaneous symmetrizing surgery and without simultaneous symmetrizing surgery. Thirty-day complications included transfusion, wound dehiscence, surgical site infection, hematoma/seroma and thromboembolism. Costs of initial hospitalization and subsequent surgeries were determined. Deferred symmetrizing surgeries within one year were identified. Chi-squared and Fisher exact tests, and Wilcoxon tests were used for statistical analysis. RESULTS A total of 1136 patients were identified. 638 were delayed reconstructions: 75 with simultaneous symmetrizing surgery and 563 without. There were no significant differences in patient characteristics or 30-day complications. Within one year of index reconstruction, fewer patients with simultaneous symmetrizing surgery underwent a revision surgery (29% vs 51%, (p=0.001)) or at least one additional procedure (36% vs 57%, p<0.001). Patients with simultaneous symmetrizing surgery had lower total costs ($35,897 vs $50,521, p=0.005). There were 498 immediate reconstructions: 63 with simultaneous symmetrizing surgery and 435 without. There were no significant differences in patient characteristics, 30-day complications, subsequent surgeries or total costs. CONCLUSION Symmetrizing procedures at the time of unilateral reconstruction may decrease cost and number of subsequent surgeries without increasing complications.

The Clinical Impact of the Introduction of a Robot-Assisted Program in a Specialized Hernia Center: A Propensity Score Matched Cohort Study on Short-Term Outcomes.

The role of robot-assisted approach in hernia surgery remains controversial due to high procedural costs and the proposed equal outcomes compared with open surgery. In this study, we report the 30-day results of the introduction of robot-assisted approach in a specialized regional ventral hernia repair center. This was a retrospective single-center cohort study including patients undergoing either robot-assisted or open ventral hernia repair from 2017 to 2022. Patients undergoing either approach were matched by propensity scores in a 1:2 ratio on the variables age, type of hernia (primary/incisional), and horizontal fascial defect size to reduce bias risk. Multivariable logistic regression on outcomes length of stay, reoperation, and readmission was performed. A total of 109 patients undergoing robot-assisted repair were compared to 229 undergoing open repair. Overall, 61.2% were patients hadincisional hernia. Mean hernia defect size was 4.9×6.5cm (horizontal×vertical). The mean length of stay was shorter after robot-assisted repair (0.1 vs. 1.9days, p<0.001) as was the incidence of readmission (3.7% vs. 17.0%, p<0.001). The incidence of reoperation was tangentially significantly lower after robot-assisted repair (0.9% vs. 6.6%, p=0.045); however, the estimate was significant after adjusting for confounders (OR 0.11, CI 0.01-0.89, p=0.038). Length of stay and readmission rates were significantly decreased after the introduction of a robot-assisted approach for ventral hernia repair.

Drug Release Nanoparticle System Design: Data Set Compilation and Machine Learning Modeling.

Magnetic nanoparticles (NPs) are gaining significant interest in the field of biomedical functional nanomaterials because of their distinctive chemical and physical characteristics, particularly in drug delivery and magnetic hyperthermia applications. In this paper, we experimentally synthesized and characterized new Fe3O4-based NPs, functionalizing its surface with a 5-TAMRA cadaverine modified copolymer consisting of PMAO and PEG. Despite these advancements, many combinations of NP cores and coatings remain unexplored. To address this, we created a new data set of NP systems from public sources. Herein, 11 different AI/ML algorithms were used to develop the predictive AI/ML models. The linear discriminant analysis (LDA) and random forest (RF) models showed high values of sensitivity and specificity (>0.9) in training/validation series and 3-fold cross validation, respectively. The AI/ML models are able to predict 14 output properties (CC50 (μM), EC50 (μM), inhibition (%), etc.) for all combinations of 54 different NP cores classes vs. 25 different coats and vs. 41 different cell lines, allowing the short listing of the best results for experimental assays. The results of this work may help to reduce the cost of traditional trial and error procedures.

Cost-Utility of Lumbar Interbody Fusion Surgery: A Systematic Review.

Lumbar interbody fusion (LIF) is a common surgical intervention for treating lumbar degenerative disorders. Increasing demand has contributed to ever-increasing healthcare expenditure and economic burden. To address this, cost-utility analyses (CUAs) compare value in the context of patient outcomes. CUAs quantify health improvements using quality-adjusted life years (QALYs), allowing decision-makers to determine procedure value. While there is a growing body of literature assessing LIF value, a comprehensive synthesis of LIF CUAs is lacking. This systematic review aims to address this gap by assessing all available CUAs of LIF techniques, to support evidence-based practices that improve outcomes and promote efficient resource use. Systematic Review STUDY SAMPLE: This study sample consisted of adult patients with lumbar degenerative conditions specifically treated with lumbar interbody fusion, including grade I or II degenerative spondylolisthesis, lumbar spinal stenosis, disc degeneration, and spondylosis, with or without low back and/or leg pain. List here the types of patients included? Adult, only degenerative conditions, etc. OUTCOME MEASURES: Direct (healthcare) and indirect (non-healthcare) costs, cost sources and calculation methods, utility scores, QALY gain, cost-utility, incremental cost-effectiveness ratios, and willingness-to-pay thresholds. Outcomes were reported as median and interquartile ranges (IQR). A systematic review was conducted following PRISMA guidelines. PubMed, Web of Science, and Embase were searched from inception to October 23, 2023, for CUAs reporting QALYs and costs of LIF procedures. Relevant studies were selected and data extracted. Subgroup analyses compared minimally invasive versus open surgery and anterior versus posterior approaches. Study quality was assessed using the CHEC-Extended tool. Quantitative meta-analysis was not performed due to methodological heterogeneity. Out of 2047 identified studies, 14 met inclusion criteria. The mean CHEC-Extended score was 72.1%. Most studies reported on TLIF (n=11) and utilized EQ-5D questionnaire to calculate utility (n=9). Direct costs were sourced from institutional databases, Medicare, DRGs, Redbook, and a variety of other sources. Most indirect costs were estimated from productivity loss. TLIF demonstrated the highest median QALY gain over one year (0.43, IQR 0.121-0.705), while PLIF was highest over two years (1.33). ALIF was most favorable over one year ($30901/QALY) and OLIF was most favorable over two years ($11187/QALY). PLIF, TLIF, and LLIF exhibited similar cost-utility over two years ($44383, $45628, $48576/QALY). MIS was substantially favorable to OS at one year ($42635 vs. $226304), though similar at two years ($48576 vs. $45628/QALY). Anterior approach was favorable to posterior approach at one year ($30901.5 vs. $81038) and two years ($29881.9 vs. $44383). Cost-utility comparisons substantially varied and were sensitive to utility measures, study methodology, cost sourcing, and follow-up duration. This is the first systematic review to comprehensively assess CUAs of all LIF approaches in the existing literature. While certain approaches, such as ALIF and OLIF, may demonstrate favorable outcomes, these conclusions are limited by high methodological heterogeneity and a limited study pool. By addressing existing gaps in study design and reporting, future comparative cost-utility research can better inform evidence-based decision-making and optimize the value of spinal surgical care.

A multicenter micro-costing analysis of flexible cystoscopic procedures in Korea.

This study aims to develop and implement an economic evaluation using a micro-costing approach to provide a precise and transparent analysis of the direct costs of cystoscopic procedures in Korean hospitals. The study seeks to identify key cost components and evaluate whether current reimbursement rates accurately reflect these direct costs. Significant variations in cost items were identified across different studies. An economic evaluation was conducted using a micro-costing methodology for the cost analysis of cystoscopic procedures, developed through literature review, data collection from studies, and expert consultations. Gangnam Severance Hospital (GSH) performed 2,188 cystoscopic procedures, including 1,847 cystoscopies and 341 JJ stent removals, with average costs of $100.8 and $110.6, respectively. At National Health Insurance Service Ilsan Hospital (NHIMC), 1,463 procedures were performed, including 1,167 cystoscopies and 296 JJ stent removals, with average costs of $119.2 and $125.3. Cystoscopy costs at GSH were driven by reprocessing ($45.8, 45.4%) and equipment ($33.1, 32.9%), while NHIMC's were $52.5 (44.0%) for equipment and $48.7 (40.8%) for reprocessing. Both hospitals incurred financial losses, with NHIS (National Health Insurance Service) covering only about 71.7% and 60.6% of costs for cystoscopy, and 71.0% and 62.7% for JJ stent removal. The significant discrepancy between HIRA (Health Insurance Review & Assessment Service)'s estimated costs and those identified here suggests that current fees for cystoscopic procedures may be underestimated and require reassessment. Given the results, reevaluating these rates is essential to ensure fair compensation for healthcare providers and to deliver optimal patient care.

Evaluating the impact of 2011 tort reform limiting noneconomic damages in North Carolina and Tennessee on testing, imaging, and procedure utilization.

To evaluate the impact of tort reform laws passed in 2011 capping noneconomic damages in North Carolina and Tennessee on rates and adjusted per user costs of tests, imaging, and procedures in the Medicare fee-for-service population. State-level synthetic difference-in-differences, adjusting for the percent of FFS Medicare beneficiaries in the state who were female, had ever been on Medicare Advantage, were eligible for Medicaid for at least 1 month of the year, and total state risk-adjusted, standardized per-capita costs. Analyses of North Carolina and Tennessee were performed separately. We measured the average treatment effect on the treated. Centers for Medicare and Medicaid Services Geographic Variation Public Use File, 2007-2019. Our analysis showed no economically significant impact of these laws in either state, though we found a small but statistically significant increase (average treatment effect on the treated: $46, 95% confidence interval: $6-$87) in adjusted per user cost of procedures in Tennessee. Our findings suggest that caps on noneconomic damages alone may be insufficient to modify physician practice habits and impact utilization. Future work should attempt to better understand the economic and noneconomic incentives that shape physician ordering decisions.

ПРАВА, ЗАКОННЫЕ ИНТЕРЕСЫ И ОБЯЗАННОСТИ НЕСОВЕРШЕННОЛЕТНИХ УЧАСТНИКОВ УГОЛОВНОГО СУДОПРОИЗВОДСТВА

Abstract Introduction: this article examines the legal support available to juvenile participants in criminal proceedings. The study is relevant in light of the gaps in the Russian criminal procedure legislation, which do not allow minors to fully protect their rights during criminal proceedings. Literature Review: a review of the literature was conducted, examining the scientific publications of N.V. Anisimova, U.N. Ahmedov, Y.A. Veshkurtseva, N.Y. Litvintseva, O.V. Ponomarenko, E.I. Sidorova, and O.A. Teplyakova. The study also considers the most significant empirical materials in the form of court decisions from various regions of Russia. Materials and Methods: the article's methodological foundation was established through the utilisation of a range of techniques, including formal legal, systemic structural, dialectical and empirical approaches. Results of the study demonstrate that an in-depth examination of the legal regulation of the procedural statuses of minors, including those of suspects, accused persons, victims and witnesses, is a crucial area of focus. The authors of the article have identified a deficiency in the level of data protection afforded to participants in criminal proceedings. It has been established that there is no possibility of involving the relatives of minors as legal representatives or of meeting with legal representatives before conducting an interrogation. Furthermore, the right to legal representation afforded to a minor as a witness or victim does not guarantee their representation. Consequently, the payment for the services of this participant does not relate to procedural costs. Additionally, a number of other expenses incurred by the victim throughout the criminal proceedings are not reimbursed. Some inconsistencies have been identified between the provisions of the criminal procedure legislation. Discussion and Conclusions: it is proposed that the amendments developed for Part 4 of Article 46, Part 4 of Article 47 and Part 4 of Article 92, Part 4 of Article 280 of the Code of Criminal Procedure of the Russian Federation be implemented, as well as that the provisions of paragraph 12 of Article 5 of the Code of Criminal Procedure of the Russian Federation be supplemented. It is anticipated that these measures will enhance the legal protection of minors in general and achieve a more equitable balance between the rights of minor witnesses and victims and those of suspects and accused.

Safety and Efficacy of Novel Cost-Effective EUS Coiling and Glue Technique for the Management of Large Gastric Varices: A Long-Term Follow-up Study

Abstract Aims and Objective Mortality by gastric variceal bleeding can reach up to 30%. Gastric varices can be treated by either direct endoscopic glue or endoscopic ultrasound (EUS) coiling + glue injection. Now, enough data show that EUS coil + glue is an effective option for large varices. However, it is a costlier option than direct endoscopic glue injection. In our study, after putting the coil under EUS guidance, direct endoscopic glue injection is done with a 21G sclerotherapy needle. Since the EUS needle was not used for the glue injection, it can be reused for up to three cases for deployment of the EUS coil, hence reducing the cost of the whole procedure. In short, our study aims to find the safety and efficacy of a cost-effective method of EUS coiling + glue injection in a cohort of the Indian population. Material and Methods Retrospective review of prospectively collected data on EUS coiling + direct endoscopic glue injection over a period spanning from July 2017 to December 2023 from a tertiary care center in North India. Results A total of 103 patients (gastroesophageal varices type 2, GOV2 [n = 82] and isolated gastric varices type 1, IGV1 [n = 21]) were taken up for the study. Among the 103 patients, 74 patients were males and 29 were females. The mean follow-up duration of the study population was 34.2 ± 21 months. The average size of the varix was 2.3 cm. The average number of coils was 3.3 and the volume of injected glue was 3.1 mL. In our study, 4 out of 103 patients had rebleeding, but the cause of rebleeding turned out to be nonvariceal. Regarding the intraprocedural and postprocedural adverse events, 1 out of 103 patients in our study experienced abdominal pain and fever, which responded to oral analgesics and antipyretics. There was no active bleeding from the puncture site or evidence of systemic embolization. Technical success was 100% in our study. Reuse of needles was not associated with any increment in risk of infection. Conclusion EUS coiling + direct endoscopic glue injection is a safe and effective endoscopic therapy for large gastric varices with sustainable long-term beneficial effects with a negligible amount of rebleeding. Direct endoscopic injection of glue following EUS coiling with a 21G sclerotherapy needle can significantly reduce the cost of the procedure without any risk of infection.

Changing of Condylar Fracture Approach in Cipto Mangunkusumo Hospital

Management of condylar fracture draws controversy for over three decades. Previously, closed reduction with intermaxillary !xation (IMF) had been predominant for many surgeons, considering shorter length of procedure, ability to achieve preinjury occlusion with acceptable adjustment, and low cost of procedure. Introduction of osteosynthesis material rigid internal !xation (RIF) and adaptive miniplate !xation marked technology development in condylar fracture management and became popular in term of the applicability and outcome results. Over period time, several studies proposed vary classi!cation system and selection patient criteria for surgical treatment on the basis of age, location of fracture, degree of communition, direction of proximal fragment displacement, location of condylar head, concomitant medical illness or associated trauma, and patient’s preferences to achieve optimum goal. This review focuses on the shifting of condylar fracture management at Cipto Mangunkusumo Hospital from 2004-2012.

HONORÁRIOS SUCUMBENCIAIS NO DIREITO DO TRABALHO: ANÁLISE DA DECISÃO DA ADI 5.766

This article addresses the decision of the Federal Supreme Court (STF) in Direct Action of Unconstitutionality (ADI) 5766, which declared the unconstitutionality of provisions in the Labor Reform related to the payment of court costs and expert and attorney fees by workers who are beneficiaries of free legal aid. The main objective is to analyze the impacts of this decision on access to justice and the implications it brings for the judicial system and labor relations. The methodology adopted was bibliographic in nature, focusing on the analysis of doctrinal works, academic articles, and judicial decisions. The research was guided by a central question: What are the impacts of the ADI 5766 decision regarding the exemption from costs and fees on access to justice for economically disadvantaged workers? In the theoretical framework, topics such as free legal aid, the constitutional right to access to justice, expert and attorney fees in labor law, and the changes brought by the 2017 Labor Reform were discussed. The STF's decision was analyzed in light of these concepts to understand its relevance for the effectiveness of labor rights and the possible consequences for the judicial system and the labor market. The conclusion emphasizes that the STF's decision represents a significant advance in protecting access to justice for workers in vulnerable situations by guaranteeing the exemption from procedural costs for those who lack financial means. The research concludes that the STF’s decision seeks to balance the right to free legal aid with the preservation of the integrity of the labor process, with impacts that must be monitored for workers, employers, and the judiciary.

A Surrogate-Based Approach for Bend-Twist Coupling Optimization of a Horizontal Axis Wind Turbine Composite Blade

A design study on the effect of bend-twist coupling in a composite blade of horizontal axis wind turbine (HAWT) is conducted. Using specific lamination sequences with unidirectional plies, a laminated composite is obtained whose mechanical stresses are coupled in its bending and twisting. Given the aerodynamic forces on the blade during its operation, mechanical stresses emerge in the material, which, due to its bend-twist coupled behavior, conforms elastically, adapting its geometry to the wind flow. The tailoring of aeroelastic effects can be applied to wind turbine blades to improve the performance of wind turbines. Furthermore, the manufacturing costs, either from material or process perspectives, are potentially reduced with well-designed layup sequences. A blade is first designed according to specific parameters using the Blade Element Momentum Theory (BEMT) under the assumption of total rigidity. These include operational and constructive parameters (e.g., desired output power, airfoil profile characteristics, nominal wind velocity, number of blades, etc.). The effect of bend-twist coupling in the laminated composite is analyzed by fluid-structure interaction (FSI). The layup sequence is parametrized within ANSYS Composites PrepPost (ACP) with different laminations for upper and lower face of the blade, given both geometry and stress distributions differ for each face. The CFD and the structural behavior are coupled in a two-way FSI system, along with material properties evaluated from ACP. Thus, deformations are computed using the pressure distribution from CFD and material properties from ACP. The power coefficient is calculated once the FSI simulation has converged, yielding the resultant torque and rotation, which are then used to evaluate the extracted power.. An optimization routine is implemented to maximize the power extraction as a function of the lamination sequence for the upper and lower faces of the blade. The computational cost of the optimization procedure is reduced by employing radial basis function neural network, acting as a surrogate model. It is predicted an increase of up to 10% in the power coefficient for the generator. The final proposed laminated composite for upper and lower faces of the blade extends the power curve of the generator, allowing it to sustain operation even in overload conditions, delaying stall of the blades and avoiding tower collapse by excessive blade tip axial deflection.

True cost estimation of common imaging procedures for cost-effectiveness analysis - insights from a Singapore hospital emergency department

ObjectivesThere is a lack of clear and consistent cost reporting for cost-effectiveness analysis in radiology. Estimates are often obtained using costing derived from hospital charge records. This study aims to evaluate the accuracy of hospital charge records compared to a Singapore hospital's true diagnostic imaging costs. MethodsA seven-step process involving a bottom-up micro-costing approach was devised and followed to calculate the cost of imaging using actual data from a clinical setting. We retrieved electronic data from a random sample of 96 emergency department patients who had CT brain, CT and X-ray cervical spine, and X-ray lumbar spine performed to calculate the parameters required for cost estimation. We adjusted imaging duration and number of performing personnel to account for variations. ResultsOur approach determined the average cost for the following imaging procedures: CT brain (€154.00), CT and X-ray cervical spine (€177.14 and €68.22), and X-ray lumbar spine (€79.85). We found that the true cost of both conventional radiography procedures was marginally higher than the subsidized patient charge, and all costs were slightly lower than the private patient charge except for X-ray lumbar spine (€73.49 vs.€79.85). We identified larger differences in cost for both CT procedures and smaller differences in cost for conventional radiography procedures, depending on the patient's private or subsidized status. For private status, the differences were: CT brain (Min: €194.20; Max: €264.40), CT cervical spine (Min: €219.54; Max: €399.05), X-ray cervical spine (Min: €5.27; Max: €61.94), and X-ray lumbar spine (Min: €6.36; Max: €108.04), while for subsidized status, the differences were: CT brain (Min: €7.56; Max: €62.64), CT cervical spine (Min: €47.02; Max: €132.49), X-ray cervical spine (Min: €15.88; Max: €103.44), and X-ray lumbar spine (Min: €13.66; Max: €149.44). Considering examination duration and the number of personnel engaged in a procedure, there were significant variations in the minimum, average, and maximum imaging costs. ConclusionThere is a modest gap between hospital charges and actual costs, and we must therefore exercise caution and recognize the limitations of utilizing hospital charge records as absolute metrics for cost-effectiveness analysis. Our detailed approach can potentially enable more accurate imaging cost determination for future studies.

Robotic carotid artery stenting: a multicenter, propensity score–matched analysis of clinical outcomes and cost-effectiveness

OBJECTIVE Preclinical studies suggest that robotic carotid artery stenting (CAS) could be superior to manual CAS. However, very limited comparative data exist for patients who have undergone robotic versus manual CAS. In addition, no data exist comparing the costs of manual and robotic CAS. METHODS All robotic CAS cases at two academic neurosurgery centers were retrospectively reviewed and 1:1 propensity matched with manual CAS cases. Personnel costs, supply costs, and total procedure costs were collected in collaboration with hospital administration by using time-driven activity-based cost analysis. RESULTS A total of 24 robotic CAS operations were performed between 2019 and 2023. Comorbidities and baseline procedural characteristics were well matched between robotic and manual cases. Unplanned manual conversion was observed in only 1 robotic case (4.2%). Robotic CAS complications and outcomes were comparable to manual. Robotic CAS was associated with a significantly increased fluoroscopy time (29.0 vs 19.2 minutes; p &lt; 0.001). Robotic procedure time (88.9 ± 18.2 minutes) was significantly (p = 0.003) longer than manual time (68.72 ± 22.4 minutes). Health personnel costs ($1589.71 ± $176.92 vs $1375.99 ± $233.39, p = 0.005); supply costs ($3918.25 ± $421.20 vs $2152.74 ± $1030.26, p &lt; 0.001); and total procedure costs ($5306.11 ± $608.95 vs $3437.56 ± $1165.67, p &lt; 0.001) were greater for robotic CAS. CONCLUSIONS In the first multicenter study and largest sample to date, the authors show that robotic CAS, with a low rate of procedural failure and postoperative complications, is safe and feasible. In addition, robotic CAS achieves comparable clinical outcomes to manual CAS. Robotic CAS was associated with increased fluoroscopy time, but fluoroscopy time decreased as operators gained familiarity with the CorPath GRX system. Robotic CAS was associated with a greater procedural cost, which was driven by greater personnel and supply costs. Robotic CAS failed to show superiority to manual CAS. These findings set a foundation for randomized controlled trials of robotic CAS, and also highlight the need for further studies to optimize robotic CAS and reduce its associated costs.

Costs of colorectal cancer screening in Sweden: an observational, longitudinal cost description

ObjectiveColorectal cancer (CRC) screening programmes have been implemented worldwide, but the evidence of the economic consequences of screening programmes relies on data from short-term trials. The aim of this paper...

Factors influencing white blood cell mobilisation in healthy granulocyte donors.

Granulocyte transfusions represent a therapeutic option for severely neutropenic patients with bacterial or fungal infections that are otherwise unresponsive to conventional therapy. Prior clinical studies suggest that patients receiving higher granulocyte doses achieve superior outcomes. Consequently, suboptimal donor stimulation and collection leading to lower granulocyte doses likely correlate with worse clinical outcomes. A retrospective analysis was conducted on mobilisation data from 312 granulocyte collections from healthy donors between January 2020 and May 2023. This study was performed in a single blood donor center exclusively supporting a comprehensive cancer center. Donors underwent stimulation with 480 mcg of filgrastim (granulocyte colony stimulating factor [G-CSF]) subcutaneously and 8 mg of dexamethasone orally administered 12 to 14 h before collection. The correlation between donor characteristics (age, gender, body weight (BW), body mass index (BMI), baseline haemoglobin (Hgb), and platelet (PLT) counts) and mobilisation efficiency (Δ WBC, defined as post-mobilisation WBC count-baseline WBC count) was examined to identify factors associated with enhanced mobilisation efficiency. Additionally, the impact of multiple donations on Δ WBC in repeat donors was assessed. The median donor age was 43 years (range 18-81), with 224 male and 88 female donors. Female donors exhibited significantly higher baseline PLT counts and post-mobilisation WBC counts. However, donor gender did not significantly affect Δ WBC. A negative correlation was observed between Δ WBC and age (r = -0.235, p = 0.001), with older donors (61-81 years) exhibiting significantly lower mobilisation efficiency. BW and BMI differences had no significant effect on Δ WBC. A positive correlation was identified between baseline PLT count and Δ WBC (r = 0.140, p = 0.014), with females having significantly higher baseline PLT counts (p = 0.0004). No correlation was found between Δ WBC and baseline Hgb (r = 0.004, p = 0.477). Repeat donors showed no statistically significant change in Δ WBC with subsequent donations, with a mean interval of 136.5 days between collections. Mobilisation efficiency was not impacted by donor BW or BMI suggesting that BW-based G-CSF stimulation is not essential for optimising WBC mobilisation. Rather, a fixed single dose of 480 mcg of G-CSF and 8 mg of dexamethasone was sufficient to mobilise donors, thus reducing the procedural costs and the potential risks for medication-related side effects. The positive correlation found between baseline PLT count and Δ WBC suggests that PLT count could be used as a potential predictor of mobilisation efficiency. Mobilisation response in up to four collections in repeat granulocytes donors was not affected in subsequent donations. However, sample size is a limitation, and more data is needed for a meaningful conclusion of whether frequent granulocyte donations are safe and effective.

Review on endoscopic capsules

This research provided an in-depth analysis of endoscopic capsules as an innovative application of the Internet of Things (IoT) in healthcare. The study revealed the importance of these systems in advancing gastrointestinal diagnostics due to their non-invasive nature and ability to provide comprehensive internal imaging. The work systematically investigated the device’s technical design, power management strategies, communication protocols, and how it performs its secure and efficient operations. Findings from this analysis highlighted the transformative impact of these capsules despite current constraints, such as battery limitations and procedural costs. Ultimately, this wide review confirmed that endoscopic capsules redefine medical diagnostics, fusing patient comfort with innovative technology. Moreover, as developments continue, these devices have promising potential to shape the future of intelligent, interconnected healthcare solutions.

Predictive factors for early mortality after EUS-guided gastroenterostomy in malignant gastric outlet obstruction

Background and study aim: Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has recently emerged as a potential treatment option for malignant gastric outlet obstruction (mGOO), with a relatively long duration of patency and low rate of reintervention. Its intrinsic risk for serious adverse events and high procedure cost mandates careful patient selection beyond the common safety profiles. This study aimed to assess for predictors of early post-EUS-GE mortality. Patients and methods: We conducted a retrospective analysis of all patients with unresectable mGOO who underwent EUS-GE. Predictive factors for postoperative 30-day mortality with crude and adjusted hazard ratios were examined using univariate and multivariate penalized likelihood Firth logistic regression analyses. Results: Technical and clinical success was achieved in 96.7% and 93.1% of the patients, respectively. The 30-day mortality rate after the procedure was 11.7%, and no procedural complications were observed. The 30-day mortality group had a significantly low rate of initial clinical success (66.7% vs. 96.2%, p=0.007). Univariate analysis identified significantly higher postoperative 30-day mortality in patients with poor baseline ECOG performance status scale (≥2) and ascites. The presence of grade 2 ascites was confirmed as an independent predictive factor in the multivariate analysis (adjusted hazard ratio 52.41, 95% confidence interval 1.55 to 1775.64, p=0.024). Conclusion: EUS-GE should be carefully considered for patients with ascites which was an independent predictor for early mortality after procedure in mGOO, especially those with grade 2 or higher level of ascites.

Data‐driven framework for predicting the sorption capacity of carbon dioxide and methane in tight reservoirs

AbstractAs energy demand continues to rise and conventional fuel sources dwindle, there is growing emphasis on previously overlooked reservoirs, such as tight reservoirs. Shale and coal formations have emerged as highly attractive options due to their substantial contributions to global gas reserves. Enhanced shale gas recovery (ESGR) and enhanced coalbed methane recovery (ECBM) based on gas injection are advanced techniques used to increase the extraction of gas from shale and coal formations. One of the key challenges associated with these formations and their enhanced recovery methods is accurately predicting the sorption process and its profile. This is crucial because it affects how methane (CH4) and carbon dioxide (CO2) are stored and released from the rock, and it significantly impacts the evaluation of gas content and the potential productivity of these formations. Due to the high cost of experimental procedures and the moderate accuracy of existing predictive approaches, this study proposes various cheap and consistent data‐driven schemes for predicting the sorption of CH4 and CO2 in shale and coal formations. In this regard, three intelligent models, including generalized regression neural network (GRNN), radial basis function neural network (RBFNN), and categorical boosting (CatBoost), were taught and tested using more than 3800 real measurements of CH4 and CO2 sorption in shale and coal formations. To find automatically their appropriate control parameters and improve their prediction ability, RBFNN and CatBoost were evolved using grey wolf optimization (GWO). The obtained results exhibited the encouraging prediction capabilities of the suggested models. In addition, it was found that CatBoost‐GWO is the most accurate scheme with total root mean square (RMSE) and determination coefficient (R2) of 0.1229 and 0.9993 for CO2 sorption, and 0.0681 and 0.9970 for CH4 sorption, respectively. Additionally, this approach demonstrated its physical validity by respecting the real sorption tendencies with respect to operational parameters. Furthermore, the CatBoost‐GWO model outperforms recently published machine learning approaches. Lastly, the findings of this study offer a significant contribution by demonstrating that the suggested model can greatly improve the ease of estimating CO2 and CH4 sorption in tight formations, thereby facilitating the simulation of other parameters related to this process. © 2024 Society of Chemical Industry and John Wiley &amp; Sons, Ltd.

HPB SO12 - Comparison of outcomes between stapled closure and sutured closure of pancreatic stump following robotic distal pancreatectomy

Abstract Background Postoperative pancreatic fistulas (POPFs) are associated with high patient mortality and morbidity. There are multiple approaches in managing pancreatic stumps following distal pancreatectomy. We compared the outcomes between sutured closure and stapled closure following robotic distal pancreatectomy and splenectomy, and the associated cost difference between the two techniques. Method We retrospectively analysed consecutive robotic distal pancreatectomy and splenectomy cases between October 2022 and January 2024 in a single United Kingdom tertiary hospital. Stapled closure was the initial standard approach. Sutured closure utilising 3/0 Prolene was regularly performed from July 2023. The study cohort was divided into these two groups and outcomes were compared. Primary outcome was POPF rates and secondary outcomes included postoperative length of stay (LOS), 30-day readmission rates and postoperative complications graded by Clavien-Dindo classification (CDC). Equipment costs for the respective procedures were obtained from hospital procurement team. Results 36 patients were reviewed; 14 (38.9%) were stapled and 22 (61.1%) were sutured. Patient characteristics including mean age, gender and ASA grade were similar in both groups. 23/36 (63.9%) patients had confirmed malignancy on postoperative histopathology – similar distribution in both groups. 6/14 (42.9%) in the stapled group vs 4/22 (18.2%) in the sutured group developed POPF Grade B (p=0.14). LOS, 30-day readmission and CDC complication rates were similar in both groups. Median costs were £2236.40 and £1541.86 in the stapled and sutured groups respectively. Conclusion Sutured closure of pancreatic stump yielded similar outcomes to stapled closure following robotic distal pancreatectomy, associated with a significant cost saving in favour of sutured closure.

Reducing healthcare costs by timely diagnosis and management in functional motor disorders.

Functional motor disorders (FMDs) are prevalent and highly disabling conditions among young adults, leading to reduced independence. Despite advancements in diagnosis and treatment, the economic burden of FMDs remains largely unknown. This study evaluates the impact of accurate FMDs diagnosis on direct healthcare costs within the Italian National Health System by comparing healthcare utilization and costs before and after diagnosis. This before-after study included 40 patients with a definite diagnosis of FMDs. Retrospective data on healthcare utilization, including diagnostic tests, specialist visits, hospitalizations, Emergency Room (ER) visits, and rehabilitation services, were collected from diaries and documents two years before and after diagnosis. Healthcare direct costs decreased by 67%, from an average of €4,467 [95% CI 3,604-5,329] to €1,461 [95% CI 945-1,976] after diagnosis. Hospitalization costs fell from €2,618 [95% CI 1,899-3,336] to €492 [95% CI 162-821], and ER costs dropped from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Diagnostic procedure costs decreased significantly, from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Specialist visit costs remained unchanged. Rehabilitation costs increased from €371 [95% CI 194-547] to €635 [95% CI 318-915], but this rise was not statistically significant. Accurate diagnosis of FMDs significantly reduces healthcare costs by minimizing unnecessary tests, hospitalizations, and ER visits while emphasizing rehabilitation. This highlights the economic and clinical benefits of improved diagnostic accuracy and specific multidisciplinary intervention. Investing in cost-effective diagnostic tools is crucial for earlier diagnosis and reducing delays.