Resource utilization and charges of patients with and without diagnosed venous thromboembolism during primary hospitalization and after elective inpatient surgery: a retrospective study

Aims: To assess incremental charges of patients experiencing venous thromboembolisms (VTE) across various types of elective inpatient surgical procedures with administration of general anesthesia in the US.

Methods: The authors performed a retrospective study utilizing data from a nationwide hospital operational records database from July 2014 through June 2015 to compare a group of inpatients experiencing a VTE event post-operatively to a propensity score matched group of inpatients who did not experience a VTE. Patients included in the analysis had a hospital admission for an elective inpatient surgical procedure with the use of general anesthesia. Procedures of the heart, brain, lungs, and obstetrical procedures were excluded, as these procedures often require a scheduled ICU stay post-operatively. Outcomes examined included VTE events during hospitalization, length of stay, unscheduled ICU transfers, number of days spent in the ICU if transferred, 3- and 30-day re-admissions, and total hospital charges incurred.

Results: The study included 17,727 patients undergoing elective inpatient surgical procedures. Of these, 36 patients who experienced a VTE event were matched to 108 patients who did not. VTE events occurred in 0.2% of the study population, with most events occurring for patients undergoing total knee replacement. VTE patients had a mean total hospital charge of $60,814 vs $48,325 for non-VTE patients, resulting in a mean incremental charge of $11,979 (p?<?.05). Compared to non-VTE patients, VTE patients had longer length of stay (5.9 days vs 3.7 days, p?<?.001), experienced a higher rate of 3-day re-admissions (3 vs 0 patients) and 30-day re-admissions (7 vs 2 patients).

Conclusions: Patients undergoing elective inpatient surgical procedures with general anesthesia who had a VTE event during their primary hospitalization had a significantly longer length of stay and significantly higher total hospital charges than comparable patients without a VTE event.     

Transparenz im Journalismus

The transparency that journalists and newsrooms can produce for their audience has long been regarded as a rather marginal criterion for journalistic quality. But new transparency models??due to the interactivity, immediacy, archiving capacity and the absent limitation of space in the internet??offer greater potentials than classical instruments in print and broadcasting. In comments, web videos, blogs, twitter feeds and social networks, journalists discuss with users and publicly account for editorial decisions. Transparency is fashionable in the digital public sphere; its evaluation, however, is not clear, but ambiguous and complex. This paper conceptualizes (self-)transparency and qualitatively classifies the available instruments in a three-dimensional matrix model. This is to facilitate the analysis of problematic areas and potential conflicts: Newsrooms demonstrating open self-reflection dismiss the ideal of ??objective journalism??. Yet, transparency is not only an ethical demand, but is also supposed to strengthen trust in journalistic products because it permits quality evaluations by the audience. An experiment shows, for the first time, that self-transparency has an effect on trust in some aspects but not as a basic principle. Analysing this interdependency, we have to distinguish between transparency of process and of product as well as between different media.     

ECONOMIC CONSEQUENCES OF THE POSTED WORKERS DIRECTIVE

The consequences of an increase in the minimum wage for foreign workers in the construction sector, implied by the EU Posted Workers Directive, are analyzed. Due to the rising price of construction services, the factor demand for both construction services and capital in the tradeable good sector falls, and the wage rate in this sector declines. While the share of domestic workers increases with respect to both foreign workers and capital in the construction sector, this need not suffice to reduce unemployment. A possible higher level of employment of natives is not sufficient to raise natives’ welfare.     

Energy and habitat: Designing a sustainable urban ecosystem

As the world's cities grow so new ways of satisfying their demands for food and fuel resources will have to be found, especially in the third world where total fuel demands are expected to expand several fold in one generation. An ecological model for a future complex urban community is presented to illustrate the place of energy in a growing system and how habitat—the physical component—possesses life cycles interdependent with living species. Recycling, biomass fuels, telecommunications, marine living and the propagation of viable organizations are all elements that will enable the globe to sustain future expanding metropolises.     

Preservation: Planning for the survival of things

Preservation—the immortalisation of living and designed things—is a channel for transmitting messages from the past to the future. Image is all important for conveying the meaning. To be preserved, a thing must have a constituency of supporters and a long-lived institution to serve as trustee: when appreciators of the message are no longer recruited, extinction is at hand. Community ecology, if extended to images, suggests some appropriate preservation policies for societies approaching steady state, eg adding to the total stock of biomass, to diversity, and to useful knowledge, while promoting new organised relationships between man and environment.