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1. Right ventricular function declines after cardiac surgery in adult patients with congenital heart disease

Author

Mark J. Schuuring, Berto J. Bouma, Barbara J.M. Mulder, Mark G. Hazekamp, Pauline P. M. Bolmers, Dave R. Koolbergen, Wim K. Lagrand, Stefan De Hert, E. M. F. H. de Beaumont, Rianne H.A.C.M. de Bruin-Bon, Amsterdam Cardiovascular Sciences, Cardiology, Cardiothoracic Surgery, Amsterdam institute for Infection and Immunity, Intensive Care Medicine, Anesthesiology, and Other Research

Subjects
Adult, Heart Defects, Congenital, Male, medicine.medical_specialty, Time Factors, Heart disease, Ventricular Dysfunction, Right, Doppler echocardiography, Risk Assessment, law.invention, Young Adult, Troponin T, law, Risk Factors, Internal medicine, Cardiopulmonary bypass, Medicine, Humans, Radiology, Nuclear Medicine and imaging, Cardiac Surgical Procedures, Creatine Kinase, Cardiac imaging, Netherlands, Congenital heart disease, Academic Medical Centers, Original Paper, Tricuspid valve, Chi-Square Distribution, medicine.diagnostic_test, business.industry, Recovery of Function, Cardiac surgery, medicine.disease, Intensive care unit, Right ventricular function, Echocardiography, Doppler, medicine.anatomical_structure, Treatment Outcome, Echocardiography, Radiology Nuclear Medicine and imaging, Cardiology, Linear Models, Ventricular Function, Right, Female, business, Cardiology and Cardiovascular Medicine, Biomarkers
Abstract

Right ventricular function (RVF) is often selectively declined after coronary artery bypass graft surgery. In adult patients with congenital heart disease (CHD) the incidence and persistence of declined RVF after cardiac surgery is unknown. The current study aimed to describe RVF after cardiac surgery in these patients. Adult CHD patients operated between January 2008 and December 2009 in the Academic Medical Centre in Amsterdam were studied. Clinical characteristics, laboratory tests, surgical data and intensive care unit outcome were obtained from medical records. RVF was measured by trans-thoracic echocardiography (TTE) and expressed by tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging (RV S') and myocardial performance index (MPI) pre-operatively and direct, at intermediate and late follow up. Of a total of 185 operated, 86 patients (mean age 39 +/- A 13 years, 54% male) had echo data available. There was a significant fall in RVF after cardiac surgery. TAPSE and RV S' were significantly higher and MPI was significantly lower pre-operatively compared to direct post-operative values (TAPSE 22 +/- A 5 versus 13 +/- A 3 mm (P

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2. A web-based generalist-specialist system to improve scheduling of outpatient specialty consultations in an academic center.

Author

Weiner, Michael, Hoyek, Georges El, Wang, Lynnette, Dexter, Paul R., Zerr, Ann D., Perkins, Anthony J., James, Felgrace, Juneja, Rattan, and El Hoyek, Georges

Subjects
*OUTPATIENT medical care, *MEDICAL errors, *MEDICAL practice, *MEDICAL education, *MEDICAL care, *INTERNET standards, *MEDICINE, *RESEARCH, *FERRANS & Powers Quality of Life Index, *ACADEMIC medical centers, *RESEARCH methodology, *EVALUATION research, *MEDICAL cooperation, *COMPARATIVE studies, *MEDICAL referrals, *RESEARCH funding, *MEDICAL appointments, *OUTPATIENT services in hospitals, MEDICAL standards
Abstract

Background: Failed referrals for specialty care are common and often represent medical errors. Technological structures and processes account for many failures. Scheduling appointments for subspecialty evaluation is a first step in outpatient referral and consultation.Objective: We determined whether moving from paper-based referrals to a Web-based system with automated tracking features was associated with greater scheduling of appointments among referred patients.Design: Staggered implementation of a quality-improvement project, with comparison of intervention and control groups.Participants: Patients 21 or more years of age referred from any of 11 primary-care clinics to any of 25 specialty clinics.Interventions: Faxed referrals were replaced by a Web-based application shared by generalists and specialists, with enhanced communications and automated notification to the specialty office.Measurements: We compared scheduling before and after implementation and time from referral to appointment. A logistic regression analysis adjusted for demographics.Main Results: Among 40,487 referrals, 54% led to scheduled specialty visits before intervention, compared to 83% with intervention. The median time to appointment was 168 days without intervention and 78 days with intervention. Scheduling increased more when duplicate referrals were not generated (54% for single orders, 24% for multiple orders). After adjustment, referrals with the intervention were more than twice as likely to have scheduled visits.Conclusions: With a new Web-based referrals system, referrals were more than twice as likely to lead to a scheduled visit. This system improves access to specialty medical services. [ABSTRACT FROM AUTHOR]

Published
2009
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3. Modelling the return on investment of preventively vaccinating healthcare workers against pertussis

Author

Marie-Josée J. Mangen, Hero de Boer, Gerard Frijstein, Anke M. Hövels, Luqman Tariq, and Extramural researchers

Subjects
Adult, Male, medicine.medical_specialty, Pediatrics, STRATEGIES, IMPACT, Whooping Cough, Cost, NETHERLANDS, OUTBREAK, Health Personnel, Preventive vaccination, Disease Outbreaks, Pertussis, Return on investment, Health care, medicine, Humans, Healthcare workers, Hospital Costs, Investments, Whooping cough, health care economics and organizations, Netherlands, Pertussis Vaccine, Academic Medical Centers, Cross Infection, business.industry, Nosocomial outbreak, Vaccination, Infant, Newborn, Outbreak, Length of Stay, medicine.disease, Infectious Diseases, Emergency medicine, Sick leave, Pertussis vaccine, Female, business, Models, Econometric, medicine.drug, Research Article
Abstract

Background Healthcare workers (HCWs) are at particular risk of acquiring pertussis and transmitting the infection to high-risk susceptible patients and colleagues. In this paper, the return on investment (ROI) of preventively vaccinating HCWs against pertussis to prevent nosocomial pertussis outbreaks is estimated using a hospital ward perspective, presuming an outbreak occurs once in 10 years. Methods Data on the pertussis outbreak on the neonatology ward in 2004 in the Academic Medical Center Amsterdam (The Netherlands) was used to calculate control costs and other outbreak related costs. The study population was: neonatology ward staff members (n = 133), parents (n = 40), neonates (n = 20), and newborns transferred to other hospitals (n = 23). ROI is presented as the amount of Euros saved in averting outbreaks by investing one Euro in preventively vaccinating HCWs. Sensitivity analysis was performed to study the robustness of the ROI. Results are presented at 2012 price level. Results Total nosocomial pertussis outbreak costs were €48,682. Direct control costs (i.e. antibiotic therapy, laboratory investigation and outbreak management control) were €11,464. Other outbreak related costs (i.e. sick leave of HCWs; restrictions on the neonatology ward, savings due to reduced working force required) accounted for €37,218. Vaccination costs were estimated at €12,208. The ROI of preventively vaccinating HCWs against pertussis was 1:4, meaning 4 Euros could be saved by every Euro invested in vaccinating HCWs to avert outbreaks. ROI was sensitive to a lower vaccine price, considering direct control costs only, average length of stay of neonates on the neonatology ward, length of patient uptake restrictions, assuming no reduced work force due to ward closer and presuming more than one outbreak to occur in 10 years’ time. Conclusion From a hospital ward perspective, preventive vaccination of HCWs against pertussis to prevent nosocomial pertussis outbreaks results in a positive ROI, presuming an outbreak occurs once in 10 years. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0800-8) contains supplementary material, which is available to authorized users.

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