Direct Cost Comparison of Open Carpal Tunnel Release in Different Venues.

Background: The increased efficiency and cost savings have led many surgeons to move their practice away from the traditional operating room (OR) or outpatient surgery center (OSC) and into the clinic setting. With the cost of health care continuing to rise, the venue with the lowest cost should be utilized. We performed a direct cost analysis of a single surgeon performing an open carpal tunnel release in the OR, OSC, and clinic. Methods: Four treatment groups were prospectively studied: the hospital OR with monitored anesthesia care (OR-MAC), OSC with MAC (OSC-MAC), OSC with local anesthesia (OSC-local), and clinic with local anesthesia (clinic). To determine direct costs, a detailed inventory was recorded including the weight and disposal of medical waste. Indirect costs were not included. Results: Five cases in each treatment group were prospectively recorded. Average direct costs were OR ($213.75), OSC-MAC ($102.79), OSC-local ($55.66), and clinic ($31.71). The average weight of surgical waste, in descending order, was the OR (4.78 kg), OSC-MAC (2.78 kg), OSC-local (2.6 kg), and the clinic (0.65 kg). Using analysis of variance, the clinic's direct costs and surgical waste were significantly less than any other setting (P < .005). Conclusions: The direct costs of an open carpal tunnel release were nearly 2 times more expensive in the OSC compared with the clinic and almost 7 times more expensive in the OR. Open carpal tunnel release is more cost-effective and generates less medical waste when performed in the clinic versus all other surgical venues.

Determination of the best appropriate management methods for the health-care wastes in Istanbul.

Health-care waste management has been a significant problem in most economically developing countries as it is in Turkey. Most of the time, the main reason for the mismanagement of these wastes is the lack of appropriate legislation and effective control; other reasons are: financial strains and a lack of awareness. Being aware of the significance of the subject, in this paper the management of the health-care wastes in Istanbul, as a Metropolitan City of Turkey, was analyzed to create an integrated health-care waste management system in the city. Within the scope of the study, the existing situation and management practices such as the amount of the health-care wastes generated, segregation procedures, collection, temporary storage and transportation of the wastes within and outside of the institution were examined. Deficiencies, inconsistencies and improper applications were revealed. The existing Turkish Medical Wastes Control Regulation and institutional structure of the health-care waste management body were reviewed. After the evaluation and comparison with the requirements of other national and international organizations, items to be changed/added in the Regulation were identified. At the end of the study, the best management methods for the Istanbul City were determined and started to be applied at the institutions. After this study, the existing Regulation has been changed. The modified Regulation was published in 2005 and implementation has started. It is expected that by the application and implementation of the research outcomes, the management of health-care wastes in Istanbul and then in all over Turkey will be improved. The results obtained can also be used in most economically developing countries where there are similar environmental problems and strict budgets.

Improvement and modification of the routing system for the health-care waste collection and transportation in Istanbul.

Handling of health-care wastes is among the most important environmental problems in Turkey as it is in the whole world. Approximately 25-30tons of health-care wastes, in addition to the domestic and recyclable wastes, are generated from hospitals, clinics and other small health-care institutions daily on the European and the Asian sides of Istanbul [Kocasoy, G., Topkaya, B., Zeren, B.A., Kiliç, M., et al., 2004. Integrated Health-care Waste Management in Istanbul, Final Report of the LIFE00 TCY/TR/054 Project, Turkish National Committee on Solid Wastes, Istanbul, Turkey; Zeren, B.A., 2004. The Health-care Waste Management of the Hospitals in the European Side of Istanbul, M.S. Thesis, Bogaziçi University, Istanbul, Turkey; Kiliç, M., 2004. Determination of the Health-care Waste Handling and Final Disposal of the Infected Waste of Hospital-Medical Centers in the Anatolian Side of Istanbul. M.S. Thesis, Bogaziçi University, Istanbul, Turkey]. Unfortunately, these wastes are not handled, collected or temporarily stored at the institutions properly according to the published Turkish Medical Waste Control Regulation [Ministry of Environment and Forestry, 2005. Medical Waste Control Regulation. Official Gazette No. 25883, Ankara, Turkey]. Besides the inappropriate handling at the institutions, there is no systematic program for the transportation of the health-care wastes to the final disposal sites. The transportation of these wastes is realized by the vehicles of the municipalities in an uncontrolled, very primitive way. As a consequence, these improperly managed health-care wastes cause many risks to the public health and people who handle them. This study has been conducted to develop a health-care waste collection and transportation system for the city of Istanbul, Turkey. Within the scope of the study, the collection of health-care wastes from the temporary storage rooms of the health-care institutions, transportation of these wastes to the final disposal areas and the cost-benefit analyses of the existing and the proposed optimum transportation routes are investigated and the most feasible routes from the point of view of efficiency and economy have been determined. In order to solve the scheduling and route optimization problem, special software programs called MapInfo and Roadnet were used. For the program, the geocodes of hospital locations, data about the amount of the health-care wastes generated, the loading and unloading process times, and the capacity of the collecting vehicles were taken into account. The new systems developed aim at the daily collection of the health-care wastes from the institutions and their transportation directly to the final disposal area/facility by using the shortest and the most efficient routes to resolve the routing and scheduling problem and to reduce the cost arising from the transportation.

Medication knowledge and self-management by people with type 2 diabetes.

OBJECTIVE: To explore medication knowledge and self-management practices of people with type 2 diabetes. DESIGN: A one-shot cross sectional study using in-depth interviews and participant observation. SETTING: Diabetes outpatient education centre of a university teaching hospital. SUBJECTS: People with type 2 diabetes, n=30, 17 males and 13 females, age range 33-84, from a range of ethnic groups. OUTCOME MEASURES: Ability to state name, main actions and when to take medicines. Performance of specific medication-related tasks; opening bottles and packs, breaking tablets in half, administering insulin, and testing blood glucose. RESULTS: Average medication use > or = 10years. Respondents were taking 86 different medicines, mean 7 +/- 2.97 SD. Dose frequency included two, three and four times per day. All respondents had > or = 2 diabetic complications +/- other comorbidities. The majority (93%) were informed about how and when to take their medicines, but only 37% were given information about side effects and 17% were given all possible seven items of information. Younger respondents received more information than older respondents. Older respondents had difficulty opening bottles and breaking tablets in half. Twenty percent regularly forgot to take their medicines. Increasing medication costs was one reason for stopping medicines or reducing the dose or dose interval. The majority tested their blood glucose but did not control test their meters and 33% placed used sharps directly into the rubbish. CONCLUSION: Polypharmacy was common. Medication knowledge and self-management were inadequate and could lead to adverse events.

[Prospective study of the causes for destruction of labile blood products during 1999 at a University Hospital Center]. / Etude prospective des causes de destruction des produits sanguins labiles, au cours de l'année 1999 dans un CHU.

The destruction of the blood cell product (BCP) is a situation which is hard to accept in the present context of transfusional safety which aims at covering the transfusional needs in the most appropriate way. In our University Hospital, 500 BCP out of 20,000 are destroyed per year, which represent a cost of 100,000 $. A prospective research was carried out from January 1st to December 31st 1999 in order to analyse the causes of the destruction of the BCP and to differentiate the inevitable destructions for the patient's security from the avoidable destructions which might have benefited from corrective measures. For each group of simultaneously destroyed BCP, an information note specified the patient's pathology, the reasons for the prescription, the number and the type of transfused and destroyed BCP in the same day, the time spent between distribution and return, and the causes of destruction. In 1999, a total of 483 LBP out of 19,802 which were distributed, have been returned and destroyed, that is to say 2.4% for a 99.3% traceability which involved 242 patients. Among these destroyed BCP, 28.3% came from inevitable causes--death or acute intensive care which needed a lot of transfusions--69.7% were categorised as being related to avoidable causes depending on the organisation of transport and care, unadapted safety measures. The corrective measures to be taken, concern the improvement of transport procedures, the set-up of a nominative BCP reservation system in the Blood Center, the scheduling of the BCP deliveries from the blood bank, and a better adaptation of the safety measures to the transfusional needs.