Suchergebnisse

BackgroundThe primary objective was to describe the total direct inpatient costs among solid tumor and lymphoma patients with chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost. The secondary objective was to describe the out-of-pocket patient payments and the factors that were associated with higher out-of-pocket patient payments.MethodsThis was a single-center observational study conducted at the largest cancer center in Singapore. All of the adult cancer patients hospitalized due to FN from 2009 to 2012 were studied. The primary outcomes were the total hospital cost and the out-of-pocket patient payments (adjusted by government subsidy) per FN episode. Univariate analysis and multiple linear regression were conducted to identify the factors associated with higher FN costs.ResultsThree hundred and sixty seven adult cancer patients were documented with FN-related hospitalizations. The mean total hospital cost was US$4,193 (95% CI: US$3,779-4,607) and the mean out-of-pocket patient payment was US$2,230 (95% CI: US$1,976-2,484), per FN episode. The factors associated with a higher total hospital cost were longer length of stay, severe sepsis, and lymphoma as underlying cancer. The out-of-pocket patient payment was positively associated with longer length of stay, severe sepsis, lymphoma diagnosed as underlying cancer, the therapeutic use of granulocyte colony-stimulating factor (GCSF), the private ward class, and younger patients.ConclusionsThe total hospital cost and out-of-pocket patient payments of FN management in lymphoma cases were substantial compared with other solid tumors. Factors associated with a higher FN management cost may be useful for developing appropriate strategies to reduce the cost of FN for cancer patients.

BackgroundThe primary objective was to describe the total direct inpatient costs among solid tumor and lymphoma patients with chemotherapy-induced febrile neutropenia (FN) and the factors that were associated with higher direct cost. The secondary objective was to describe the out-of-pocket patient payments and the factors that were associated with higher out-of-pocket patient payments.MethodsThis was a single-center observational study conducted at the largest cancer center in Singapore. All of the adult cancer patients hospitalized due to FN from 2009 to 2012 were studied. The primary outcomes were the total hospital cost and the out-of-pocket patient payments (adjusted by government subsidy) per FN episode. Univariate analysis and multiple linear regression were conducted to identify the factors associated with higher FN costs.ResultsThree hundred and sixty seven adult cancer patients were documented with FN-related hospitalizations. The mean total hospital cost was US$4,193 (95% CI: US$3,779-4,607) and the mean out-of-pocket patient payment was US$2,230 (95% CI: US$1,976-2,484), per FN episode. The factors associated with a higher total hospital cost were longer length of stay, severe sepsis, and lymphoma as underlying cancer. The out-of-pocket patient payment was positively associated with longer length of stay, severe sepsis, lymphoma diagnosed as underlying cancer, the therapeutic use of granulocyte colony-stimulating factor (GCSF), the private ward class, and younger patients.ConclusionsThe total hospital cost and out-of-pocket patient payments of FN management in lymphoma cases were substantial compared with other solid tumors. Factors associated with a higher FN management cost may be useful for developing appropriate strategies to reduce the cost of FN for cancer patients.

Our planet is increasingly threatened by degradation in water quantity and quality due to climate change, population growth and development pressures. Water shortage is one of the most challenging environmental problems to humankind in the 21st century under the changing climate. Water shortages and scarcity escalate risks to food security and economic viability. For decades, water management has been dominated by supply oriented paradigm of expanding the capacity of accessible water (e. g. building dams). While large scale infrastructure projects provided effective solutions for chronic water crises in the past, they have come at expensive, irreversible and delayed ecological, economic and social costs. As more questions are raised concerning over reliance on infrastructure solutions, discussions about a sustainable future suggest a greater focus on the demand side of the equation is needed. In this paper, we use multi-recursive and runoff coefficient analysis methods to analyze the annual runoff of the mainstreams (Kuye River, Tuwei River, Wuding River and Jialu River) in the middle reaches of Yellow River. The main objective is to estimate the impacts of climate change and human activity on water resources in the study area and test the potential of water demand management to lessen the gap between supply and demand. Results show remarkable drop in the average annual runoff as a combined effect of climate change and human activity. Moreover, results show that human activities are the direct reason for the changes of river runoff, and the proportion of human activities account the biggest is Wuding river, next is Kuye river, Jialu river is smallest, these changes lead to the decrease of river runoff, and even drying up in recent years. This result highlights the importance of using WDM to diminish the increasing gap between demand and supply. Motivated by this, the paper presents a comprehensive framework for implementation WDM in the middle reaches of Yellow River. The framework includes a wide range of instruments: legislative, economic, technological and educational. The core step of the framework, collaboration among water planners, water service providers and end-users lies as an essential mechanism for achieving long term trade-offs between ecological and socio-economic water needs.

Our planet is increasingly threatened by degradation in water quantity and quality due to climate change, population growth and development pressures. Water shortage is one of the most challenging environmental problems to humankind in the 21st century under the changing climate. Water shortages and scarcity escalate risks to food security and economic viability. For decades, water management has been dominated by supply oriented paradigm of expanding the capacity of accessible water (e. g. building dams). While large scale infrastructure projects provided effective solutions for chronic water crises in the past, they have come at expensive, irreversible and delayed ecological, economic and social costs. As more questions are raised concerning over reliance on infrastructure solutions, discussions about a sustainable future suggest a greater focus on the demand side of the equation is needed. In this paper, we use multi-recursive and runoff coefficient analysis methods to analyze the annual runoff of the mainstreams (Kuye River, Tuwei River, Wuding River and Jialu River) in the middle reaches of Yellow River. The main objective is to estimate the impacts of climate change and human activity on water resources in the study area and test the potential of water demand management to lessen the gap between supply and demand. Results show remarkable drop in the average annual runoff as a combined effect of climate change and human activity. Moreover, results show that human activities are the direct reason for the changes of river runoff, and the proportion of human activities account the biggest is Wuding river, next is Kuye river, Jialu river is smallest, these changes lead to the decrease of river runoff, and even drying up in recent years. This result highlights the importance of using WDM to diminish the increasing gap between demand and supply. Motivated by this, the paper presents a comprehensive framework for implementation WDM in the middle reaches of Yellow River. The framework includes a wide range of instruments: legislative, economic, technological and educational. The core step of the framework, collaboration among water planners, water service providers and end-users lies as an essential mechanism for achieving long term trade-offs between ecological and socio-economic water needs.