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Anesthesiologists are accepted as aiming to be outstanding in patient safety and medical quality improvement. However, both preventable and inevitable adverse events still persist [ 1 , 2 ]. According to the Thai Anesthesia Incidents Study (THAI Study) database, the incidence of perioperative cardiac arrest within 24 h was 31:10,000 in 2005 with a mortality rate of 90% [ 3 , 4 ]. The Royal College of Anesthesiologists of Thailand (RCAT) initiated knowledge management tools using research to improve anesthesia processes and outcomes. Several strategies have been
Rong-Rong Zhang, Hong Wang, Ning Hui and Ping Zhang
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30. Charuluxananan S, Thienthong S, Rumgreungvanich M, Chanchayanon T, Chinachotti T, Kyokong O, et al. Cardiac arrest after spinal anesthesia in Thailand: a prospective multicenter registry of 40271 anesthetics. Anesth Analg. 2008; 107:1735-43.
Background: Currently, there is a considerable variation concerning the provision of preanesthetic-risk information, especially potential detrimental adverse outcomes.
Objective: Determine the effects of printed anesthetic-risk information before surgery including patients’ anxiety, refusal of surgery, knowledge perception of adverse events and factors affecting anxiety.
Methods: Patients in a university hospital, a tertiary care hospital, a secondary care hospital, and a neurological institute in Thailand, undergoing low-to-moderate risk surgery were randomly allocated to control group (C) and study group (S), where group C received printed general information in anesthesia, and group S received printed incidences of five anesthetic adverse events as sore throat, nausea/vomiting, tooth loss, not waking up after surgery, cardiac arrest. Spielberger State-Trait Anxiety Inventory Scale (STAIS, STAIT) for anxiety and Visual Analog Scale (VAS) for knowledge perception were recorded before and after information, and after surgery. Numbers of patients who refused surgery and needed anesthetic-risk information in the next surgery were also recorded. STAIS >45 were considered “high anxiety”.
Results: Eight-hundred and twenty-four patients were analyzed (group C: 414, group S: 410). There was no difference in age, sex, ASA physical status, salary, education level, habitat, anesthetic experience and operative risk between groups. STAIS and STAIT, proportion of patients with high anxiety, proportion of patients who refused surgery were not different between groups. Patients in control group needed anesthetic-risk information in the next surgery more than study group (p <0.001). VAS for knowledge about five adverse events in study group were significantly higher than control group (p <0.001). Risk factors by the multivariate analysis included patients with high baseline trait anxiety and low income of less than 10,000 Baht/month.
Conclusion: Printed anesthetic-risk information did not increase anxiety, but increased knowledge perception of the patients.
Background: Influenza can exacerbate chronic coronary heart diseases (CHD) and health policy recommends influenza vaccination in this population group. However, cost effectiveness of influenza vaccination in protecting CHD population has not been, to our knowledge, well studied before especially in CHD patients with different disease severities.
Objectives: To assess life-time cost utility of influenza vaccination in CHD patients either with angina and/or cardiac arrest/myocardial infarction (CA/MI) and to identify the most cost-effective influenza vaccination strategies.
Method: The Markov model of CHD progression concurrent with the influenza infection was developed to quantify life-time costs and health effects of the three influenza vaccination strategies compared with no influenza vaccination (base case): (1) influenza vaccination in all CHD patients, (2) influenza vaccination in CA/MI patients-only, and (3) influenza vaccination in angina patients-only. The cost-effectiveness analysis (CEA) was based on the societal perspective. Deterministic and probabilistic sensitivity analyses were performed to identify variables that influence the sensitivity of the results and examine the effects of model parameters uncertainty, respectively.
Results: For the base case, the expected value (EV) results of no influenza vaccination, influenza vaccination in all CHD groups, influenza vaccination in angina patients, and influenza vaccination in CA/MI are 346,437 Thai baht (THB) yielded 18.26 Quality adjusted life year (QALYs), 454,664 THB yielded 21.46 QALYs, 360,786 THB yielded 19.96 QALYs, and 437,901 THB yielded 19.72 QALYs; respectively. CEA graph comparing all influenza vaccination strategies shows that vaccination in all CHD patients groups and angina patients are in the costeffectiveness frontier, but not influenza vaccination in CA/MI patients. The cost-effectiveness rankings report shows that the willingness-to-pay (WTP) threshold (100,000 THB) is greater than the incremental cost effectiveness ratio (ICER) of vaccination in all CHD groups (ICER = 33,813 THB per QALY gained) and angina group (8,420 THB per QALY gained) and therefore the vaccination in all CHD groups, which is more expensive, but more effective would be recommended. The deterministic sensitivity analysis shows the most influential parameters driving the cost-effectiveness of vaccination strategies are the effect of influenza vaccination on CHD both for acute myocardial infarction and cardiovascular death, respectively. The probabilistic sensitivity analysis shows the same influenza strategy recommendation (vaccination in all CHD groups) as the base case analysis.
Conclusion: From a societal perspective, influenza vaccination in all CHD groups is recommended. The information from economic modeling should be confirmed by primary economic research.
7. Charuluxananan S, Thienthong S, Rungreungvanich M, Chanchayanon T, Chinachoti T, Kyokong O, Punjasawadwong Y. Cardiac arrest after spinal anesthesia in Thailand: a prospective multicenter registry of 40271 anesthetics. Anesth Analg. 2008; 107: 1735-41.
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2. Bunchungmongkol N, Punjasawadwong Y, Chumpathong S, Somboonviboon W, Suraseranivongse S, Vasinanukorn M, et al. Anesthesia-related cardiac arrest in children: the Thai Anesthesia Incidents Study (THAI Study). J Med Assoc Thai. 2009; 92:523-30.
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