PubMed · 7920814
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A Murdaugh. 1994. PROM protocols.. https://pubmed.ncbi.nlm.nih.gov/7920814/
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OBJECTIVE: To investigate the cost implications of a treatment policy of a deliberate perioperative increase of oxygen delivery in high risk surgical patients. DESIGN: A cost-effectiveness analysis comparing 'protocol' high risk surgical patients in whom oxygen delivery was specifically targeted towards 600 ml/min/m2 with 'control' patients. INTERVENTIONS: In a randomised, controlled clinical trial we previously demonstrated a significant reduction in mortality (5.7% vs 22.2%, p = 0.015) and morbidity (0.68 +/- 0.16 complications vs 1.35 +/- 0.20, p = 0.008) in 'protocol' high risk surgical patients in whom oxygen delivery was specifically targeted towards 600 ml/min per m2 compared with 'control' patients. This current study retrospectively analysed the medical care and National Health Service resource use of each patient in the trial. Departmental purchasing records and business managers were consulted to identify the unit cost of these resources, and thereby the cost of treating each patient was calculated. RESULTS: The median cost of treating a protocol patient was lower than for a control patient (6,525 pounds vs 7,784 pounds) and this reduction was due mainly to a decrease in the cost of treating postoperative complications (median 213 pounds vs 668 pounds). The cost of obtaining a survivor was 31% lower in the protocol group. CONCLUSION: Perioperative increase of oxygen delivery in high risk surgical patients not only improves survival, but also provides an actual and relative cost saving. This may have important implications for the management of these patients and the funding of intensive care.
BACKGROUND: Phototoxicity is the most significant short-term adverse effect of PUVA therapy. OBJECTIVE: We attempted to determine the incidence and possible causes of phototoxicity of sufficient degree to cause interruption of treatment. METHODS: A retrospective study was conducted of 16,506 PUVA treatments given to 414 patients in two treatment centers. RESULTS: Phototoxicity occurred in 10.9% of patients and was an adverse effect in 0.3% of treatments. Problems with the treatment protocol were the main cause. CONCLUSION: Phototoxicity is a common adverse effect, and patients should be warned of this potential occurrence. Awareness of the causes may help to reduce the incidence of this problem.