Objectives: Few studies have attempted to quantify the costs of operating room (OR) time. The purpose of this study is to quantify the variable cost per OR minute in isolated non-robotic valvular procedures -aortic valve replacement (AVR), mitral valve replacement (MVR), and mitral valve repair (MVRepair). MethOds:The Premier database, one of the most comprehensive hospital databases, was queried from 2007 to 2011 for patients undergoing AVR, MVR, or MVRepair. This database contains complete billing, hospital cost, and coding data from > 600 US facilities. Patients were identified using the following International Classification of Diseases 9 th Revision (ICD-9) procedure codes: AVR 35. 21, 35.22; MVR 35.23, 35.24; and MVRepair 35.12. Patients having coronary artery bypass grafting were excluded. The surgical approaches, right thoracotomy (RT) and any sternal incision, were identified for each patient with expert clinical assistance. Patients with right thoracotomy were then propensity score matched to patients with any sternal incision, adjusting for patient differences. Premier classified variable costs of the OR into three categories; staff for the surgery room, anesthesia, and recovery room. Outliers were identified based on the cost per minute of the procedure. The top and bottom five percent were removed. All costs were adjusted to 2012 dollars using the Medical Care Component of the Consumer Price Index. Results: There were 2,657 valvular procedures -1,604 AVR, 434 MVR, and 619 MVRepair -that met the inclusion criteria. The average cost per OR minute

A LT H 1 7 ( 2 0 1 4 ) A 7 1 9 -A 8 1 3 reasons for self-medication, factors that influenced the choice of drug and source of drug. Results: People of all socio-demographic categories practice self-medication. A total of 76.8% of the respondents indulged in self-medication practices. Of which, 33.0% used the medication inappropriately. The most frequently self-diagnosed illnesses or symptoms of illnesses were: GI illnesses, cough/cold and headache/fever. Of these illnesses, more than 35% were less than 24 hours duration and nearly 80% less than seven days duration of illness. The reasons given by respondents for selfdiagnosis and self-medication were non-seriousness of the illnesses, for emergency use and prior experience about the illness with similar symptoms (39.7%) and even advice of non-physician health professional (33.5%). Whatever the duration of illnesses and reasons for self-diagnosis, nearly 65% requested drugs by mentioning the names of the drugs and more than one-fifth by telling the symptoms of their illnesses. Requests for analgesics/antipyretics were very high (60%) followed by antimicrobial drugs (40%) for all reported illness. Drug requested mostly in other conditions include cold/cough suppressants, Gastro Intestinal drugs and very low for ORS. ConClusions: The level of inappropriate drug use denotes self-medication as an unhealthy option, and it therefore, should be discouraged.

Objectives: Few studies have attempted to quantify the costs of operating room (OR) time. The purpose of this study is to quantify the variable cost per OR minute in isolated non-robotic valvular procedures -aortic valve replacement (AVR), mitral valve replacement (MVR), and mitral valve repair (MVRepair). MethOds:The Premier database, one of the most comprehensive hospital databases, was queried from 2007 to 2011 for patients undergoing AVR, MVR, or MVRepair. This database contains complete billing, hospital cost, and coding data from > 600 US facilities. Patients were identified using the following International Classification of Diseases 9 th Revision (ICD-9) procedure codes: AVR 35. 21, 35.22; MVR 35.23, 35.24; and MVRepair 35.12. Patients having coronary artery bypass grafting were excluded. The surgical approaches, right thoracotomy (RT) and any sternal incision, were identified for each patient with expert clinical assistance. Patients with right thoracotomy were then propensity score matched to patients with any sternal incision, adjusting for patient differences. Premier classified variable costs of the OR into three categories; staff for the surgery room, anesthesia, and recovery room. Outliers were identified based on the cost per minute of the procedure. The top and bottom five percent were removed. All costs were adjusted to 2012 dollars using the Medical Care Component of the Consumer Price Index. Results: There were 2,657 valvular procedures -1,604 AVR, 434 MVR, and 619 MVRepair -that met the inclusion criteria. The average cost per OR minute

Objectives: In the last decade awareness has been raised due to unsafe and dangerous devices entering the European market, putting patient safety at stake. Consequently, evidence requirements may not be enough to ensure a high-quality and safe provision of medical devices in Europe.This research aims at exploring the authorization and reimbursement processes and the associated evidence requirements comparing four high-impact regions Europe, United States, Australia and Canada. MethOds: First, we performed a literature search about the authorization and reimbursement in the four high-impact regions. Second, seven high-risk medical devices were chosen as examples and current authorization and reimbursement status were assessed. Information was extracted from publicly available summaries, from PubMed, and from the clinical trial database (clincialtrial.gov), supplemented by the worldwideweb. Results: The evidence required for the authorization and reimbursement processes clearly differs in the four high-impact regions. All seven devices have been authorized in Europe, three in Australia, one in the United States, and one in Canada. Currently none of the seven devices is recommended for reimbursement in the four high-impact regions. cOnclusiOns: Looking at the difference in evidence requirements, more harmonization, transparency and specific regulations are needed worldwide for the authorization and reimbursement of high-risk medical devices to ensure a high-quality and safe provision.