We report a rare case of malignant peripheral nerve-sheath tumour of the diaphragm in a 12-year-old boy with neurofibromatosis presented clinically and radiographically as recurrent lung infection. Ultrasound revealed a pedunculated diaphragmatic tumour invading the posterior chest wall. This case highlights that this unusual tumour may limit diaphragmatic excursion leading to, and even being masked by, superimposed lung infection. In patients with neurofibromatosis, ultrasound is recommended when chest radiography shows a basal lung opacity.
A85 level simulation considering a cohort of 1.000.000 individuals of 60 years of age in a time horizon of 5 years, assuming a retirement age of 65. PCV effectiveness was extrapolated from infant results. Absence days due to health events were retrieved from national labor legislations. Average wage was retrieved from the Brazilian Institute for Geography and Statistics (IBGE) 2012 data and productivity was estimated from the indicator 'revenue generated by the employee', from a market research developed by Exame magazine in 2012 using IBGE and the Brazilian Central Bank data. The base case considered a large corporation in Brazil with approximately 4000 eligible individuals. Values were expressed in 2012 USD.
A85level simulation considering a cohort of 1.000.000 individuals of 60 years of age in a time horizon of 5 years, assuming a retirement age of 65. PCV effectiveness was extrapolated from infant results. Absence days due to health events were retrieved from national labor legislations. Average wage was retrieved from the Brazilian Institute for Geography and Statistics (IBGE) 2012 data and productivity was estimated from the indicator 'revenue generated by the employee', from a market research developed by Exame magazine in 2012 using IBGE and the Brazilian Central Bank data. The base case considered a large corporation in Brazil with approximately 4000 eligible individuals. Values were expressed in 2012 USD. RESULTS: Independent campaign with PPV23 and PCV13 vaccination plus free campaign totaled US$40.62 and US$61.40 per employee respectively.
OBJECTIVES: Anastomotic Leakage (AL) is a serious complication that may follow colorectal resection, increasing overall costs. The aim of this study was to assess the additional inpatient economic burden of AL at one Italian hospital. METHODS: 317 patients who underwent colorectal resection between January 2015 and December 2016 in Policlinico Universitario Campus Biomedico were included in this retrospective cohort study. For each patient, baseline demographics, clinical characteristics, healthcare resource utilization and costs were extracted from the hospital's database. The primary endpoint was inpatient costs. Bivariate comparisons were conducted between patients with and without AL using Chi square tests for categorical outcomes and t-tests or Wilcoxon rank sum test for continuous outcomes. RESULTS: Mean (SD) age in the cohort was 66.7 (13.2) years and 51.8% of patients were male. 79.5% of patients had malignant disease and 58.9% had an American Society of Anesthesiologists (ASA) score of 2/6. More patients had laparoscopic surgery (72.6%) compared to open, in 23% of cases derivative stoma was made during the primary operation. 39 patients (12.3%) developed AL during hospital stay. When compared to patients without AL, more AL patients were male (71.8% vs 51.8%), more had cancer (92.3% vs 77.7%) and more had a derivative stoma (20.5% vs. 9.9%). Age, surgery approach, are similar in two groups. In the bivariate analysis, patients with AL had significantly higher total inpatient costs (V14,781.8 vs V7,110.8, p<0.001), higher LOS (20.1 vs 10.3 days, p<0.001) and ICU admissions (38.5% vs 9.0%, p<0.001) relative to patients without AL. CONCLUSIONS: AL increases the inpatient costs 2 times in this Italian hospital. Reducing AL may improve quality of care and substantially reduce hospital costs while increasing the efficiency of resource utilization.
OBJECTIVES: Anastomotic Leakage (AL) is a serious complication that may follow colorectal resection, increasing overall costs. The aim of this study was to assess the additional inpatient economic burden of AL at one Italian hospital. METHODS: 317 patients who underwent colorectal resection between January 2015 and December 2016 in Policlinico Universitario Campus Biomedico were included in this retrospective cohort study. For each patient, baseline demographics, clinical characteristics, healthcare resource utilization and costs were extracted from the hospital's database. The primary endpoint was inpatient costs. Bivariate comparisons were conducted between patients with and without AL using Chi square tests for categorical outcomes and t-tests or Wilcoxon rank sum test for continuous outcomes. RESULTS: Mean (SD) age in the cohort was 66.7 (13.2) years and 51.8% of patients were male. 79.5% of patients had malignant disease and 58.9% had an American Society of Anesthesiologists (ASA) score of 2/6. More patients had laparoscopic surgery (72.6%) compared to open, in 23% of cases derivative stoma was made during the primary operation. 39 patients (12.3%) developed AL during hospital stay. When compared to patients without AL, more AL patients were male (71.8% vs 51.8%), more had cancer (92.3% vs 77.7%) and more had a derivative stoma (20.5% vs. 9.9%). Age, surgery approach, are similar in two groups. In the bivariate analysis, patients with AL had significantly higher total inpatient costs (V14,781.8 vs V7,110.8, p<0.001), higher LOS (20.1 vs 10.3 days, p<0.001) and ICU admissions (38.5% vs 9.0%, p<0.001) relative to patients without AL. CONCLUSIONS: AL increases the inpatient costs 2 times in this Italian hospital. Reducing AL may improve quality of care and substantially reduce hospital costs while increasing the efficiency of resource utilization.
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