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Open access

Andrzej Żyluk and Piotr Janowski

Results of the Treatment of Major, Complex Hand Injuries

Complex hand injuries are associated with serious consequences including long period off-work, permanent disability, inability to return to original profession or to work at all. As these injuries are common, they create considerable economical consequences and, therefore, it is desirable their treatment would be as perfect as possible to reduce potential loss of function.

The aim of the study was analysis of the structure of complex, multi-structural hand injuries and evaluation of the outcomes of the treatment of these injuries in both medical (recovery of function) and economical (period of inability to work and costs of medical care) aspects.

Material and methods. The study presents the results of treatment of 78 patients suffered from severe, major hand injuries, involving damage of at least two of four anatomical structures within the hand or wrist (bones, tendons, arteries or nerves) as well as severe injury involving at least two digits. Functional results were assessed at a mean of 10 months after the accident. Tendons were repaired in all 42 patients, bones were fixed in 29 (69%), nerves were repaired in 21 (50%), arteries in 14 (33%) and in two patients skin defect was covered by the flap (one local and one groin flap).

Results. Total active motion of affected digits amounted 2/3 of normative active motion of the healthy digits and total grip strength approximated half of the grip strength of the unaffected hand. In patients with nerve injuries, a satisfactory recovery of sensation in the affected digits was obtained. Dexterity of the hand in daily activity was scored 30 points in DASH scale. Injury-related duration of sick leave in 31 patients worked at the time of the accident amounted 4.4 months in average (range 1-12). A total of 27 subjects (87% of worked) returned to work: 24 to their previous profession and three had to qualify for a new job. Total hospital costs of the treatment in the analysed group amounted a mean of 2600 PLN.

Conclusion. The outcomes of the treatment of major hand injuries achieved in our institution over the period of the one year were satisfactory, considering their severity and complexity. These results, in our mind, show clearly advantages coming from an existence of qualified service for hand injuries.

Open access

Albana Ahmeti, Artan Simaku, Iria Preza and Silva Bino

Abstract

Background: Diarrheal diseases count for a considerable proportion of morbidity, mortality and elevated use of health services and costs, especially in developing countries. In limited resource countries like Albania, it is essential to assess the costs associated with diarrhea, from health provider and social perspective, as a first step toward prioritization of interventions.

Materials and Methods: We used the 2011 information by gathering data from primary care, emergency rooms (ER) and hospitals. Average non-medical and medical costs were used. To assess the social costs of diarrhea we interviewed parents of children with diarrhea. Based on this information the total cost of diarrhea in Albania was calculated.

Results: The total mean cost per hospitalized, emergency room and outpatient diarrhea case was $228.97, $17.68 and $9.24, respectively. The total social costs per each hospitalized, ER and outpatient diarrhea case were $45.66, $15.22 and $15.22, respectively. The final burden of diarrhea, in terms of costs, in Albania was approximately $3 million in 2011.

Conclusion: The high burden of diarrhea associated costs for the Albanian health care system finances dictates the necessity to assess the costs of a potential rotavirus immunization program in order to prioritize the interventions based on scientific evidence.

Open access

Dace Āriņa, Kaspars Kļavenieks and Juris Burlakovs

Abstract

Production of refuse derived fuel from municipal solid waste in future shall play a strategic role in an integrated waste management system. The amount of landfilled biodegradable materials thus will be diminished according to provisions of the 1999 Waste Landfill Directive. The aim of this article is to evaluate cost effectiveness based on cost evaluation of the different complication of the waste pre-treatment equipment complectation and based on regenerable waste quantities in Latvia. The comparison of cost estimates is done in 3 scenarios considering potential waste quantities in Latvia: Scenario I - planned annual waste quantity is 20 kT; Scenario II - 40 kT and Scenario III - 160 kT. An increase in amount of waste and processing capacity means the decrease in costs of mechanical pre-treatment of 1 ton of waste. Thus, costs of mechanical sorting line under different scenarios with capacities of 10 t h-1, 20 t h-1 and 80 t h-1 are EUR 32 per t, EUR 24 per t and EUR 15 per t, respectively. Most feasible cost for a set of mechanical pre-treatment equipment for the capacity of 10 t h-1 is EUR 32 per t by using rotating drum screener with the following manual sorting. Mechanical pre-treatment equipment of unsorted municipal waste is economically nonbeneficial, when the use of fine (biologically degradable) fraction is not possible. As the sorting of biodegradable kitchen waste is not developed under the current waste management system in Latvia, the lines for mechanical pre-treatment of household waste would be better to install in landfills.

Open access

Igor Jokanović, Bojana Grujić, Dragana Zeljić, Žarko Grujić and Mila Svilar

Abstract

The provision and maintenance of road infrastructure is a major global business, consequently it is essential that road maintenance services are provided in the most cost effective manner. Without regular maintenance, roads can rapidly fall into disrepair, preventing realization of the longer term impacts of road improvements on development, such as increased agricultural production and growth in school enrollment, which is of particular importance for a network of local (access) roads. Inadequate local roads maintenance in Albania is proposed to be solved by implementing performance based maintenance approach for which the costing exercise is presented within the paper.

Open access

Ladislav Kováč and Jana Jakubová

Abstract

The experiments aimed at the comparison of the growth and production parameters of sorghum with other field crops were established in the experimental workplaces CVRV-VÚA in Milhostov. In the course of favourable meteorological factors, the slowest initial development of vegetation height and dynamics of biomass accretion was observed in sorghum. From 15th August, however, sorghum accretion intensity significantly exceeded all the monitored field crops. The total cost of the cultivation of sorghum for silage accounted for 870.34 € ha-1 and of maize for silage 861.36 € ha-1. The difference resulted from different levels of material costs. In the experiment, the harvested amount reached 62.70 t ha-1 for sorghum silage and 54.20 t ha-1 for maize (33% moisture). At these yield and silage costs 33 € t-1, sorghum achieved a profit of 1198.76 € ha-1 without subsidy, while maize achieved a profit of 927.24 € ha-1. The yields exceeding 26.37 t ha-1 for sorghum and 26.10 t ha-1 for maize would be sufficient to achieve profits.

Open access

Alina Puțan, Oana Raluca Ivan and Attila Tamas

Abstract

Current status of the hospital units is worrying: insufficient funding, increasing the number of cases considered / treated, providing quality services at public hospital unit. In this research we have undergone an empirical research carried out in the hospital units of category III and IV, from Alba County, this sample selection aims to identify an optimal solution to exercise management control which should serve to management decisionmaking. Responsibility centers, at the level of hospital unit, establish the liability for each segment of expenditure, expenditure tracking and proper grounding even their places of training, delimitation expenditure which does not strictly dependent on the production activities that are related strictly by the process; establishing the deviations of preset expenses levels; establishing a system of rules allowing highlighting the responsibilities of each performer, introducing a system of resource allocation and tracking of the use of their by developing specific cost budget for each responsibility center. The disadvantages of decentralization based on activity centers consists in increase the consumption of resources in certain activities, unclear delimitation of cause-effect relationships that create difficulties in adopting the relevant decisions by management, etc.

Open access

Jindřich Ježek, Jiří Nožička and Árpád Török

Abstract

The paper deals with the issue of sensitivity analysis and its possible use in price formation in passenger road transport. The input variables are selected on the model example. Based on the calculation, the sensitivity of the output to these input variables is determined, and the question how these inputs affect the overall result is answered.

Open access

Martina Margorínová, Mária Trojanová, Martin Decký and Eva Remišová

Abstract

Building and improving road infrastructure in Slovakia is currently influenced by the amount of state funding. Therefore, it is necessary to determine the effectiveness of each proposed solution of road project, which is based on life-cycle costs. Besides capital costs, social costs are also important, which valued the negative impacts due to road construction and operation on road users, the environment, and the population living in the affected area. Some components of social costs have shortcomings in quantifying and valuating, which need to be resolved. The one of important components which affects human health and the value of an area, and have some shortcomings are noise costs. Improvement of this component will lead to more accurate valuation of economic efficiency of roads.

Open access

Luleeya Ocharot, Jiruth Sriratanaban, Sureerat Ngamkiatphaisan and Narin Hiransuthikul

Abstract

Background

The impact of adverse events on costs of medical care in developing countries is more limited than in developed countries.

Objective

To estimate uncompensated medical care costs as a result of adverse events in hospitalized patients.

Method

Retrospective study based on a panel reviews of the medical records and hospital charges relating to 574 inpatients in the electronic database of a tertiary-care university hospital in Bangkok, Thailand, of which 138 were identified to have adverse events in 2009. The main outcome measure was hospital charges for medical care standardized by Thai diagnosis-related groups (Thai-DRGs).

Result

After controlling for personal and clinical factors, the average medical cost of an adverse event was estimated at US $128.98 per adjusted relative weight of Thai-DRGs, equivalent to 52% of the standard payment rate paid to the hospital set by a Universal Coverage Scheme.

Conclusion

Adverse events in the hospital increased the cost of medical care despite adjustment for the case-mix based on DRG. Under the close-ended DRG-based payments for hospitals in Thailand, this meant that adverse events resulted in significant amounts of uncompensated care.

Open access

Dariusz Kwaśniewski and Maciej Kuboń

Abstract

The objective of the paper was to present straw pellets production technology and to determine their production costs. The paper presents also the cost structure and economic effectiveness of pellets production. Tests were carried out in EKO-BIOMASA company which produces pellets. It is located in Biechów in Świętokrzyskie Voivodeship. Unit costs of pellets production were: 310.20 PLN ∙ t-1 for option 1, 285.40 PLN ∙ t-1 for option 2 and 278.90 PLN ∙ t-1 for option 3. The most favourable was option 3 when the pellet production was carried out on the technology line in the 3-shift system day and night. In all three variants of pellet production, the highest costs were in case of electric energy. Its participation in the cost structure in relation to the option was within 42% (option 3) and 38% (option 1). The obtained indicator of economic effectiveness for all the investigated options was higher than one.