BackgroundIn the aftermath of the global financial crisis, millions of households have been left with debts that they are unable to manage. Indebtedness may impair the wellbeing of those affected by it for years to come. This systematic review focuses on the long-term consequences of indebtedness on health.MethodsThe method used in the paper is a systematic review. First, bibliographic databases were searched for peer-reviewed articles. Second, the references and citations of the included articles were searched for additional articles.ResultsThe results from our sample of 33 peer-reviewed studies demonstrate serious health effects related to indebtedness. Individuals with unmet loan payments had suicidal ideation and suffered from depression more often than those without such financial problems. Unpaid financial obligations were also related to poorer subjective health and health-related behaviour. Debt counselling and other programmes to mitigate debt-related stress are needed to alleviate the adverse effects of indebtedness on health.ConclusionsThe results demonstrate that indebtedness has serious effects on health.

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With sublingual administration, the drug has to dissolve rapidly in a small volume of saliva. Based on the present absorption studies in rabbits, the solid dispersion preparation and cyclodextrin complexation were postulated to be useful ways to attain successful sublingual administration of perphenazine. Good sublingual absorption was also achieved by micronization of perphenazine. As far as we are aware, this paper is one of the first to evaluate the sublingual administration of a solid dispersion in vivo.

Operative care is one of the major areas of healthcare services as over 310 million surgeries are conducted yearly. Surgery cancellations is a widely used indicator when evaluating the quality of preoperative care. Cancellations cause financial lost for organizations, however there is only limited research about the costs. The aim of this study was to evaluate the cost of elective day of surgery (DOS) cancellations in 13 operative specialties at a university hospital in Finland between September 1, 2015 and May 31, 2016 after a structured preoperative protocol was implemented to practice and a cancellation rate of 4.7% was recognized. Procedure prices conducted the data for the research and were collected from the hospital’s invoicing system. Financial loss and savings of cancellations were calculated from the total cost of procedures. As a result the total cost of DOS cancellations during the nine-month time period was 953,374.27 euros and mean loss of a single cancelled operation was 2,459.91 euros. The total of material savings for the hospital were 106,917.33 euros. As a conclusion, DOS cancellations cause unnecessary wastage, and financial aspects should be followed and evaluated systematically by setting goals and providing continuing developments.

A preoperative nursing care structure should be implemented in clinical practice and then evaluated to measure whether the hypothetical outcomes reported in this literature review can be achieved.

Aims and objectives:To evaluate the impact of implementing an evidence-based, structured preoperative protocol on day of surgery cancellations in 13 operative specialties.Background: Surgery cancellations cause unnecessary harm for patients and organisations as many cancellations could be prevented. Preoperative care has developed in recent years, and several preoperative interventions have been introduced. However, the optimal model for organising preoperative care remains unknown. Cancellations are a commonly used indicator when evaluating the success of preoperative care.Design: Observational study with two study phases: before and after.Methods: The cancellation data were collected from the hospital register from 1September 2013-31 May 2014 (n = 591) and from September 2015-May 2016(n = 542). The compliance rate of the preoperative protocol was evaluated in group sessions (n = 13) during spring 2016 using the participation of preoperative healthcare professionals (n = 49). The data were analysed statistically.Results: Cancellation rates varied between 1.6%-9.7% (in the first phase) and between 1.5%-7.7% (in the second phase). A remarkable decrease was found in patients who failed to attend their scheduled procedures. The mean of compliance to the preoperative protocol across all specialties was 82.3%. A correlation between the rate of cancellation and the rate of compliance with the preoperative protocol was found.Conclusions: A preoperative protocol promotes the scheduled arrival of surgical patients to the hospital and therefore decreases cancellation rates.Relevance to clinical practice: An evidence-based preoperative care protocol should be introduced for all healthcare professionals working in preoperative care to ensure smooth, safe and high-quality care for surgical patients. | INTRODUCTIONCancellations are a problem in perioperative care, and most of them are preventable (Kumar & Gandhi, 2012). It has been estimated that 50%-65% of cancellations could be potentially avoided (Chughtai, Michael, & Qurashi, 2014;Fitzsimons, Dilley, Moser, & Walker, 2016;Kim & Lee, 2014). In this study, day of surgery cancellation (DOS) is defined as a scheduled elective operative procedure that was cancelled on the same day it was planned to occur. DOS cancellations are described to be one of the 23 nursing-sensitive quality indicators for evaluating and monitoring efficiency, patient safety and crisis event management in perioperative care (Wu et al., 2017 The largest costs of cancelled surgeries after the preparation of the surgery room and during the surgery itself are related to human resources (62.8%) (Perroca, Jerico Mde, & Facundin, 2007).In tertiary care paediatric outpatient surgical centres, the cost of a cancelled urology patient was 4,802 US dollars, which led to an approximately 500,000 dollar loss over a 7-month period with a cancellation rate of 13.3% (Pohlman, Staulcup, Masterson, & Vemulakonda, 2012). Calculating the actual overall cost of cancellations is complicated because of the variations in care ...

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Aqueous solubility of a drug substance is an important attribute affecting oral bioavailability.Nanonization, particle size reduction to submicron level, is an elegant approach to improve drug solubility and dissolution by increasing the surface energy, which in turn necessitates the use of stabilizers. The purpose of this study was to develop a nanosuspension of a practically water-insoluble investigational molecule by nanomilling approach using wet media milling. A variety of polymeric and surface active excipients were tested for their wettability. A combination of hydroxypropyl methylcellulose and sodium lauryl sulfate (SLS) were selected as stabilizers on the bases of compatibility studies and efficient wettability behaviour in contact angle measurements (≈80˚). A factorial design set-up was used to study the effect of milling bead diameter and stabilizer concentration on the efficiency of particle size reduction.Nanonization outcome was different when milling beads of 0.5 mm and 1 mm diameter were used at different concentrations of the stabilizers, which demonstrated the complex nature of the whole system. Storage of the nanosuspensions under different temperature conditions resulted only in minor changes of the particle size fractions.