Cost calculation and prediction in adult intensive care: A ground-up utilization study

Publisher's copy made available with the permission of the publisherThe ability of various proxy cost measures, including therapeutic activity scores (TISS and Omega) and cumulative daily severity of illness scores, to predict individual ICU patient costs was assessed in a prospective “ground-up” utilization costing study over a six month period in 1991. Daily activity (TISS and Omega scores) and utilization in consecutive admissions to three adult university associated ICUs was recorded by dedicated data collectors. Cost prediction used linear regression with determination (80%) and validation (20%) data sets. The cohort, 1333 patients, had a mean (SD) age 57.5 (19.4) years, (41% female) and admission APACHE III score of 58 (27). ICU length of stay and mortality were 3.9 (6.1) days and 17.6% respectively. Mean total TISS and Omega scores were 117 (157) and 72 (113) respectively. Mean patient costs per ICU episode (1991 $AUS) were$6801 ($10311), with median costs of$2534, range $106 to$95,602. Dominant cost fractions were nursing 43.3% and overheads 16.9%. Inflation adjusted year 2002 (mean) costs were $9343 ($ AUS). Total costs in survivors were predicted by Omega score, summed APACHE III score and ICU length of stay; determination R2, 0.91; validation 0.88. Omega was the preferred activity score. Without the Omega score, predictors were age, summed APACHE III score and ICU length of stay; determination R2, 0.73; validation 0.73. In non-survivors, predictors were age and ICU length of stay (plus interaction), and Omega score (determination R2, 0.97; validation 0.91). Patient costs may be predicted by a combination of ICU activity indices and severity scores.J. L. Moran, A. R. Peisach, P. J. Solomon, J. Martinhttp://www.aaic.net.au/Article.asp?D=200403

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Impact energy absorption of three mouthguard materials in an aqueous environment

PubMedID: 19208026High impact energy absorption is an essential property for mouthguard materials. The impact test performance of three popular mouthguard materials was evaluated, using the procedure in American Society for Testing and Materials (ASTM) Standard D3763. Conventional ethylene vinyl acetate (EVA; T&S Dental and Plastics, Myerstown, PA, USA) served as the control. Pro-form™ (Dental Resources Inc., Delano, MN, USA), another EVA material, and PolyShok™ (Sportsguard Laboratories, Kent, OH, USA), an EVA product containing polyurethane were also evaluated. Specimens having dimensions of 3 inch × 3 inch × 4 mm were prepared from each material. After processing that followed manufacturer recommendations, specimens were conditioned for 1 h in 37°C deionized water and loaded at 20 mph by a 0.5 inch diameter indenter containing a force transducer (Dynatup Model 9250 HV; Instron Corp., Canton, MA, USA). Both large-diameter (3 inches) and small-diameter (1.5 inch) support rings were used. For comparison, two specimens of each material were tested in the dry condition. Energy absorption was determined from the area under the force-time curve at 30 ms, and results for the water-conditioned specimens were compared using anova and the Kruskal-Wallis test. For the large-diameter support ring, energy absorption (mean ± SD in ft·lbf inch-1), normalized to specimen thickness, was: EVA (n = 5), 110.2 ± 48.4; Pro-form™ (n = 4), 110.0 ± 11.3; PolyShok™ (n = 5), 105.7 ± 16.5. For the small-diameter support ring, energy absorption was: EVA (n = 6), 140.5 ± 13.9; Pro-formTM (n = 5), 109.0 ± 26.0; PolyShok™ (n = 6), 124.4 ± 28.4 (1 ft·lbf inch -1 = 0.534 J cm-1). Because of substantial variation within some specimen groups, there was no significant difference in energy absorption for the three water-conditioned mouthguard materials and the two support ring sizes. The energy absorption for each material was much greater for other specimens tested in the dry condition. © 2009 John Wiley & Sons A/S

Mortality and cost outcomes of elderly trauma patients admitted to intensive care and the general wards of an Australian tertiary referral hospital

COPYRIGHT 2009 Australian Society of AnaesthetistsMortality and cost outcomes of elderly intensive care unit (ICU) trauma patients were characterised in a retrospective cohort study from an Australian tertiary ICU Trauma patients admitted between January 2000 and December 2005 were grouped into three major age categories: aged > or =65 years admitted into ICU (n = 272); aged -65 years admitted into general ward (n = 610) and aged or = 65 years, ventilated) were: ICU or = 65 not-ventilated (OR 0.061) and ward > or = 65 (OR 0.086); increasing injury severity score and increased Charlson comorbidity index of 1 and 2, compared with zero (OR 2.21 [1.40 to 3.48] and OR 2.57 [1.45 to 4.55]). The raw mean daily ICU and hospital costs in A$2005 (US$) for age or = 65 to ICU, and > or = 65 to the ward were; for year 2000: ICU, $2717 (1462) and$2777 (1494); hospital, $1837 (988) and$1590 (855); ward $933 (502); for year 2005: ICU,$3202 (2393) and $3086 (2307); hospital,$1938 (1449) and $1914 (1431); ward$1180 (882). Cost increments were predicted by age < or = 65 and ICU admission, increasing injury severity score, mechanical ventilation, Charlson comorbidity index increments and hospital survival. Mortality cost-effect was estimated at -63% by least squares regression and -82% by treatment-effects regression model. Patient demographic factors, injury severity and its consequences predict both cost and survival in trauma. The cost mortality effect was biased upwards by conventional least squares regression estimation.L.Y.L. Chan, J.L. Moran, C. Clarke, J. Martin and P.J. Solomo