[Comparison between implantation costs of peripherally inserted central catheter and implanted subcutaneous ports]. / Comparaison entre le coût d'une pose de cathéter veineux central d'insertion périphérique et d'une chambre implantable.

INTRODUCTION: Peripherally Inserted Central Catheter or PICC Line and implanted subcutaneous ports are two types of central catheters allowing drug administration and blood samplings. These two devices are very controversial (because of infectious and thrombotic complications), it seemed interesting to estimate their cost of implantation and to correlate them with the reimbursement by the Health Insurance. MATERIALS AND METHODS: Direct (material and drugs) and indirect (use of the room and staff) costs were prospectively evaluated for PICC Lines and implanted subcutaneous ports. RESULTS: The global costs of the implantation of a PICC Line and of an implanted subcutaneous port in the interventional radiology room and in the operating room were respectively evaluated at 220.2 €, 286.6 € and 666.3 €. DISCUSSION-CONCLUSION: Only a PICC Line in outpatients can be reimbursed by the health insurance; which amounts to 110.4 €. The establishment therefore loses money with every implantation. However, PICC Lines offer to the patients a fast access to a central venous way and thus an optimal therapeutic care, fulfilling one of the main missions of the public health institutions. Implanted subcutaneous ports are economically worth being implanted only in ambulatory inpatients. Its implantation in radiology seemed more profitable because the indirect costs were much more moderate.

[Proposal of a costing method for the provision of sterilization in a public hospital]. / Proposition d'une méthode de facturation de la prestation de stérilisation dans un centre hospitalier public.

INTRODUCTION: To refine the billing to institutions whose operations of sterilization are outsourced, a sterilization cost approach was developed. The aim of the study is to determine the value of a sterilization unit (one point "S") evolving according to investments, quantities processed, types of instrumentation or packaging. MATERIALS AND METHODS: The time of preparation has been selected from all sub-processes of sterilization to determine the value of one point S. The time of preparation of sterilized large and small containers and pouches were raised. The reference time corresponds to one bag (equal to one point S). Simultaneously, the annual operating cost of sterilization was defined and divided into several areas of expenditure: employees, equipments and building depreciation, supplies, and maintenance. RESULTS: A total of 136 crossing times of containers were measured. Time to prepare a pouch has been estimated at one minute (one S). A small container represents four S and a large container represents 10S. By dividing the operating cost of sterilization by the total number of points of sterilization over a given period, the cost of one S can be determined. DISCUSSION/CONCLUSION: This method differs from traditional costing method in sterilizing services, considering each item of expenditure. This point S will be the base for billing of subcontracts to other institutions.

[Medication errors: analysis of a digoxin overdose case in a neonatology unit]. / Erreur médicamenteuse : analyse d'un surdosage en digoxine dans un service de néonatalogie.

Neonatology and pediatrics are units where medication errors occur. Indeed, the complexity of nursing care, the lack of information and marketing authorization for drugs contribute to the occurrence of often underestimated iatrogenic events. Through a case of digoxin overdose in a neonatology unit, each stage of the drug circuit was analyzed. From prescription to administration to dispensation, the accumulation of individual errors put a newborn in danger. The analysis and declaration of such events can improve safety and the quality of patient care.

[Cost of cataract surgery in a public hospital]. / Évaluation du coût de la chirurgie de la cataracte dans un établissement public de santé

With more than 500,000 operations per year, cataract surgery is currently the most frequently performed surgical operation in France. Several procedural techniques are described, but phacoemulsification after micro-incision is the most common. The cost and reimbursement by the French social security depend on whether the procedure is conducted on an inpatient or outpatient basis. The objectives of this prospective study were to evaluate the cost of cataract surgery in a public hospital setting and to correlate differences in surgical practice with financial impact. One hundred twenty-five operations were observed in the operating room and many data points were recorded for analysis. Topical anesthesia was administered in 87.2% of cases; the mean duration of the surgery was 42minutes. The mean direct cost was 366 € (drugs, sterilization of reused equipment, medical devices, etc). The extended cost of the surgery (infrastructure, hospitalization, food and laundry, etc.) was computed to be 1130 € for outpatients and 1335 € for inpatients assuming a one-night stay in the hospital. In view of the reimbursement provided by social security, this innovative study in a public hospital demonstrates that cataract surgery is a profitable activity, reinforcing our strategic plans.

[Direct cost of cataract surgery in public hospital]. / Approche du coût direct de la chirurgie de la cataracte dans un établissement de santé public.

INTRODUCTION: With more than 500,000 operations per year, cataract surgery is the most performed act nowadays in France. Several techniques can be used but the phacoemulsification after micro-incision is the most common and the purpose is to put an intraocular lens into the eye. AIM: To approach the direct cost of the cataract surgery and to compare it to the amounts of reimbursements, and to get some epidemiological and statistical data about this surgery. MATERIAL AND METHODS: This study is prospective; many operations were followed up in the operating room and every following data were recorded: age of the patient, type of anaesthesia, type of intraocular lens, adverse events, name of surgeon, duration of the intervention, single use material and medications used during operation and their quantity for each operation. RESULTS: One hundred and twenty-five cataract surgeries were followed. Patients mean age was 74,1 years and the anaesthesia was topical in 87,2% of cases; only two patients had general anaesthesia. The mean duration was 42 minutes. The mean direct cost was 366 € but reached 630 € in case of capsular tear. The cost greatly varied depending on the surgeon. Two references of lens (foldable monofocal, that cost between 100 and 150 €) represented 80% of the implanted lenses. CONCLUSION: This type of study may lead to a standardisation of surgical techniques and evaluate the proportion of supply and medications in that type of surgery.

Early assessment of motor dysfunctions aids in successful occlusion of the middle cerebral artery.

Occlusion of the rodent middle cerebral artery by embolism, using an intraluminal filament, produces behavioral alterations which resemble many symptoms associated with stroke. This model has been used to examine treatment interventions for the disease, however, variable success rate in completely blocking the middle cerebral artery may present inconclusive interpretation of the data. To detect successful occlusion of the middle cerebral artery, we demonstrate here sensitive and reliable behavioral parameters including the elevated body swing test, the postural tail-hang test, the spontaneous rotational test, and the forelimb akinesia test. These assays provide a criterion for identifying animals with incomplete occlusion which could promote host-related spontaneous recovery and might confound true effects of experimental therapies on ischemia-induced dysfunctions. From a practical standpoint, the early reliable identification of partial cerebral ischemia aids in immediate and efficient adjustments of the surgical procedure to create a complete and stable ischemia stroke animal model.