Impactul statului definite de maladia cu tensiune ridicată (HTA) din mediul rural.

În lucrare sunt prezentate rezultatele unui studiu ce ține de impactul statului și a pacienților defi nite de maladia cu tensiune ridicată (HTA) realizat pe parcursul anului 2014 în raionul Criuleni. În studiu au fost incluse cheltuieli directe ce țin de tratamentul a maladiei cu tensiune ridicatâ (HTA) ce a inclus: cheltuieli de caz tratat ambulator, cheltuieli de caz tratat în staționar, cheltuieli de medicamente compensate, de CNAM, cheltuieli de medicamente suportate de pacienți

Centralization of Esophageal Cancer Surgery: Does It Improve Clinical Outcome?

Background: The volume-outcome relationship for complex surgical procedures has been extensively studied. Most studies are based on administrative data and use in-hospital mortality as the sole outcome measure. It is still unknown if concentration of these procedures leads to improvement of clinical outcome. The aim of our study was to audit the process and effect of centralizing oesophageal resections for cancer by using detailed clinical data. Methods: From January 1990 until December 2004, 555 esophagectomies for cancer were performed in 11 hospitals in the region of the Comprehensive Cancer Center West (CCCW); 342 patients were operated on before and 213 patients after the introduction of a centralization project. In this project patients were referred to the hospitals which showed superior outcomes in a regional audit. In this audit patient, tumor, and operative details as well as clinical outcome were compared between hospitals. The outcome of both cohorts, patients operated on before and after the start of the project, were evaluated. Results: Despite the more severe comorbidity of the patient group, outcome improved after centralizing esophageal resections. Along with a reduction in postoperative morbidity and length of stay, mortality fell from 12% to 4% and survival improved significantly (P = 0.001). The hospitals with the highest procedural volume showed the biggest improvement in outcome. Conclusion: Volume is an important determinant of quality of care in esophageal cancer surgery. Referral of patients with esophageal cancer to surgical units with adequate experience and superior outcomes (outcome-based referral) improves quality of care

Legislative Documents

Also, variously referred to as: House bills; House documents; House legislative documents; legislative documents; General Court documents

Preoperative Chemoprophylaxis Is Safe in Major Oncology Operations and Effective at Preventing Venous Thromboembolism

BACKGROUND: We prospectively evaluated the safety and efficacy of adding pre-operative chemoprophylaxis to our institution’s operative venous thromboembolism (VTE) prophylaxis policy as part of a physician led quality improvement initiative. STUDY DESIGN: Patients undergoing major cancer surgery between August 2013 and January 2014 were screened according to service-specific eligibility criteria and targeted to receive pre-operative VTE chemoprophylaxis. Bleeding, transfusion, and VTE rates were compared to historical controls who had not received pre-operative chemoprophylaxis. RESULTS: The 2,058 eligible patients who underwent operation between August 2013 and January 2014 (post-intervention) were compared to a cohort of 4,960 patients operated on between January 2012 and June 2013 that did not receive pre-operative VTE chemoprophylaxis (pre-intervention). In total, 71% of patients in the post-intervention group were screened for eligibility; 82% received pre-operative anticoagulation. When compared to the pre-intervention group, the post-intervention group had significantly lower transfusion rates (pre vs. post-intervention, 17% vs 14%; difference 3.5%, 95% CI: 1.7% – 5%, p=0.0003) without significant difference in major bleeding (difference 0.3%, 95% CI: −0.1% – 0.7%, p=0.2). Rates of deep venous thrombosis (1.3% vs 0.2%; difference 1.1%, 95% CI: 0.7% – 1.4%, p <0.0001) and pulmonary embolus (1.0% vs 0.4%; difference 0.6%, 95% CI: 0.2% – 1%, p=0.017) were significantly lower in the post-intervention group CONCLUSIONS: In patients undergoing major cancer surgery, institution of a single dose of pre-operative chemoprophylaxis, as part of a physician led quality improvement initiative, did not increase bleeding or blood transfusions and was associated with a significant decrease in VTE rates