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With the disruptive technology innovation time arrival, small and medium-sized enterprises (SMEs) have been the motor of innovation and played an increasingly major role in national economic development. As the shift towards an ‘open innovation’ paradigm, awareness of intellectual property rights has increased, and patents have been an important tool for Chinese pharmaceutical enterprises. Considering its mass production of low-level generic drugs, there are still many arguments about its lack of innovation. This article aims to identify if and how patents, as essential indicators of innovation, generate financial performance measured by SMEs in the pharmaceutical sectors. Patent data are a vital source of competitive intelligence. A positive association was found between annually added patents and gross sales. Many other patent indicators, such as the number of forward citations and patent transfer, were statistically significant. Moreover, the results suggested that there was a one-year lag between patent publication and financial performance. A series of patent quantity and quality indicators have shown significant effects on the financial performance of Chinese pharmaceutical enterprises. These patents generate a positive financial impact, which builds up a solid basis for keeping sustainable innovation capability in the Chinese drug industry.

Business-to-business (B2B) companies devote significant resources to measure customer satisfaction but lack guidance on critical aspects of implementing satisfaction programs. Accordingly, executives ask: (1) What are the key strategic attributes driving B2B customer satisfaction? (2) Are the strategic attributes satisfaction balancing, satisfaction maintaining, or satisfaction enhancing based on the pattern of asymmetry? (3) Do the sign and magnitude of asymmetry vary across industry and customer subgroups? and (4) Is there a generalizable link between satisfaction and financial performance for B2B firms? Study 1 uses qualitative and secondary research to identify and validate eight strategic attributes pertinent to B2B companies: quality of product/service, pricing, safety, sales process, project management, corporate social responsibility, communication, and ongoing service and support. Study 2 examines industry-subgroup heterogeneity in the nature of asymmetry across industries, then links satisfaction with performance (i.e., sales). Study 3 finds customer-subgroup heterogeneity in the nature of asymmetry within the customer base of a B2B service provider, then links satisfaction with performance (i.e., dollar value of purchase).

Objective: To quantify the prevalence of hospital admissions, the financial impact, and the trends in surgical procedure rates for AOM and CAOM for all ages before and after 13-valent pneumococcal conjugate vaccine (PCV13) introduction. Methods: Retrospective analysis of the National Inpatient Sample (NIS) from 1998 to 2013 to determine the prevalence of AOM/CAOM related admissions and weighted frequencies of AOM/CAOM related International Classification of Diseases, ninth revision (ICD-9) hospital diagnoses. Prevalence of surgical procedures to treat CAOM, cost of admission, length of stay, and cost per day of admission were tabulated. Trend analysis of this data was performed. Results: A total of 46 580 patients were hospitalized with AOM in the designated time period, of which 37 366 had CAOM. The prevalence of hospital admission due to AOM had the most pronounced decrease from pre-vaccine era (1998) to post-PCV13 implementation (2013) in age group 0 to 4 (32%) followed by age group 5 to 19 (7%). Age groups 20-64 and 65+ showed slight increases in prevalence. The trend in prevalence of admissions due to CAOM mirrors that of overall admissions with an 18% and 5.8% decrease in age groups 0-4 and 5-19, respectively, and a 1% increase in ages 20+. The inflation adjusted mean cost of admission did not significantly increase between 2001 and 2013. The total cost per admission was $4428 and $7546 for those with AOM and CAOM, respectively. Mastoidectomy rates increased by 17% in hospitalized children during the post-vaccine era but decreased in the elderly population. Conclusion: The prevalence of AOM/CAOM hospital admissions decreased from the pre-vaccine era (1998) to post-PCV13 implementation (2013) in pediatric patients. Surgical procedure utilization and cost of hospital admission for AOM/CAOM did not increase throughout the study period.

We examined the financial incentives to avoid readmissions under Medicare’s Hospital Readmission Reduction Program for safety-net hospitals (SNHs) and teaching hospitals (THs) compared with other hospitals. Using Medicare’s FY2016 Hospital Compare and readmissions data for 2,465 hospitals, we tested for differential revenue gains for SNHs ( n = 658) relative to non-SNHs ( n = 1,807), and for major ( n = 231) and minor ( n = 591) THs relative to non-THs ( n = 1,643). We examined hospital-level factors predicting differences in revenue gains by hospital type. The revenue gains of an avoided readmission were 10% to 15% greater for major THs compared with non-THs ($18,047 vs. $15,478 for acute myocardial infarction) but no different for SNHs compared with non-SNHs. The greater revenue gains for THs were strongly positively predicted by hospitals’ poor initial readmission performance. We found little evidence that the Hospital Readmission Reduction Program creates disincentives for SNHs and THs to invest in readmission reduction efforts, and THs have greater returns from readmissions avoidance than non-THs.

BackgroundTargeted oral agents are now increasingly being utilized in cancer treatment, but are expensive. Changing the dose of these medications due to toxicity or discontinuation secondary to disease progression or death causes waste from unused medication. Limiting waste is an important goal, as waste has a substantial financial impact on patients and insurance companies.MethodsPatients started on oral targeted agents' sunitinib, everolimus, axitinib, or vemurafenib between January 2012 and February 2015 who obtained their medications at Holden Comprehensive Cancer Center specialty pharmacy were included in the analysis. We acquired dispensing data retrospectively for each of the agents and reviewed patient charts. Wasted tablets/capsules were calculated from their last fill to the dates of stoppage or dose adjustment. The amount associated with the wastage was calculated using the average wholesale price. Repository drug usage data during the same time period was obtained.ResultsEighty-eight patients had their prescriptions filled at Holden Comprehensive Cancer Center during the study time period. Waste occurred in 41% of all patients with primary reasons attributed to cancer progression in 25 patients, death in five patients, toxicity in five patients and increase in dosage of targeted therapy in two patients. A total of 1179 tablets or capsules were wasted from all causes, priced at a total of $248,595.69.ConclusionOral chemotherapy medications are associated with wastage, which is a significant financial burden to society. Progression of disease emerged as the single most important factor accounting for wastage. Novel ideas are needed to prevent wastage, thereby reducing healthcare costs.

Objective: An in silico study of type 1 diabetes (T1DM) patients utilized the UVA-PADOVA Type 1 Diabetes Simulator to assess the effect of patient blood glucose monitoring (BGM) system accuracy on clinical outcomes. We applied these findings to assess the financial impact of BGM system inaccuracy. Methods: The study included 43 BGM systems previously assessed for accuracy according to ISO 15197:2003 and ISO 15197:2013 criteria. Glycemic responses for the 100 in silico adult T1DM subjects were generated, using each meter. Changes in estimated HbA1c, severe hypoglycemic events, and health care resource utilization were computed for each simulation. The HbA1c Translator modeling approach was used to calculate the financial impact of these changes. Results: The average cost of inaccuracy associated with the entire group of BGM systems was £155 per patient year (PPY). The average additional cost of BGM systems not meeting the ISO 15197:2003 standard was an estimated £178 PPY more than an average system that fulfills the standard and an estimated £235 PPY more than an average system that appears to meet the ISO 15197:2013 standard. Conclusion: There is a clear relationship between BGM system accuracy and cost, with the highest costs being associated with BGM systems not meeting the ISO 15197:2003 standard. Lower costs are associated with systems meeting the ISO 15197:2013 system accuracy criteria. Using BGM systems that meet the system accuracy criteria of the ISO 15197:2013 standard can help reduce the clinical and financial consequences associated with inaccuracy of BGM devices.

Background: Surgical site infection (SSI) occurs in 0.25% to 6% of children after cardiothoracic surgery (CTS). There are no published data regarding the financial impact of SSI after pediatric CTS. We sought to determine the attributable hospital cost and length of stay associated with SSI in children after CTS. Methods: We performed a retrospective, matched cohort study in a 26-bed cardiac intensive care unit (CICU) from January 2010 through December 2013. Cases with SSI were identified retrospectively and individually matched to controls 2:1 by age, gender, Risk Adjustment for Congenital Heart Surgery score, Society of Thoracic Surgeons–European Association for Cardiothoracic Surgery category, and primary cardiac diagnosis and procedure. Results: Of the 981 cases performed during the study period, 12 with SSI were identified. There were no differences in demographics, clinical characteristics, or intraoperative data. Median total hospital costs were higher in participants with SSI as compared to controls (US$219,573 vs US$82,623, P < .01). Children with SSI had longer median CICU length of stay (9 vs 3 days, P < .01), hospital length of stay (18 vs 8.5 days, P < .01), and duration of mechanical ventilation (2 vs 1 day, P < .01) and vasoactive administration (4.5 vs 1 day, P < .01). Conclusions: Children with SSI after CTS have an associated increase in hospital costs of US$136,950/case and hospital length of stay of 9.5 days/case. The economic burden posed by SSI stress the importance of infection control surveillance, exhaustive preventative measures, and identification of modifiable risk factors.

Employee theft is one of the most harmful crimes that can occur to a small business. Research on this crime has focused primarily on its financial impact and how to prevent it. However, like other forms of crime, employee theft also has more personal and subjective effects on victims. To date, these aspects of employee theft victimization have been largely ignored. We address this gap in the literature by exploring the emotional consequences of employee theft as experienced by the owners of small businesses. Guided by grounded theory methodology, we conducted a series of in-person interviews with the owners of small businesses to gain a better understanding of the total impact of employee theft. Analysis of interviews indicated that victimized business owners experienced a range of cognitive and emotional reactions to theft. At times, these reactions were severe, and they were exacerbated if the victim had a strong emotional connection with the offender.

This article contributes to the literature on the financial impact of cancer by presenting findings on the use of credit cards as a response to the financial crisis of relocation for specialist treatment for patients diagnosed with a hematological malignancy. The findings are from a study, funded by the Leukaemia Foundation of Queensland, examining the financial impact of relocation for specialist treatment for hematology patients in Queensland. To date, there has been no work on financial management strategies for hematology patients or research on the use of credit cards by cancer patients. The findings on the use of credit cards as a response to the financial crisis of serious illness are discussed in terms of income profile, gender, financial management strategy, and a sense of urgency and need.

Background Medication reconciliation is one of the more challenging aspects of inpatient care, and its accuracy is paramount to safe transitions of care. Studies have shown that pharmacists have a role in medication reconciliation through improving patient safety and avoiding costs associated with medication errors. The wide-scale use of pharmacists in this process has been limited by time constraints, cost, and lack of resources. Objective This study evaluates the impact of pharmacists in resolving medication errors, decreasing readmission rates, and reducing institutional costs during the discharge medication reconciliation process. Methods Pharmacists evaluated discharge medication reconciliation documentation for patients to determine its accuracy, the accuracy of the admission reconciliation documentation, and any potential issues unrelated to accuracy. Analysis of these data determined the time required for pharmacist involvement, the number of errors identified by pharmacists, the quality of pharmacist interventions, the cost avoidance for each error, and the overall impact on hospital readmission. Results During the 7-week study period, pharmacists performed 67 discharge medication reviews and identified 84 errors. Seventy-five percent were considered to be significant and 6% were considered to be serious. The 30-day readmission rate in the study cohort was 18% compared with 20% in the control group. Based on the clinical severity scale and pharmacist salaries, pharmacist interventions resulted in $42,300 in cost avoidance. Conclusion Pharmacists involved in this pilot discharge process identified and resolved significant errors on medication reconciliation orders that resulted in a financial benefit to the institution.

The purpose of this study is to create a decision framework based on life-cycle cost (LCC) for failed portland cement concrete pavement (PCCP) materials in Indiana. The Indiana Department of Transportation (DOT) has a standard practice in testing and accepting the construction of PCCP. The challenge, though, is to make informed decisions concerning PCCP sections of failed materials and whether they should be removed and replaced or be accepted with a heavy penalty. This paper presents a decision framework for failed materials based on the long-term performance of PCCP and its LCC. The framework incorporates the PAVESPEC LCC module, a tool package developed as part of the performance-related specifications research efforts. The comparison of as-designed LCC and as-constructed LCC reveals the financial impact of failed PCCP materials. Probability and user confidence were incorporated to address the risk of accepting failed materials because of inferior pavement performance and shortened service life. Many simulations of various failed material scenarios were executed to develop, calibrate, and validate the decision framework. It was found that the interaction between acceptable quality characteristics (AQCs), that is, flexural strength, air content, thickness, and smoothness, had a significant impact on the LCC estimates. This framework was able to capture the composite impact of multiple AQCs deviating from their design target and provides a monetary base for the Indiana DOT to make informed decisions concerning failed PCCP materials.

Thirty-day mortality represents a variable that is commonly used to measure the quality of surgical care. The definition of 30-day mortality and the application of a risk adjustment to its measurement may vary among different organizations comparing physician quality. In the midst of this confusion, conflicting interests arise for surgeons who must weigh the potential benefit of surgical interventions to individual patients versus the potential loss of access by future patients should 30-day mortality ratings be adversely affected. Similarly, surgeons may become adversely impacted by the lack of compensation from avoiding “high-risk” cases, but might face a more severe financial impact if they have a higher mortality rating compared to their peers.

Nature-based tourism can be an important source of income for regional economies but relies on a healthy environment. Using data collected from business and non-business visitors to Australia’s coast adjacent to the Great Barrier Reef, the authors generate estimates of the potential financial impact of environmental degradation, demonstrating a novel way of testing and controlling for hypothetical response bias. More than 90% of non-business visitors and 67% of business visitors came to the region for at least one nature-related reason. Average daily expenditure was similar for both visitor segments (≈AUD$190), but the determinants of expenditure varied. All visitors reacted much more negatively to the prospect of environmental degradation than to a 20% increase in (local) prices, although business visitors were much less responsive than non-business visitors. Adjusting for hypothetical response bias, the authors estimate that substantial environmental degradation could reduce visitor expenditures (and thus local tourism incomes) by at least 17%.

Background:Biceps tenodesis may be performed for symptomatic tendinopathy or tearing of the long head of the biceps tendon. Biceps tenodesis is also commonly performed as an adjunctive procedure. However, the indications and prevalence of biceps tenodesis have expanded.Purpose:To establish the incidence and risk factors for revision biceps tenodesis.Study Design:Case-control study; Level of evidence, 2.Methods:The PearlDiver database of Humana patient data was queried for patients undergoing arthroscopic or open biceps tenodesis (Current Procedural Terminology [CPT] 29828 and CPT 23430, respectively) from 2008 through the first quarter of 2017. Patients without a CPT laterality modifier were excluded from analysis. Revision biceps tenodesis was defined as patients who underwent subsequent ipsilateral open or arthroscopic biceps tenodesis. The financial impact of revision biceps tenodesis was also calculated. Multivariate binomial logistic regression was performed to identify risk factors for revision biceps tenodesis, such as patient demographics as well as concomitant procedures and diagnoses. Odds ratios (ORs) and 95% CIs were calculated, and all statistical comparisons with P < .05 were considered significant.Results:There were 15,257 patients who underwent biceps tenodesis. Of these, 9274 patients (60.8%) underwent arthroscopic biceps tenodesis, while 5983 (39.2%) underwent open biceps tenodesis. A total of 171 patients (1.8%) and 111 patients (1.9%) required revision biceps tenodesis after arthroscopic and open biceps tenodesis, respectively ( P = .5). Male sex (OR, 1.38 [95% CI, 1.04-1.85]; P = .02) was the only independent risk factor for revision biceps tenodesis after the index open biceps tenodesis. After arthroscopic biceps tenodesis, age >45 years (OR, 0.58 [95% CI, 0.39-0.89]; P = .01) and concomitant rotator cuff tear (OR, 0.58 [95% CI, 0.47-0.71]; P < .001) were independent protective factors for revision biceps tenodesis. The total cost of revision biceps tenodesis after open and arthroscopic biceps tenodesis was US$3427.95 and US$2174.33 per patient, respectively.Conclusion:There was no significant difference in the revision rate between arthroscopic and open biceps tenodesis. Risk factors for revision surgery included male sex for open biceps tenodesis, while age >45 years and rotator cuff tears were protective factors for arthroscopic biceps tenodesis.

Background: The short-term outcomes of concussions within Major League Baseball (MLB) warrant further consideration beyond a medical standpoint given that performance, career, and financial data remain unknown. The perception of this injury directly affects decision making from the perspective of both player and franchise. Purpose: To evaluate the effect of concussion on MLB players by (1) establishing return-to-play (RTP) time after concussion; (2) comparing the career length and performance of players with concussion versus those who took nonmedical leave; and (3) analyzing player financial impact after concussion. Study Design: Cohort study; Level of evidence, 3. Methods: Contracts, transactions, injury reports, and performance statistics from 2005 to 2017 were analyzed by comparing matched players who sustained a concussion versus those who took nonmedical leave. Of the 4186 eligible MLB players, 145 sustained concussions resulting in the activation of concussion protocol and 538 took nonmedical leave. RTP time was recorded. Career length was analyzed in reference to an experience-based stratification of full seasons remaining after the concussion. Changes in player performance and salary before and after concussion were compared with the same parameters for players who took nonmedical leave. Results: The mean RTP time was 26 days (95% CI, 20-32 days) for athletes with concussion and 8 days (95% CI, 6-10 days) for those who took nonmedical leave. Athletes with concussion had a mean of 2.8 full seasons remaining, whereas athletes who took nonmedical leave had 3.1 seasons remaining ( P = .493). The probability of playing in the MLB after concussion compared with the nonmedical leave pool was not significantly lower ( P = .534, log-rank test; hazard ratio, 1.108). Postconcussion performance decreased significantly in position players, including a lower batting average and decreased on-base percentage in the players with concussion compared with those returning from nonmedical leave. Players who sustained a concussion lost a mean of US$654,990 annually compared with players who took nonmedical leave. Conclusion: This study of the short-term outcomes after concussion in limited-contact MLB athletes demonstrates that concussions may not decrease career spans but may result in decreased performance in addition to financial loss when compared with matched controls who took nonmedical leave. In sports such as baseball that are not subject to repetitive head trauma, career spans may not decrease after a single concussive event. However, sentinel concussions have deleterious short-term effects on performance and compensation among MLB players.

Appendicitis is the most common emergent problem encountered by pediatric surgeons. Driven by improved cosmetic outcomes, many surgeons are offering pediatric patients single-incision laparoscopic appendectomy. We sought to investigate the financial impact of different surgical approaches to appendectomy. A retrospective study of patients with acute appendicitis undergoing appendectomy from February 2010 to September 2011 was conducted. Based on surgeon preference, patients underwent open appendectomy (OA), laparoscopic appendectomy (LA), or single-incision laparoscopic appendectomy (SILA). Demographic information, surgical outcomes, surgical supply costs, and total direct costs were recorded. A total of 465 patients underwent appendectomy during the study. The mean age of all patients was 11.2 years (range, 1 to 18 years). There were no conversions in the LA or SILA groups. There was a significant difference among surgical technique in regard to surgical supply costs (OA $159 vs LA $650 vs SILA $814, P < 0.01) and total direct costs (OA $2129 vs LA $2624 vs SILA $2991, P < 0.01). In our institution, both multiport laparoscopic and SILA carry higher costs when compared with OA, largely as a result of the cost of disposable instrumentation. Cost efficiency should be considered by surgeons when undertaking a minimally invasive approach to appendectomy.

Purpose To define the financial impact of a pharmacy residency program at a large academic medical center, to assess physician evaluation of pharmacy residents on patient rounds, and to describe the role of the pharmacy resident. Methods One pharmacy resident recorded all interventions during a 4-month period. Interventions were classified as cost-saving or cost-avoiding and were evaluated as such. The cost-savings and cost-avoidance of interventions, along with the costs of alternative weekend coverage and Medicare reimbursement, were summed to determine the financial impact of residency positions. To calculate costs associated with pharmacy residency programs, resident stipend and benefits as well as cost of preceptor teaching and preparation time were added together. Various daily activities were logged to describe the role of the pharmacy resident. To assess physician evaluation of including pharmacy resident on rounds, a short, optional survey was administered to members of the medical team. Results Over the 4-month study period, a total of 347 interventions were made by the pharmacy resident. The total cost-savings and cost-avoidance for interventions during the study period was $110,601. When comparing the costs and benefits of the residency program, there was a net benefit of $55,821 during the study period. Based on survey results, physician evaluation of the inclusion of pharmacy residents on rounds was positive. The resident provided pharmaceutical care to a mean of 15 patients daily, required about 1 hour of preceptor teaching time daily, and provided 7 inservices during the 4-month period. Conclusion Pharmacy residency programs have a positive financial impact. Pharmacy residents are thought by physicians to be helpful, and they enhance patient care when included on rounds.

In 2008, the Centers for Medicare and Medicaid Services (CMS) implemented a provision that denies Medicare payment for hospital-acquired conditions (HACs). This provision brings attention to the quality of patient care and the financial impact associated with “never-events” occurring during a patient’s hospitalization. Our review of HACs focuses on the 5 which are most pertinent to the neurohospitalist: stages III and IV pressure ulcers, catheter-associated urinary tract infection, vascular catheter-associated infection, manifestations of poor glycemic control, and falls resulting in fractures, dislocations, and/or intracranial injuries. We address why CMS came up with them, their impact on quality patient care and hospital finances, and how the neurohospitalist can continue to participate in the future of HAC prevention and management as they relate to one’s patients, hospital, and community.

The strategic importance of business-to-business (B2B) relationships is well recognized, but their financial impact remains equivocal. This study links social capital from three types of B2B networks of young technology firms with their initial public offering (IPO) value. The authors identify three relevant types of absorptive capacity that facilitate the transformation of B2B social capital into IPO value. For the transformation to occur, the authors find that young firms need not only the opportunity to access the resources provided by B2B relationships but also the ability to leverage them through the complementary capability—namely, absorptive capacity. They test the hypotheses on a sample of 177 IPOs, and the results are robust to endogeneity concerns and alternative measures. As one of the first studies in marketing–finance interface to focus on young firms, the findings provide novel insights, such as the deleterious financial consequence of having marketing and research-and-development B2B relationships without the relevant absorptive capacity. The authors conclude with a discussion of managerial implications regarding communicating the value of absorptive capacity, disclosure of marketing-related information, and the importance of marketing for young technology firms.

Adolescent obesity continues to present one of the most difficult challenges for health care providers. Obesity-related comorbidities previously almost unknown to adolescents have become commonplace. The financial impact of obesity is staggering and the psychological effects devastating. As with morbidly obese adults, traditional weight loss methods of dietary, exercise, and behavioral modification have rendered poor results in the severely obese adolescent. The optimal treatment and management of adolescent obesity remains unknown, but surgical weight loss methods, including the laparoscopic adjustable gastric banding (LAGB), may be a viable option for those teens who meet criteria for the procedure. Adolescents choosing the surgical route should be under the care of a multi-disciplinary surgical weight loss team with expertise in the evaluation and management of adolescent obesity and the capability of meeting the distinct physical and psychological needs of this age group. The LAGB is a tool to aid in weight loss but it is no quick fix, or magic bullet. For a successful outcome, a lifelong commitment to a changed lifestyle is essential. The author outlines practice guidelines for adolescents undergoing LABG at Connecticut Children’s Medical Center Surgical Weight Management Program.

Firms spend considerable efforts to build brand awareness and associations among consumers. Yet there is a limited understanding of the financial returns of such investments. In this article, the authors present a framework that uses trademarks as measures of firms' branding efforts. They classify trademarks into two categories—brand-identification trademarks and brand-association trademarks—and propose that they are indicators of firm efforts to build brand awareness and associations among consumers, respectively. The authors then evaluate the chain of effects linking such assets with metrics of firms' financial value. A longitudinal analysis of data collected from secondary sources reveals that the stock (i.e., total number) of brand-association trademarks available to firms in time period t increases their cash flow, Tobin's q, return on assets, and stock returns and reduces their cash-flow variability in period t + 1. Furthermore, the authors observe that the stock of brand-identification trademarks owned by firms in period t − 1 influences the effects of brand-association trademarks on cash flow, Tobin's q, and stock returns. Together, these findings provide useful insights into the financial value of branding.

Aim:To study the physical, psychosocial, emotional and financial impact of having a rare diagnosis.Background:A whole spectrum of problems were known in the member groups of Rare diseases Sweden su...

Fever has been shown to be related to extended hospital stays in neurologically injured patients. We performed meta-analyses of the impact of fever on length of stay (LOS) in the Intensive Care Unit (ICU) and for total hospital length of stay, including all recent scholarship published since 1/1/1995 pertaining to thermoregulation of neurogenic fever and length of hospital stay. We also developed estimates of the financial impact on hospital costs. Fever was shown to have a large, statistically significant impact on both ICU and hospital LOS. For ICU LOS, combined effect size g = .88, Z = 4.24, P < .0001. For hospital LOS, g = .79, Z = 2.2, P = .0278. Mean additional ICU days = 5.7 days; mean additional hospital days = 8.5 days. We estimate that fever added an average of $17,414 in hospital cost to total hospital stays; mean $13,672 (95% Confidence Interval [CI]: $10,074, $17,270) in additional ICU costs and mean $3,742 (CI: —$1,203, $8,820) in additional routine costs.

The financial and personal impact of migraines in the workplace is substantial. Effective management of workplace migraines includes screening, prevention, and effective treatment. Worksite screeners are available to detect the burden of undiagnosed migraine in the workplace. Decreasing the personal and financial impact of migraines in the workplace requires a variety of strategies predicated on collaborative efforts among workers, occupational health nurses, other providers, and management.

Japan has one of the world's comparatively largest elderly populations. Over time, prevalent traditions of family care have declined while the need for such care, as more patients live to experience chronic and acute illnesses, increases. In order to manage these changes effectively, the Japanese government has experimented with different insurance and health care systems. The author explores long-term care insurance and new medical insurance systems that have been tried thus far with an eye towards their effectiveness and financial impact.

Pharmaceutical companies in the US and Europe are recognising the various benefits of using pre-launch named patient programmes (NPPs) as an essential component of their global market access strategy to optimise product launches, produce real-life forecasting data and deliver early access to patients. This paper presents results of the first study to assess the financial impact of using a pre-launch NPP on a product launch. A multivariate analysis demonstrated that implementing pre-launch NPPs had a significant effect on the cash market share of a drug within the first year of launch. Specifically, in a particular drug market, there was a 1.362 times higher odds of spending $1 on a drug that participated in an NPP compared with a drug that did not use NPP. The paper also discusses the various regulatory and practical challenges companies face when implementing NPPs across Europe, and the increasing use of specialist management organisations to coordinate these tailored European programmes.

This article describes the development of a mixed methods approach in a study of the financial implications of the death of a partner. The authors seek to integrate analysis and interpretation of quantitative data from the British Household Panel Survey with qualitative, in-depth interviews with recently bereaved people. A key aim is to build a team that is constantly sharing ideas and information from the two components to inform the combined methodology. The article shows how we are trying to mix methods and integrate ways of working, giving details of the practicalities and issues arising thus far. We further reflect on how integrated team working may lead to more inclusive and consensual ways of knowing and influence integrated outputs.

General surgery residency involves a mixture of 1) education of residents and 2) service by residents. The service that residents provide is not directly reimbursed in our current healthcare system by private healthcare insurance companies. This investigation characterizes the amount of reimbursement a typical resident would be able to collect if residents were allowed to collect for their services as a first assistant. The case logs of residents who graduated over 2 years from our general surgery residency program were reviewed. Data from each resident's last 2 years (postgraduate years 4 and 5) were included in this study. Relative value units (RVUs) for each Current Procedural Terminology code were reviewed. Collections were calculated by multiplying the Medicare conversion factor of $36.7856/RVU, the corresponding RVU, and a “standard” collection rate of 16 per cent for first assistants. There were 13 general surgery residents. These residents provided first assistant help with 91,473 RVUs over 2 years. A total amount of $535,380 could have been collected on first assistant fees for the last 2 years of their residency. Each resident would have been able to collect an average at least $41,414 just for first assistant operative fees. Resident assistance in the operating room provides significant savings for private healthcare insurance companies each year by reducing the need for first assistants. The data demonstrate that private insurance companies receive a considerable amount of pro bono service from residents. Changes in the financing of the current healthcare system in the United States will require educators to examine other sources ( i.e., private insurance companies) for support of graduate medication education.

Individuals with epilepsy consistently report diminished quality of life. The clinical characteristics of seizures and the unpredictable nature of seizure occurrences are some factors that affect quality of life. Prolonged or repetitive seizures can impose psychologic comorbidities, social issues, and lifestyle restrictions that can affect quality of life of patients and their caregivers and family members, who also bear the considerable indirect costs of seizures, including time away from work or school, and even loss of employment. The availability and use of an at-home medication to terminate prolonged or repetitive seizures or in seizure emergencies improves quality of life for patients and their families. Fewer visits to the emergency department are associated with a reduction in the financial burden to families and the health care system. This article discusses factors that contribute to the personal and financial impact of prolonged seizures on adult and pediatric patients, their families, and caregivers.

Clinical pathways are comprehensive systematized patient care plans for specific procedures. The clinical pathway for laparoscopic cholecystectomy was implemented in our department in March 2002. The aim of this study is to evaluate the clinical pathway for this procedure 1 year after implementation. A study was conducted on all the patients included in the clinical pathway since its implementation. The assessment criteria include degree of compliance, indicators of clinical care effectiveness, financial impact, and survey-based indicators of satisfaction. The results are compared to a series of patients undergoing surgery the year prior to implementation of the clinical pathway. As our hospital has a system of cost management, we analyzed the mean cost per procedure before and after clinical pathway implementation. Evaluation was made of a series of 160 consecutive patients who underwent surgery during the period 1 year prior to development of the clinical pathway and met the accepted inclusion criteria. The mean length of hospital stay was 3.27 days, and the mean cost per procedure before pathway implementation was 2149 (±768) euros. One year after implementation of the pathway, 140 patients were included (i.e., an inclusion rate of 100%). The mean length of hospital stay of the patients included in the clinical pathway was 2.2 days. The degree of compliance with stays was 66.7 per cent. The most frequent reasons for noncompliance were staff-dependent, followed by patient-dependent causes (oral intolerance, pain, etc.). The mean cost in the series of patients included in the clinical pathway was 1845 (± 618) euros. Laparoscopic cholecystectomy is an ideal procedure for commencing the systemization of clinical pathways. Results show that it has significantly reduced the length of hospital stay and mean cost per procedure with no increased morbidity and with a high degree of patient satisfaction.

Human resources (HR) management constitutes a blend of human-capital practices, some of which are required for corporate maintenance, but others of which create value for a company. The task that faces HR managers who seek to establish the financial impact of their departments is to be able to show which practices are the ones that create value. One wide-ranging study has shown a clear relationship between specific human-capital-management practices and increased shareholder value. However, apparently not all HR practices boost value—even though it seems they should. Although additional research will be needed to establish which practices boost the bottom line (and which are merely maintenance activities), the data indicate what HR managers have long suspected. That is, HR-management practices are not a necessary evil that creates a drag on corporate profits, as some executives seem to believe. Rather, solid human-capital management does improve corporate profits and creates shareholder value.

The growing number of small states is one of the sui generis characteristics of a future enlarged EU. A wealth of research has been undertaken to analyse the likely effect of candidate states on future enlargement. Most of this has concentrated on large candidate countries, particularly the evaluation of their immediate financial impact on the EU. This paper purports to examine some of the economic effects which small candidate states would have on the enlarged EU with particular reference to its trade policy. Analysis is made of the characteristics of small candidates to shed light on their likely positions and behaviour patterns and, consequently, their effect on the future direction of EU economic policy.

Physicians are becoming reluctant to provide emergency on-call availability without direct compensation from the hospital because of increasing patient visits and a growing proportion of uninsured patients. Accurately valuing on-call compensation is required to insure regulatory compliance and to control the economic exposure to the hospital. Failure to arrange for appropriate physician coverage can give rise to material fines under EMTALA. In establishing the fair market value (FMV) of compensation arrangements, a market approach is generally preferable. However, reliable market data frequently is unavailable. Instead, an analytical approach can be used to establish an objective measure of the value of on-call services relative to a physician’s work time. Then, factors that are unique to the hospital can be considered, along with market data, to reach a final determination of the FMV. In light of the regulatory implications, the financial impact to the hospital and the significant judgment required in arriving at FMV, the use of an independent expert is frequently advisable.

The purpose of this article is to explore the impact of devolution to Wales on the policy control of the UK core executive. Our case study is the implementation of the additionality principle guiding EU structural funds. Successive UK governments have been reluctant implementers of this principle and have played the ‘gatekeeper’ role in controlling the financial impact of EU funds on domestic public spending. Devolution presents a challenge to central control over this policy. In this context, we seek to refine the ‘gatekeeper’ concept by drawing on the insights of the core executive approach.

O utbreaks of Norovirus infection in hospitals are common, but the financial impact is often poorly defined. Following a major outbreak, we propose a simple costing system. The key cost drivers identified were: 1. Lost bed days (LBDs) and cancelled elective surgical operations. The cost of an occupied or closed bed was £204 per day; 2. The period of staff sickness, estimated at an average of four days. Staff costs were estimated at £79.45 per day; 3. The employment of additional nurses; 4. Environmental cleaning (£200 per ward); 5. Additional microbiology costs (£8.27 per sample); 6. Ward consumable costs, estimated at £5 per ward per day. The outbreak involved 16 wards, affecting 139 patients and 124 staff (mainly nurses) over a two week period. LBDs due to inpatient sickness amounted to £85,068. Lost days due to staff sickness cost £39,407. 150 cancelled surgical operations equates with 525 LBDs, costing £107,100. The cost of employing additional nursing staff was £41,465. Further costs included £3,200 for 16 ‘deep cleans', £560 for ward consumables, £1,150 for microbiology specimens and £1,165 for additional infection control hours. The total cost of the outbreak was estimated at £279,115. The costing model described quickly identified key financial pressures and could be applicable to other Norovirus outbreaks.

Category: Ankle, Diabetes, Hindfoot, Lesser Toes, Midfoot/Forefoot, Infection Introduction/Purpose: Osteomyelitis of the foot and ankle is a common condition with a high economic burden in the United States, particularly in the context of diabetes mellitus. The timely and accurate diagnosis of osteomyelitis is important to initiate treatment and possibly reduce overall healthcare costs. Plain radiographs are the initial study of choice given their widespread availability and low cost. Magnetic resonance imaging (MRI) is generally considered the most sensitive imaging modality for detecting osteomyelitis, however it is associated with significant cost and may not change overall treatment as compared to plain radiographs. The purpose of our retrospective study is to determine whether the use of MRI at our institution changed clinical decision making and calculate the financial impact in patients with foot and ankle osteomyelitis. Methods: We retrospectively identified patients at our tertiary care, academic center treated for a diagnosis of osteomyelitis using ICD-9 codes 730.07, 730.17, and 730.27. Demographic data including age, sex, race and ethnicity and patient comorbidities was collected. The use of plain radiographs, MRI, and any operative procedures up to 2 years after the index encounter for each patient were identified. An impact MRI was defined as an MRI that led to an operative procedure within the same admission encounter. The cost of an impact MRI was estimated using the equation: (average MRI cost)*(total MRIs/impact MRIs). Chi- squared test was used to statistically compare patients that underwent procedures in the MRI group vs. those in non-MRI group. Results: 619 patients undergoing osteomyelitis treatment between January 2009 and September 2015 at our institution were identified, of which 40.4% were female and 59.6% were male. 151 patients had a total of 227 MRIs of the lower extremity performed vs. 468 patients that did not have MRIs performed. Of the MRI cohort, 104/151 patients (68.9%) had subsequent operative procedures, whereas in the non-MRI cohort 299/468 patients (63.9%) had subsequent operative procedures (p = 0.26). Of the 227 MRIs performed, 85 were deemed impactful MRIs and 142 were deemed non-impactful MRIs. Average MRI cost at our institution for the lower extremity with and without contrast was $5069.75. Using our previous definition, the cost of an impact MRI was calculated to be effectively $13,539.21. Conclusion: MRI can be an effective modality in aiding the clinical diagnosis of osteomyelitis, however, it can be an unnecessary cost when not used to guide treatment. In our study, we did not find a significant difference in the operative rate between patients undergoing MRIs vs. those that did not. We also found that the effective cost of an MRI that led to a change in treatment was $13,539, almost 2.7 times higher than the average cost of an MRI at our institution.

Previous research asserts that branding is important for both the business-to-business (B2B) and business-toconsumer (B2C) companies. However, literature is silent about the appropriateness of different types of branding strategies for the two types of companies. B2B and B2C companies are inherently different owing to their widely different operations and consumer bases. Therefore, we propose that different marketing strategies may not be equally valuable for the two types of companies. The present research examines the impact of two types of marketing strategies-advertising and branding strategy-on the shareholder value of companies. In particular, we focus on how these impacts vary across B2B and B2C companies, using a sample of 73 B2B and 78 B2C companies in India. The results reveal that B2B firms are uniformly following corporate branding strategy. In contrast, a significant variation is found in the branding strategies of B2C companies. However, branding strategy of a B2C firm is not associated with its shareholder value. Further, the findings suggest that advertisingexpenditure-shareholder-value relationship holds only for B2C companies, but not for B2B firms. Our results are robust after controlling for relevant control variables. The findings suggest that the marketing managers at B2B companies should not base their marketing decisions solely on the models developed for B2C companies. Further, academic researchers are advised to differentiate between B2B and B2C companies while studying the financial impact of marketing variables.

Many working-age individuals with advanced chronic kidney disease (CKD) are unable to work, or are only able to work at a reduced capacity and/or with a reduction in time at work, and receive disability payments, either from the Canadian government or from private insurers, but the magnitude of those payments is unknown.The objective of this study was to estimate Canada Pension Plan Disability Benefit and private disability insurance benefits paid to Canadians with advanced kidney failure, and how feasible improvements in prevention, identification, and early treatment of CKD and increased use of kidney transplantation might mitigate those costs.This study used an analytical model combining Canadian data from various sources.This study included all patients with advanced CKD in Canada, including those with estimated glomerular filtration rate (eGFR)30 mL/min/mWe combined disability estimates from a provincial kidney care program with the prevalence of advanced CKD and estimated disability payments from the Canada Pension Plan and private insurance plans to estimate overall disability benefit payments for Canadians with advanced CKD.We estimate that Canadians with advanced kidney failure are receiving disability benefit payments of at least Can$217 million annually. These estimates are sensitive to the proportion of individuals with advanced kidney disease who are unable to work, and plausible variation in this estimate could mean patients with advanced kidney disease are receiving up to Can$260 million per year. Feasible strategies to reduce the proportion of individuals with advanced kidney disease, either through prevention, delay or reduction in severity, or increasing the rate of transplantation, could result in reductions in the cost of Canada Pension Plan and private disability insurance payments by Can$13.8 million per year within 5 years.This study does not estimate how CKD prevention or increasing the rate of kidney transplantation might influence health care cost savings more broadly, and does not include the cost to provincial governments for programs that provide income for individuals without private insurance and who do not qualify for Canada Pension Plan disability payments.Private disability insurance providers and federal government programs incur high costs related to individuals with advanced kidney failure, highlighting the significance of kidney disease not only to patients, and their families, but also to these other important stakeholders. Improvements in care of individuals with kidney disease could reduce these costs.De nombreux individus en âge de travailler et atteints d’insuffisance rénale chronique (IRC) de stade avancé sont incapables d’occuper un emploi ou se voient dans l’obligation de travailler à temps réduit ou à des postes ne requérant pas de trop grandes capacités physiques. La situation de ces individus les contraint à recevoir des prestations d’invalidité, soit de la part du gouvernement du Canada, soit auprès d’assureurs privés. On ne connaît toutefois pas l’ampleur réelle de ces prestations.Évaluer le montant des prestations d’invalidité versées par le Régime de pensions du Canada et par des assureurs privés à des Canadiens vivant avec l’IRC de stade avancé. Déterminer à quel point des améliorations possibles au niveau de la prévention, du diagnostic et de l’intervention précoce, et d’une meilleure accessibilité à la transplantation rénale pourraient soit réduire ces coûts, soit retarder ou raccourcir les périodes de paiement.Il s’agit d’un modèle analytique combinant des données canadiennes provenant de diverses sources.Tous les patients canadiens atteints d’IRC de stade avancé, y compris ceux présentant un débit de filtration glomérulaire (DFGe)30 mL/min/1,73 mEstimés en matière de prestations d’invalidité dans le cadre d’un programme provincial de soins en néphrologie, jumelés à la prévalence de l’IRC de stade avancé, de même que le montant approximatif des prestations d’invalidité versées par le Régime de pensions du Canada et les régimes d’assurance privés.Nous estimons que les Canadiens souffrant d’IRC de stade avancé reçoivent au moins 217 millions de dollars par an en prestations d’invalidité. Cette estimation dépend de la proportion de personnes incapables de travailler et donc, une variation possible de cette estimation pourrait signifier que les patients atteints d’IRC de stade avancé reçoivent en fait jusqu’à 260 millions de dollars par an en prestations d’invalidité. Les stratégies applicables pour réduire la proportion de personnes atteintes d’une maladie rénale de stade avancé, soit par le biais de la prévention, du ralentissement de la progression de la maladie ou de la diminution de sa gravité, ou alors par l’augmentation du nombre de transplantations pourraient réduire le montant des prestations versées par le Régime de pensions du Canada et les régimes d’assurance privée de 13,8 millions de dollars par an en cinq ans.Cette étude ne tient pas compte de la manière dont la prévention de l’IRC ou l’augmentation du nombre de transplantations rénales seraient susceptibles de permettre d’économiser sur les coûts en santé de façon plus globale.Les fournisseurs d’assurance-invalidité privée et les programmes du gouvernement fédéral supportent des coûts très élevés face aux personnes atteintes d’IRC de stade avancé. Ce constat met en lumière la portée de l’insuffisance rénale non seulement pour les patients et leurs familles, ou pour le système de santé, mais également pour ces autres intervenants majeurs. Des améliorations dans les soins prodigués aux personnes souffrant de maladies rénales pourraient contribuer à réduire ces coûts.

The authors describe the most important methodological challenges often encountered in conducting research and evaluation on the financial impact of health promotion. These include selection bias, skewed data, small sample size, metrics. They discuss when these problems can and cannot be overcome and suggest how some of these problems can be overcome through a creating an appropriate framework for the study, and using state of the art statistical methods.

Purpose. To examine the literature from the past 20 years and identify those studies that support the economic merit of health promotion. Data Source. A panel of experts was used to identify the top studies supporting the purpose of this article. Study Inclusion and Exclusion Criteria. Studies were chosen based on the following criteria: the study (1) examined the relationship between health risks and financial outcomes, or health promotion programs and financial outcomes; (2) provided strong and compelling financial data supporting the worth of health promotion; (3) had a high-quality methodology; (4) answered an important question or replicated important findings with superior methodology; and (5) represented U.S.-based initiatives published since 1980. After initially nominating a group of studies for consideration, panelists rated each on a scale from 1 to 3 representing their opinion of importance. Studies rating the highest were included for this discussion. Data Extraction Methods. Studies were analyzed by population characteristics, design, statistical tests, limitations, and results. This information was summarized for each identified article. Major Conclusions. A relationship between modifiable health risk factors and health care costs is supported by research. Health promotion interventions appear to provide positive financial returns, most notably for health care costs and absenteeism reduction. Private sector initiatives seem to be driving economic-based research. Overall, health promotion shows promising results for providing financial advantages for its sponsors; however, if this discipline is to show its true worth, considerable funding is needed from government or philanthropic sources to cover the substantial costs of quality research.

A conceptual framework to guide research on the financial impact of health promotion programs is described. Important questions that must be answered within this framework are discussed and brief summaries of the research addressing these questions are summarized. Key issues and challenges that are encountered in designing and implementing financial outcome research are reviewed.

Intraoperative echocardiography (IOE) has become an important part of cardiovascular anesthesiology. An IOE service should provide the equipment and personnel needed to acquire and interpret echocardiographic images during surgery and communicate findings to the medical record. It also should archive images and reports, provide training in echocardiography skills, arrange for continuous quality improvement, and develop a means to bill for echocardiography services. Although the costs of providing IOE services can be estimated, the financial impact of starting such a service will vary greatly between institutions depending on the availability and use of existing resources and expertise. IOE is not a trivial skill and requires considerable training and experience to perform competently. Reimbursement for IOE services provided by anesthesiologists is highly dependent on local policies and will require continued vigilance and effort to be made fair and reasonable for all providers. The primary motivation for anesthesiologists to become involved in IOE is improved patient care.

This article provides an overview of some of the key issues concerning the future of pensions and retirement in Europe. The main theme of the article is that health status has a critical bearing on the future of both pensions and retirement. If ageing populations are unhealthy, not only will this be costly in personal, family and societal terms but, in addition, it closes down policy options which have the potential to offset the financial impact of ageing, such as extended employment. Therefore it is important, in policy terms, to consider the three issues (pensions, retirement and health) together and not repeat the common tendency to separate the social security and health questions. The article focuses on four key issues with regard to the European Union: the reform of pensions, the implications of pension reform for intergenerational solidarity, the future of retirement, and the link between economic activity and health. It starts with a brief overview of the demographic context.

The travel industry is struggling to survive the erratic movement of the domestic and international economies and the effect on both business and leisure travel. While suppliers are seeking innovative pricing strategies, travel agencies often bear a critical financial impact on a day-to-day basis. This article discusses an easily applied technique for identifying and measuring the productivity components of efficiency and effectiveness in a small travel agency environment.

Pain is the most frequently reported symptom in the health care industry today. Chronic pain in the United States costs millions of dollars annually, and its financial impact is mounting. For individuals living in the United States, chronic pain affects nearly all normal activities and often leaves the person feeling helpless and hopeless. Literature supports the idea that chronic pain does not have the same debilitating effect in the Eastern cultures as it does in the Western cultures. Therefore, clients from both a Western and Eastern culture were studied. This qualitative research, based on grounded theory, sampled 20 persons from India and 20 from the United States. Focused, open-ended inter-views were used as the major manner of gathering data. Although the condition of chronic pain was the same for each culture, there were significant differences regarding the phenomenon of chronic pain. This research indicates the need for health professionals to assess, implement a plan of care for, and evaluate patients' suffering and need for improved quality of life rather than focusing only on the elimination of pain.

A large number of patients with febrile illness are evaluated in emergency departments. Blood cultures are often obtained on such patients without reference to established guidelines. As a result of such practice, unnecessary blood cultures are being ordered with negative financial impact on both hospitals and pa tients.Generally speaking, as the number of blood cul tures obtained increases so does the number of false positive results. Follow-up on these results directly impacts on patient care as these patients are often subjected to call backs, additional work up, and ad mission to the hospital.This study reviews the manner in which blood cul tures were ordered before and after the introduction of general guidelines for their use. It outlines a proc ess whereby excessive ordering of blood cultures can be eliminated and suggests that this approach may be effective in limiting inappropriate use of other labo ratory and diagnostic studies.

Introduction Back pain is a fairly common problem, which affects a large portion of the population across all ages and has an impact on quality of life. It has a major financial impact on the health care system and industry due to loss of productive labor hours. Intervertebral disk degeneration is the single most common implicated cause of back pain. Presently, there is no medical treatment or therapeutic agent to address this problem and surgery is the only offered option. Intevertech 1(IVT-1), currently being patented by Intervertech Inc, represents a novel peptide produced in mammals. It has the ability to heal injured tissues and increase cell resistance to hypoxic episodes. The aim of this study was to determine how nucleus pulposus (NP) and annulus fibrosus (AF) cells respond to different Intervertech 1 concentrations when cultured in a three dimensional system consisting of an alginate scaffold. Materials and Methods Isolation and culture of Bovine intervertebral disk cells: Adult bovine tails (2 to 3 years old) were obtained 2 to 3 hours after slaughter. The IVDs were dissected from their adjacent vertebral bodies and separated into NP and AF. AF and NP cells were isolated by digestion with collagenase, and were resuspended in 1.2% alginate in 0.15M sodium chloride at a concentration of 2 million cells per mL. Droplets of cell suspension were released through a 18-gauge needle into 102 mM calcium chloride solution and left to polymerize for 5 minutes.1 The beads were placed in 48 well plates at a density of 5 beads/well (in 1 mL of DMEM high glucose supplemented with 10% fetal bovine serum and antibiotics). Analysis of proteoglycan (aggrecan) synthesis:Alginate beads were stabilized for 5 days in 1 mL of DMEM and then exposed to 5 nM-400 nM of IVT-1 in DMEM supplemented with 25µCi of 35S-sulfate/mL for 48 hours to determine aggrecan synthesis. At the end of the culture period, media was collected and dialyzed exhaustively against RO water (Microdialysis chamber, Life Technologies with Spectr/Por 3, 3-kDa molecular weight cut-off dialysis membrane) followed by cold chase with 1M MgSO4 for 2 hours to remove unincorporated 35S-sulfate. Counts per minutes (CPM) reads were normalized to control and expressed as an arbitrary value. All experiments were performed in triplicates. Results were considered significant with a p Results In both cell types proteoglycan synthesis increased with dosage in culture up to 10 nM, then tended to plateau between 25 nM and 50 nM but increased at 100 n M and 200 nM (Fig. 1). Maximal response was at 200 nM but declining thereafter. At all time points, the levels of proteoglycan synthesis by AF cells was greater than by NP cells. Conclusion The role of Intevertech 1 in disk metabolism is not understood. Intevertech 1 is a small peptide involved in a wide variety of physiological functions. This study indicates that IVT-1 is able to stimulate proteoglycan synthesis in bovine disk cells cultured in a 3D system. Perhaps surprisingly, intervertech 1 stimulates AF cells to produce more proteoglycan than NP cells. This difference may relate to receptor usage on AF and NP cells by intervertech 1. The most significant biochemical change to occur in disk degeneration is loss of proteoglycan. Promotion of proteoglycan synthesis is the main strategy for disk regeneration therapy and this peptide shows promise in this direction and can be established as a potential therapeutic agent for annular repair especially in later stages of disk degeneration when the disc's load bearing behavior shifts to the annulus. One major advantage of Intevertech 1 over recombinant growth factors for therapeutic use is the large saving in cost. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared Mwale, F, Ciobanu, I, Giannitsios, D, Roughley, P, Steffen, T, and Antoniou, J. Effect of oxygen levels on proteoglycan synthesis by intervertebral disk cells. Spine 2011;36:E131-E138

Background Diabetic ketoacidosis (DKA) is an emergency medical condition that can be life-threatening if not managed properly. We designed DKA management guidelines based on the current American Diabetes Association recommendations. No previous studies have been done to demonstrate the effects of DKA guidelines on the residents9 knowledge, quality of patient care and financial impact on the hospital. Design Longitudinal case-control study with two arms: educational and patient care/financial impact. An electronic Web-based assessment/educational tool was used to evaluate DKA knowledge level in internal medicine residents. Multiple aspects of patient care, length of hospital stay and hospital charges were compared before and after guidelines implementation. The same measures were used for analysis in a non-teaching local hospital where no DKA guidelines were implemented. Methods A Web-based testing software ( TestWare ) was used for educational/assessment testing before and after DKA guidelines implementation. Resident level of knowledge, reflected by test scores, was compared to residents at the same level of training. All patients admitted during one calendar year were included in the study. Comparisons between two hospitals were done and each patient chart was reviewed to analyze the degree of compliance and changes in patient care cost before and after DKA guidelines introduction. Results The total number of internal medicine residents tested before and after the DKA guidelines implementation was 37 and 65 respectively. Testing scores improved from 48% to 54% after implementation of the guidelines ( p = .06). The total number of patients was 178. Overall, the degree of compliance with current guidelines improved in both hospitals (49% before to 77% after at Community Medical Center [ p Conclusion The Web-based educational/assessment testing tool was effective, leading to improvement on average in the knowledge level by 9%. The introduction of DKA guidelines after Web-based testing significantly improves care for patients with DKA. Web-based educational/assessment testing followed by DKA guidelines implementation can be utilized in any hospital striving to improve quality of care for DKA patients.