Hospital care

Stutz DR, Janusz SJ, eds. 1988. Hazardous materials injuries. A handbook for pre-hospital care. 2nd ed. Beltsville, MD Bradford Communications Corporation, 149, 372-374. 

Comparisons between Enropean stndies are also difficult. Tolley and Gyldmark (1993) reviewed costs of treatment, care, and support for HIV-positive and AIDS patients in eleven Enropean conntries, which were based on data from the second half of the eighties. The anthors inflated cost fignres to 1990 prices and converted them from local currency to US by using national healthcare-specific price indices and health-specific purchasing power parities. The standardized cost estimates ranged between US 1,700 (social care per HIV-positive) and US 28,200 (hospital care per AIDS person-year), with the exception of a Greek study, which produced an adjusted cost estimate for the hospital treatment and care of AIDS patients of US 70,400 per person-year. 

The most common reason for lack of rt-PA use in otherwise eligible patients remains, however, delay in presentation to the hospital. The California Acute Stroke Pilot Registry (CASPR) investigators examined the effect of various hypothetical interventions on the rate of rt-PA use. Their data suggested that if all patients with a known time of onset presented to medical attention immediately, the expected overall rate of thrombolytic treatment within 3 hours would have increased from 4.3% to 28.6%. By comparison, the expected rate of treatment that would result from instantaneous prehospital response was 5.5%, from perfect hospital care was 11.5%, and from extension of time window to 6 hours was 8.3%. 

For approximately 20% to 30% of people with schizophrenia, drug treatment is ineffective. A standard definition of treatment resistance includes patients who have persistent positive symptoms despite treatment with at least two different antipsychotics given at adequate doses (at least 600 chlorpro-mazine equivalents) for an adequate duration (4 to 6 weeks). In addition, patients must have a moderately severe illness as defined by rating instruments, and have a persistence of illness for at least 5 years.40 These patients are often highly symptomatic and require extensive periods of hospital care. 

Direct Medical Physician office visits Hospital care... 

Direct costs include both medical and nonmedical expenditures for the detection, treatment, and prevention of disease. Direct medical costs reflect resources consumed in the "production" of health care, such as pharmaceutical products and services, physician visits, and hospital care. Direct nonmedical costs reflect expenditures for products and services that are not directly related to disease treatment but are still related to patient care. Examples of direct nonmedical costs include transportation to a pharmacy or physician s office and housekeeping during the illness period. Indirect costs account for changes in productivity of an individual because of illness. The monetary value of lost or altered productivity is typically used as a measure of indirect costs. Intangible costs and consequences are nonmonetary in nature and reflect the impact of disease and its treatment on the individual s social and emotional functioning and quality of life. Table 12.2 provides examples of these types of costs and consequences. 

In an era of escalating health care costs, "inputs" to the production of health care, such as pharmaceuticals, physician visits, laboratory/diagnostic services, and hospital care, are often viewed in isolation from each other as if one sector of the health care economy can be optimized independent of the others. When cost containment is the primary economic objective, a shortterm, risk-averse decision rubric emerges. 

Medical Management Immediate decontamination after exposure is the only way to prevent damage to victims, followed by symptomatic management of lesions. Hospital care tends to be supportive. It should be repeated that liquid arsenical vesicants produce more serious lesions on dermal surfaces than do liquid mustard. In toxic victims, liberal fluids by mouth or intravenous, and high-vitamin, high-protein, high-carbohydrate diets could be indicated. For those victims where shock is in evidence, provide the usual supportive measures such as intravenous administration, blood transfusions, or other vascular volume expanders should be indicated. 

There are substantial costs due to delirium. The increased length of hospital care is obvious but also after hospital discharge the costs increase due to increased need for institutionalisation, community health care and rehabilitation. 

Patients, in particular the elderly, are moved between different settings in the health care system. Medicines are involved in most of the stages of the journey. This includes home to hospital, home to care home or hospice, home to day centre, hospital to home, hospital to care home or hospice, ward to ward in hospital, hospital to hospital, care home to home, care home to care home. Especially on admission to, and discharge from, hospital there are several factors that can lead to errors. 

The main process (Fig. 1.1) for the care of a patient is normally the Primary care process (the patient handles their own drugs)—or the community care process (the patient gets help from community nurses at home or at a nursing home). All other processes such as hospital care (secondary/tertiary care) and the pharmacy process must support the main patient process. For improvement we must focus on patient safety and reduce drug-related problems. This means correct prescription and correct use (follow-up, documentation and communication) from the supportive process to the main process. 

Traditional cost-effectiveness analysis of general interventions, assuming there exists the incremental cost ofvarious inputs, assumes perfectly elastic long-run supply curves. That is, the product can be acquired at the same price, regardless of the quality of the product purchased. While this may be a reasonable approximation for such services as hospital care, perhaps physician services, and some non-research-intensive materials and devices, this is not a proper assumption for patent-protected drugs. 

World Health Organization. Pocket book of hospital care for children. Geneva WHO Press 2005. 

Unstable Angina (UA) and Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) are important situations which may cause SCD or ML Treatment is aimed at the prevention of these events, mainly by revascularization after the immediate medical treatment. In this section, the medical therapy will be separately discussed for the hospital care and posthospital discharge care. 

Park and Giammona l reported the effects of a 2- to 3-h exposure to CS on a 4-mo-old child. The infant was in a house into which police fired several canisters of CS. No estimate of concentration was available. On admission to the hospital, the child was suffering from severe respiratory distress and first-degree burns on the cheeks. Despite a week of treatment, pneumonia developed. The child was released after 28 d of hospital care. 

Full-thickness burns are those that char the skin and turn it black, or burn so deeply that the skin shows white. These burns usually result from direct contact with flames and have a great chance of becoming infected. All full-thickness burns should receive immediate hospital care. They should not be immersed in water, and charred clothing should not be removed from the victim. If possible, a sterile dressing or bandage should be applied to burns before the victim is transported to the hospital. 

Schizophrenia was conceptualized as a behavior taught to a child by a schizophrenogenic parent. Patients were then isolated from their families for long-term hospital care. In recent years, the approach has been to effect social rehabilitation with active involvement of the family. We will first review evidence pertinent to earlier approaches and then discuss the more recent assertive case management model. 

Hospitalization is extraordinarily expensive, and although ACM costs less than hospitalization, the overall difference is not as great as was once hoped. Although ACM has not proven to be significantly less expensive than hospital care in the short term, it is possible that once the patient is rehabilitated, subsequent costs will be substantially decreased. Furthermore, it may require several years for true rehabilitation to occur hence, short-term studies may underestimate the total cost saving. 

In summary, when properly administered, ECT is an effective treatment for the most severe mood and psychotic disorders encountered in clinical practice, especially those warranting hospital care. Its efficacy is even more striking given the fact that 50% of those successfully treated have previously been nonresponsive to one or more adequate courses of medication. Although primarily used for severe depression, it is also an effective antimanic therapy, and may be lifesaving in catatonic states. ECT has also been used successfully to treat special populations, other psychotic disorders, and various organic conditions, such as NMS and Parkinson s disease. 

Spending on prescription drugs has grown faster than other medical costs for hospital care and clinical services. Americans spent 216.7 billion on prescription drugs in 2006, up from 40.3 billion in 1990. From 1994 to 2004, drug prices rose 8.3 percent per year, well above the inflation rate of... 

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