A Cost-Effectiveness Study Comparing Ready-toAdminister and Traditional Vial-and-Syringe Method for Opioids

OBJECTIVE: The purpose of this study was to develop a cost-effectiveness model for manufacturer-prepared prefilled ready-to-administer (RTA) syringe products versus the traditional vial-and-syringe administration of intravenous (IV) opioids. METHODS: Cost parameters included cost of manufacturer-prepared prefilled RTA syringe product, traditional vial and syringe, drug preparation, drug administration, drug waste, and severity of error. Effectiveness endpoint included number of preparation and administration errors in each comparator arm. Simple decision tree was used, and incremental cost-effectiveness ratio (ICER) was calculated as the reduction in the incremental errors per observation with RTA compared with traditional vial-and-syringe method. One-way sensitivity analysis (OWSA) and probabilistic sensitivity analysis (PSA) were conducted to test the robustness of the model. TreeAge Pro software was used to create and analyze the decision model. All the cost parameters were converted to USD 2021. RESULTS: Base-case analysis showed that the cost of the RTA arm was lower by $182.61 and the number of errors in the RTA arm was lower by 94$22,554 per additional error avoided. Sensitivity analysis showed that ICER value was most sensitive to the probability of errors; however, the results were robust in showing that RTA is the preferred cost-effective option, when both the costs and effectiveness parameters were varied substantially. CONCLUSION: This economic evaluation  analyzed costs of using manufacturer-prepared prefilled RTA syringe product IV opioids and incremental benefits in terms of reduced errors, adverse events, and their associated costs. Manufacturer-prepared prefilled RTA syringe product was found to be cost-effective, demonstrating cost savings by reduction in the error rates. Integrating and adopting RTA syringe products within a health system could play an important role in improving care, building efficiency, increasing patient safety, and saving money. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40122-022-00402-z

MRI findings in ruptured ovarian ectopic pregnancy: an unexplored avenue

Ovarian ectopic pregnancy (OEP) is a rare form of ectopic pregnancy (EP) and constitutes approximately 0.5-3% of all ectopic cases. Its presentation mimics the symptoms of tubal ectopic pregnancy, hemorrhagic ovarian cyst/follicle, tubo-ovarian abscess, urinary tract calculi, appendicitis or ovarian torsion. Occasionally determining the anatomic location of an extra-tubal ectopic pregnancy based on ultrasound imaging and presentation alone can be challenging, particularly when it is adherent to the fallopian tube. Although transvaginal ultrasound (TVS) is the primary modality used in the diagnosis, various forms of OEP and its complications may be incidentally detected and further evaluated on computed tomography (CT) or magnetic resonance imaging (MRI) when an alternative diagnosis is suspected. We reported a case of a second gravid para zero, 25 years old lady, who came with pain in the left lower abdomen. Her urine pregnancy test was positive. TVS showed empty uterine cavity, an extremely tender, heterogenous hyperechoic right adnexal mass, but no obvious gestation sac (GS). A large hematoma was detected adjacent to it in the pouch of Douglas (POD). Keeping a high suspicion of ectopic pregnancy, MRI was performed to evaluate the lesion better which revealed a natural, non-assisted, ruptured right ovarian ectopic pregnancy and was subsequently confirmed at laparotomy and proven on histopathology. Patient underwent left oophorectomy and discharged on 4th day with uneventful follow up.

Assessing Unmet and Latent Demand for Pharmacists at the State Level

Background: Past reports suggest that a near balance has been reached in the supply and demand for pharmacists in the US. Although data on the level of supply of pharmacists is available, there is no continuous and systematic tracking of the level of demand (unmet and latent) for pharmacists at state level. Unmet demand, an established construct in pharmacy workforce, is important to measure the number of vacancies and assess pharmacist shortage consistently over time. Latent demand or potential demand is a novel construct and has never been measured in pharmacy workforce. With the increase in supply, it is important to measure the potential demand that could be budgeted in pharmacies in the near future. Objective: The objective of this study was to measure the unmet and latent demand for pharmacists and explore the association between latent demand and workload characteristics in community and hospital pharmacies in Wisconsin in 2011-12. Methods: The study used a cross-sectional, descriptive survey design. A sample of community pharmacies (n=1,064) and hospital pharmacies (n=126) licensed in Wisconsin in 2011-12 was identified. Key informants (managers/owners) of sampled pharmacies were sent a one-page cover letter explaining the purpose of the study and requesting participation and a three page survey form. The main outcome measures of the study were total number of FTE pharmacist positions vacant, presence of adequate staff size, additional number of FTE pharmacist positions needed to attain adequate staff size, prescription volume, daily census, hospital size and number of hours prescription department is open. Descriptive statistics were calculated for all the pharmacies collectively, then separately for community and hospital pharmacies. Pharmacy setting, vacancies and workload characteristics of pharmacies with and without latent demand were compared using chi-squared test of independence and/or t-test. Sample weights were calculated and used in all the analyses to weigh the estimates to all pharmacies in Wisconsin. Results: Overall response rate to the survey was 50.1%. Of the total number of FTE pharmacist positions budgeted in Wisconsin, 54.3 FTE positions (1.5%) were reported vacant in 2011-12. Approximately 28.2% of the community and hospital pharmacies reported the presence of latent demand. Latent demand was significantly associated with higher workload in community pharmacies and larger bed size in hospital pharmacies. Conclusion: There appeared to be a balance between the supply and demand for pharmacists in Wisconsin in 2011-12. There is a potential for additional FTE positions (latent demand) to be budgeted in pharmacies to attain adequate pharmacist staff size. It is important to consistently track the level of unmet and latent demand for pharmacists in Wisconsin and combine this information with other workforce characteristics to guide the decision making of pharmacy workforce planners and pharmacy managers.   Type: Original Researc

Impact of telehealth on health care resource utilization during the COVID-19 pandemic

Aim: To assess healthcare utilization (HCRU) among patients with incident telehealth visit during the COVID-19 pandemic. Materials & methods: Retrospective pre-post analyses was conducted using HealthJump data. Adults continuously enrolled with an incident telehealth visit between Feb and April 2020 were identified. Demographics, clinical characteristics, proportion of patients with ≥1 HCRU visits and post-index trends in HCRU were analyzed. Results: Sample constituted 2799 patients, 60.34% female and 46.23% white with mean age 59.70. Significant increase in patients with outpatient visits (5.36%, p \u3c 0.005; only established), non-face-to-face visits (99.50%, p \u3c 0.005) and prescription use (12.86%, p \u3c 0.005) was reported. Conclusion: Among patients utilizing telehealth during COVID-19 pandemic, HCRU changed significantly. Better deployment policies and adoption techniques of telehealth could potentially act as a strong tool to revolutionize the healthcare delivery, with or without the pandemic

Evaluation of fracture resistance of ceramic veneers with different preparation designs and loading conditions: An in vitro study

Purpose: The purpose of this study was to evaluate the effect of incisal butt joint and incisal overlap design on the fracture resistance of ceramic veneers under two different loading conditions, i.e., 125° and 60° representing protrusive and intercuspal movements, respectively. Materials and Methods: Thirty-two maxillary central incisors were divided into two groups of sixteen specimens each and were prepared with incisal butt joint and incisal overlap design. Ceramic veneers were fabricated and cemented. Both the groups were further divided and mechanical testing to evaluate the fracture resistance were done using the universal testing machine. The values were recorded in Newton along with the assessment of the failure mode of both veneer and the tooth. Results: Unpaired t-test showed a significant difference (P 0.05). Failure mode of teeth showed more number of coronal fracture followed by cervical fracture and root fracture, but there was no significant difference between the two groups (P > 0.05). Conclusion: Butt joint design had higher fracture resistance than palatal overlap design. Under functional loads for both designs, fracture resistance was higher at 125° than at 60° angle

Comparison of marginal and internal adaptation of copings fabricated from three different fabrication techniques: An in vitro study

Aim: The purpose of this study was to compare the marginal and internal adaptation of cobalt-chromium (Co-Cr) copings fabricated from conventional wax pattern, three-dimensional (3D)-printed resin pattern, and laser sintering technique. Materials and Methods: A total of thirty copings were made, out of which ten copings were made from 3D-printed resin pattern (Group A), ten from inlay wax pattern (Group B), and ten copings were obtained from direct metal laser sintering (DMLS) technique (Group C). All the thirty samples were seated on their respective dies and sectioned carefully using a laser jet cutter and were evaluated for marginal and internal gaps at the predetermined areas using a stereomicroscope. The values were then analyzed using one-way ANOVA test and post hoc Bonferroni test. Results: One-way ANOVA showed lowest mean marginal discrepancy for DMLS and highest value for copings fabricated from inlay wax. The values for internal discrepancy were highest for DMLS (169.38) and lowest for 3D-printed resin pattern fabricated copings (133.87). Post hoc Bonferroni test for both marginal and internal discrepancies showed nonsignificant difference when Group A was compared to Group B (P > 0.05) and significant when Group A was compared with Group C (P < 0.05). Group B showed significant difference (P < 0.05) when compared with Group C. Conclusion: Marginal and internal discrepancies of all the three casting techniques were within clinically acceptable values. Marginal fit of DMLS was superior as compared to other two techniques, whereas when internal fit was evaluated, conventional technique showed the best internal fit

Conjunctival impression cytology versus routine tear function tests for dry eye evaluation in contact lens wearers

Aims: Prolonged contact lens wear is often accompanied by dryness of the eyes. The aim of this study was to compare conjunctival impression cytology (CIC) and tear film tests such as tear film break up time (TBUT) and Schirmer test for dry eye evaluation in contact lens wearers and measure their correlation with dry eye symptoms. Setting: A case control study was done at three referral eye centers. Materials and Methods: The eyes of 230 contact lens users were compared to 250 eyes of age- and sex-matched controls. Participants were recruited based on their response to a questionnaire of dry eye symptoms, (Dry Eye Scoring System, DESS © ) and measurements of TBUT, Schirmer test, and CIC was done. A correlation analysis between symptom severity and tear film tests was performed. Pearson′s coefficient, R 2 > 0.5 was considered significant. Results: As compared to controls (r2 = 0.010), Nelson grade correlated significantly with dry eye symptoms (r2 = 0.765), among cases. However, there was moderate correlation between dry eye symptoms, Schirmer test, and TBUT (r2 = 0.557 and 0.530, respectively) among cases and a weak correlation among controls (r2 = 0.130 and 0.054, respectively). The sensitivity of TBUT was 86.4%, specificity was 82.4%, positive likelihood ratio (LR) was 4.50 [95% confidence interval (CI) 3.46-5.85)], and negative LR was 0.09. The sensitivity of the Schirmer test was 48.2%, specificity 88%, LR 2.12 (95% CI 1.48-2.96), and negative LR 0.83. Conclusion: CIC correlates better than Schirmer and TBUT with dry eye symptoms. It may be the most appropriate test for dry-eye evaluation in contact lens wearers