Combining the Real-Time Vial Sharing Strategy with Daily-Rate Charge Mode for Antimicrobial Drugs of Inpatients: An Economical and Practical Method for Patients and Hospitals.

Background: Antimicrobial agents' wastage is a huge problem, especially for pediatric patients, resulting in excessive drug expenditure and increasing the economic burden on patients' families. Moreover, the cost of disposing of antimicrobial agents' waste and the risk of environmental and occupational exposure also increased. This study aimed to explore the cost-effectiveness of the vial-sharing strategy combined with the daily-rate charge mode for pediatric inpatients to provide a strategy for reducing patients' expenditures, saving medical costs, and reducing drug proportion. Methods: This retrospective study was conducted at Pharmacy Intravenous Admixture Service (PIVAS), Shenzhen Children's Hospital, Guangdong Province, China, in 2022. Data on prescription drugs were collected from the PIVAS system. Ten antimicrobial drugs with a frequency of prescriptions no less than twice once daily were selected, and the drug costs, drug weight, and drug saved were further analyzed according to the combination of real-time vial sharing strategy and daily-rate charge mode. Traditional single vial charge mode without vial sharing was set as a control strategy. The actual expenditure of the hospital was also calculated and analyzed. Results: During 2022, ¥ 4,122,099 (34.4%) was saved for inpatients by applying a vial-sharing strategy on ten antibacterial agents, and more than 46,343,750 mg (24.6%) of drugs were totally saved. The top 5 drugs saved by the real-time vial-sharing strategy were cefoperazone-sulbactam, vancomycin, amoxicillin-sulbactam, ceftazidime, and meropenem. Taken the price into consideration, the top five payment-saved drugs were vancomycin (¥ 1,522,385), meropenem (¥ 1,311,475), cefoperazone-sulbactam (¥ 736,697), imipenem-cilastatin (¥ 406,092), and amoxicillin-sulbactam (¥ 51,394). Moreover, the account balance of the hospital was up to ¥ 426,499. Conclusion: The real-time vial sharing strategy combined with the daily-rate charge mode greatly reduces drug wastage and patients' payments. It may be useful for hospitals with PIVAS to achieve vial-sharing while protecting the best interest of inpatients.

On-line quantification and human health risk assessment of organic by-products from the removal of toluene in air using non-thermal plasma.

Harmful organic by-products, produced during the removal of volatile organic compounds (VOCs) from the air by treatment with non-thermal plasma (NTP), hinder the practical applications of NTP. An on-line quantification and risk assessment method for the organic by-products produced by the NTP removal of toluene from the air has been developed. Formaldehyde, methanol, ketene, acetaldehyde, formic acid, acetone, acetic acid, benzene, benzaldehyde, and benzoic acid were determined to be the main organic by-products by proton transfer reaction mass spectrometry (PTR-MS), a powerful technique for real-time and on-line measurements of trace levels of VOCs, and a health-related index (HRI) was introduced to assess the health risk of these organic by-products. The discharge power (P) is a key factor affecting the formation of the organic by-products and their HRI values. Higher P leads to a higher removal efficiency (η) and lower HRI. However, higher P also means higher cost and greater production of discharge by-products, such as NOx and O3, which are also very dangerous to the environment and human health. In practical applications P, HRI, and η must be balanced, and sometimes the risks posed by the organic by-products are even greater than those of the removed compounds. Our mechanistic study reveals that acetone is a crucial intermediate for the removal of toluene by NTP, and we found that toluene molecules first fragment into acetone molecules, followed by other by-products. These observations will guide the study of the mechanism of aromatic molecule dissociation in plasma.

Quantification and risk assessment of organic products resulting from non-thermal plasma removal of toluene in nitrogen.

RATIONALE: Non-thermal plasma (NTP) has proven to be an effective approach for the removal of volatile organic compounds (VOCs). However, harmful organic by-products, produced during NTP-mediated removal of VOCs, hinder practical applications of this technology. It is necessary to characterize the organic by-products to assess their health risks. METHODS: A method is proposed for analyzing and evaluating organic by-products for NTP-mediated removal of VOCs in this work. NTP generated by a coaxial dielectric barrier discharge (DBD) reactor was used for the removal of a model VOC, toluene, in nitrogen. Organic products were characterized using a real-time proton transfer reaction time-of-flight mass spectrometry (PTR-TOF-MS) apparatus. RESULTS: The PTR-TOF-MS apparatus has been shown to be effective for real-time high-sensitivity detection of trace VOCs. The main observed organic compounds, with concentrations on the order of ppb/ppm, were hydrogen cyanide, acetonitrile, propanenitrile, benzene, benzonitrile, and benzyl nitrile, etc. CONCLUSIONS: A health-related index (HRI) was introduced to assess the health risks associated with these organic products. The HRI was not correlated with the removal efficiency (η), with higher η possibly yielding higher HRI, associated with higher health risks. Specific input energy (SIE) was a key factor affecting the formation of the observed organic products and their HRI values. We conclude that in practical applications, SIE, HRI, and η must be balanced.