Opioid analgesia is the mainstay of treatment for moderate to severe acute and chronic pain and is highly effective in relieving pain but can be limited by side effects, the most common of which affect the gastrointestinal (GI) and central nervous systems. A growing body of evidence demonstrates that opioid-associated GI side effects constitute an important health problem with significant humanistic and economic consequences that warrant consideration by healthcare professionals and administrators in optimizing patients’ pain management. This article documents the frequency of opioid-associated GI side effects and describes its clinical and economic burdens based on a systematic review of the medical literature between 1966 and 2008.

Benefits of bypassing agents for maintaining haemostasis in major surgeries have been described in the literature; however, their use has a substantial economic impact. This study assessed the cost of FEIBA, an activated prothrombin complex concentrate and recombinant factor VIIa (rFVIIa) when used in inhibitor patients undergoing major surgeries. After reviewing published literature, a cost minimization model was developed describing dosing regimens recommended and used during major surgeries for FEIBA (pre-operative: 75-100 U kg(-1); postoperative: 75-100 U kg(-1) q 8-12 h days 1-5 and 75-100 U kg(-1) q 12 h days 6-14) and rFVIIa (pre-operative: 90 microg kg(-1); intra-operative: 90 microg kg(-1) q 2 h; postoperative: 90 microg kg(-1) q 2-4 h days 1-5 and 90 microg kg(-1) q 6 h days 6-14). Using a 75 kg patient and US prices, total drug cost was calculated for three scenarios: use of FEIBA or rFVIIa alone and a third case combining rFVIIa pre- and intra-operative and FEIBA throughout a 14-day postoperative period. Dosage amounts of modelled bypassing agents were similar to cases in the literature. Using FEIBA instead of rFVIIa would decrease total drug cost by >50% and save over $400,000 per surgery. Sequential use of both bypassing agents would increase total drug cost by 9% when compared with FEIBA alone, but would remain >40% lower than rFVIIa alone. Univariate sensitivity analyses confirmed robustness of results. As large amounts of bypassing agents are necessary for patients with inhibitors to undergo major surgeries, cost is a major consideration. Use of FEIBA alone or in combination with rFVIIa has emerged as a cost-saving approach.

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INTRODUCTION:Return of spontaneous circulation (ROSC) is the recapturing of hemodynamic stability in a patient recently in cardiac arrest. Non-trauma cardiac arrest can be the sequela of several underlying pathologies. Whole body CT is a common imaging study used in Emergency Departments to further evaluate patients. Yet, the diagnostic value of whole-body CT is uncertain due to limited research. We hypothesized that CT scanning did not seem to often change clinical management, and added time, risk for decompensation during CT, and cost without clinical benefit. METHODS:This retrospective study included patients with return of spontaneous circulation after presenting to the University of Kentucky Emergency Department in nontraumatic cardiac arrest or upon arrival. This study included patients >18 years of age seen between Sept. 1st, 2019, and April 26th, 2020. Data were collected on whether the patient survived admission, survived to discharge, had a whole body CT, or had a selective CT of the head, chest, and abdomen. We analyzed each case and categorized findings into non-notable or notable findings, which could have impacted management. RESULTS: 360 total cases of cardiac arrest presenting to the ED were reviewed, of those, 265 were medical arrests, and 92 of those patients received CT scans, with the remainder either not surviving to scan or admitted without CT imaging as a post-arrest. 54 out of 92 received selective CT scans of the head, chest, or abdomen; and 38 received complete scans including all three head, chest, and abdomen. There was no significant difference in mortality or findings that explained the arrest between selective and whole-body CT. There was a significant difference between selective CT and WBCT with regard to notable findings with a P value of 0.04. CONCLUSIONS:In this small study of 92 cases of cardiac arrest with selective or whole body CT scan being obtained, we conclude that WBCT is helpful in finding injury patterns that could have caused the arrest and consequences of resuscitative efforts, but does not result in any discernible mortality difference.