Le slide presentate da Pasquale Longobardi, Direttore Sanitario del Centro Iperbarico di Ravenna al 5° Congresso WUWHS (World Union of Wound Healing Societies), conferenza mondiale dedicata alla cura delle ulcere della pelle e alle ferite difficili, Firenze 25-29 settembre 2016
Aspetti clinici-economici nel trattamento del piede diabetico utilizzando OTIPasquale Longobardi
Le slide presentate da Pasquale Longobardi, Direttore Sanitario del Centro Iperbarico di Ravenna e da Klarida Hoxha, coordinatrice infermieristica CCFD al 42° Congresso EUBS2016
L'intervento del dott. Pasquale Longobardi al Consensus Conference della European Committee for Hyperbaric Medicine (ECHM) di Lille, 15-16 aprile 2016 sui temi "Diabetic foot lesions" e "Delayed wound healing (other than diabetic
Foot ulcer)"
L'oti nelle ulcere cutanee- Master in Wound Care Università la Sapienza di Roma.Pasquale Longobardi
Le slide presentate da Pasquale Longobardi, Direttore Sanitario del Centro Iperbarico di Ravenna, durante la lezione al Master in Wound Care dell’università la Sapienza di Roma. 7 giugno 2016
Le slide presentate dal Dott. Pasquale Longobardi, direttore sanitario del Centro Iperbarico di Ravenna al convegno "Rush - Traumi e primo soccorso negli sport motoristici". Montegridolfo 8 giugno 2017
Le indicazioni appropriate all'ossigenoterapia iperbaricaPasquale Longobardi
Le slide presentate da Pasquale Longobardi, Direttore Sanitario del Centro Iperbarico di Ravenna, in occasione dell'incontro di formazione ad alcuni futuri Medici di Medicina Generale al Centro Iperbarico Ravenna 13 giugno 2016
Aspetti clinici-economici nel trattamento del piede diabetico utilizzando OTIPasquale Longobardi
Le slide presentate da Pasquale Longobardi, Direttore Sanitario del Centro Iperbarico di Ravenna e da Klarida Hoxha, coordinatrice infermieristica CCFD al 42° Congresso EUBS2016
L'intervento del dott. Pasquale Longobardi al Consensus Conference della European Committee for Hyperbaric Medicine (ECHM) di Lille, 15-16 aprile 2016 sui temi "Diabetic foot lesions" e "Delayed wound healing (other than diabetic
Foot ulcer)"
L'oti nelle ulcere cutanee- Master in Wound Care Università la Sapienza di Roma.Pasquale Longobardi
Le slide presentate da Pasquale Longobardi, Direttore Sanitario del Centro Iperbarico di Ravenna, durante la lezione al Master in Wound Care dell’università la Sapienza di Roma. 7 giugno 2016
Le slide presentate dal Dott. Pasquale Longobardi, direttore sanitario del Centro Iperbarico di Ravenna al convegno "Rush - Traumi e primo soccorso negli sport motoristici". Montegridolfo 8 giugno 2017
Le indicazioni appropriate all'ossigenoterapia iperbaricaPasquale Longobardi
Le slide presentate da Pasquale Longobardi, Direttore Sanitario del Centro Iperbarico di Ravenna, in occasione dell'incontro di formazione ad alcuni futuri Medici di Medicina Generale al Centro Iperbarico Ravenna 13 giugno 2016
Seminar led by Rui Moreno, MD, PhD, from the Hospital de Santo António dos Capuchos Unidad de Cuidados Intensivos Polivalente Centro Hospitalar de Lisboa Central- Portugal.
Abstract: The impact of SSC 2012 on the planning and evaluation of my hospital's performance  The 2012 revision of the Surviving Sepsis Guidelines, together with the new sepsis bundles, will, have a profound impact on the evaluation of the performance of health care systems dealing with the recognition and early treatment of the patient with severe sepsis and septic shock.  With the application and evaluation of the new bundles (now at 3 hours and 6 hours after triage), most of the evaluation will focus in the very early stages of the process of care, when in a significant number of patients will be still in the Emergency Department (ED). This constitutes a major change when compared to the 2008 revision of the SSC, since at that time part of the evaluation was done after 24 hours of diagnosis, when most of the patients was already on the ICU.  An immediate consequence of this will be a major pressure on the ED and in the early connection of the ED with the ICU. This will can be done by creating dedicated admission pathways to patients with suspected severe sepsis and septic shock, to the presence of intensivists on the ED or even to the direct admission (by-passing the ED) to the ICU of theses patients. More than focusing in new therapies, the 2012 revision of the SSC will put the emphasis on the planning and creation of systems able to work fast and flexibly, delivering fast care where it is needed more. Only systems of care able to control and deal with these timing problems will be in condition to offer first quality care to the patient with severe sepsis and septic shock and consequently to have a good evaluation of their performance.
Ranse J. (2019). The 2018 Commonwealth Games Experience; invited speaker for 4th International Conference for Mass Gathering Medicine, Jeddah, Saudi Arabia, 16th December.
Prof. Robert Thomas, Kembridžo profesorius, onkologas, rašytojas. Pranešimas skirtas POLA tarptautinei konferencijai „Kaip pagerinti komunikaciją tarp gydytojo ir paciento?“ (2017-10-19)
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Similar to The economic analysis of HBOT in WOUND CARE
Seminar led by Rui Moreno, MD, PhD, from the Hospital de Santo António dos Capuchos Unidad de Cuidados Intensivos Polivalente Centro Hospitalar de Lisboa Central- Portugal.
Abstract: The impact of SSC 2012 on the planning and evaluation of my hospital's performance  The 2012 revision of the Surviving Sepsis Guidelines, together with the new sepsis bundles, will, have a profound impact on the evaluation of the performance of health care systems dealing with the recognition and early treatment of the patient with severe sepsis and septic shock.  With the application and evaluation of the new bundles (now at 3 hours and 6 hours after triage), most of the evaluation will focus in the very early stages of the process of care, when in a significant number of patients will be still in the Emergency Department (ED). This constitutes a major change when compared to the 2008 revision of the SSC, since at that time part of the evaluation was done after 24 hours of diagnosis, when most of the patients was already on the ICU.  An immediate consequence of this will be a major pressure on the ED and in the early connection of the ED with the ICU. This will can be done by creating dedicated admission pathways to patients with suspected severe sepsis and septic shock, to the presence of intensivists on the ED or even to the direct admission (by-passing the ED) to the ICU of theses patients. More than focusing in new therapies, the 2012 revision of the SSC will put the emphasis on the planning and creation of systems able to work fast and flexibly, delivering fast care where it is needed more. Only systems of care able to control and deal with these timing problems will be in condition to offer first quality care to the patient with severe sepsis and septic shock and consequently to have a good evaluation of their performance.
Ranse J. (2019). The 2018 Commonwealth Games Experience; invited speaker for 4th International Conference for Mass Gathering Medicine, Jeddah, Saudi Arabia, 16th December.
Prof. Robert Thomas, Kembridžo profesorius, onkologas, rašytojas. Pranešimas skirtas POLA tarptautinei konferencijai „Kaip pagerinti komunikaciją tarp gydytojo ir paciento?“ (2017-10-19)
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Hemodialysis: Chapter 3, Dialysis Water Unit - Dr.Gawad
The economic analysis of HBOT in WOUND CARE
1. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
THE ECONOMIC
ANALYSIS OF HBOT
IN WOUND CARE
Pasquale Longobardi
Hyperbaric Centre Ravenna
Affiliated researcher Sciences for Life Institute, Superior School for Advanced
Studies Sant’Anna, Pisa (Italy)
President 2016-2018 Italian Diving and Hyperbaric Society (SIMSI)
direzione@iperbaricoravenna.it
2. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
prevalence of “open” wounds
and cost of VLU in Europe (2015)
In UK in 2012-2013 there was a
prevalence of 2.2 milions of
wounds (11% open wounds).
Cost €6,1 billion (£5,3 billion)
The cost of 12 months old wounds is doubled
3. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Crude and Age-Adjusted Hospital Discharge Rates for
Nontraumatic Lower Extremity Amputation
per 1,000 Diabetic Population USA 1988–2009
Caroline Fife
1998
$43,800
2010
$58,582
in 2015 US Government spending in Health Care rose
over 11.7% (17,5% of GNP).
In the USA, Wound Care cost over $20 billion
with 5-7 million wounds annually
4. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Healthcare decision making process to
identify the economic sustainability
• the available evidence.
• good value for money
(cost effectivenes )
• Ensuring equity of access
to HBOT in the Nation
• Evaluating the absolute
proactive investments
COSTS
QUALITY
Quality-increasing
and cost-saving
innovation
5. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
HBOT is recommended in DFU as
part of a multidisciplinary care pathway
GRADE level of evidence: 2
The level of recommendation
depend on the care pathway:
2A when it is appropriate
2B when it is unclear or not
completely appropriate
GRADE level of evidence
and recommendation
1B
6. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Why is it so hard to do the right
thing in wound care?
• 6% DFU patients had "Gold Standard" TCC
used1. Cost of care was half that of those that did not.
• 17% VLU patients received adequate compression1.
• 16% of the leg ulcers were evaluated with Doppler
(required in guidelines)2
These procedure are considered time consuming.
Reimbursement is inadequate.
Lack of familiarity with Clinical Practice Guidelines
1 US WOUND REGISTER
C. Fife, WOUNDS 2012
2
7. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Cost of Wounds increases in the presence of
comorbidities and with length of time
US WOUND REGISTER
C. Fife, WOUNDS 2012
Co-morbid conditions correlated to longer weeks to heal:
• Diabetes (p=0.007)
• Systemic antibiotics (p=0.003)
• Renal failure (p=0.028)
• Immunocompromise (p=0.02)
• Smoking (p=0.02)
Cost ≥ 2 commorbities $4282
vs $3601 (p = 000024; + 16%)
The cost of unhealed wounds
increases with longer lenght
of time in service.
8. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Average value
2009 2014
Nobilio L. Health & Social Care Regional Agency of Emilia Romagna, 2015
VALUE FOR MONEY
Leg amputation ICD9-CM: 84.13–84.19)
From 2009 to 2014, the standardized major amputation rate
in Romagna was half the average in the Region
(45% less than the USA in the same period - Medicare)
Piacenza (EMILIA)
Ravenna (ROMAGNA)
9. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Cost of a leg amputation procedures
• average cost of a leg amputation was 14,070 € (£12,000)
• costs for prosthetic limbs, rehabilitation and wound care
in the year after an amputation was 23,451€ (£20,000)
• Costs of home adaptations, community care, care homes
and wheelchairs (borne by local communities)
€37,521
10. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Economic burden of DFU
and amputations in the USA
• Medicare beneficiaries with a
Lower Extremity Amputation
(LEA) have been seen by their
outpatient health care provider
about 12 times per year and
are hospitalized about 2 times
per year.
• The cost of amputation is
estimated about $ 52,000 per year
https://www.effectivehealthcare.ahrq.gov/ehc/products/294/639/Data
-Points_3_Diabetic-Foot-Ulcers-Amputations_Report_03-2011.pdf
Caroline Fife
Gil J FAIJ 2013
11. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
The costs to the patient and family
• lost wages, co-payments and deductibles
• modifications for disabled living
(reduced quality of life):
– poor ambulation (60%-80% are unable
to walk),
– chronic pain (95%), depression (35%),
– lengthy healing process and hospital
readmissions (22% at 30 days)
– contralateral amputation (36%-50%),
– high 2-year mortality rates (30%-50%)
12. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Value of the HBOT for the money spent
HBOT ≤ 35 sessions
NNT 4 (p = 0.03)
HBOT > 35 sessions
NNT 3 (p = 0.009)
Number Needed to Treat (NNT) is the estimate of the
number of patients that need to be treated in order to have
an impact on one person.
13. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Value for money
(30 HBOT sessions, NNT 4)
Nation
Cost
HBOT
session
Number
HBOT
sessions
NNT
Cost HBOT
to save an
amputation
Cost
amputation
Value for
money
Belgium 110€ 30 4 13.200€ 11.515€ 1.685-€
Czech 70€ 30 4 8.400€ 2.500€ 5.900-€
France 222€ 30 4 26.640€ 61.519€ 34.879€
Italy 81€ 30 4 9.720€ 10.800€ 1.080€
Malta 35€ 30 4 4.200€ 3.000€ 1.200-€
Norway 367€ 30 4 44.000€ 9.800€ 34.200-€
Spain NHS 50€ 30 4 6.000€ 17.500€ 11.500€
Spain private 150€ 30 4 18.000€ 17.500€ 500-€
Turkey NHS 19€ 30 4 2.280€ 1.065€ 1.215-€
UK 197€ 30 4 23.640€ 37.521€ 13.881€
USA 364€ 30 4 43.680€ 46.233€ 2.553€
saving
14. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Value for money
(40 HBOT sessions, NNT 3)
Nation
Cost
HBOT
session
Number
HBOT
sessions
NNT
Cost HBOT
to save an
amputation
Cost
amputation
(1)
Value for
money
Belgium 110€ 40 3 13.200€ 11.515€ 1.685-€
Czech 70€ 40 3 8.400€ 2.500€ 5.900-€
France 222€ 40 3 26.640€ 61.519€ 34.879€
Italy 81€ 40 3 9.720€ 10.800€ 1.080€
Malta 35€ 40 3 4.200€ 3.000€ 1.200-€
Norway 367€ 40 3 44.000€ 9.800€ 34.200-€
Spain NHS 50€ 40 3 6.000€ 17.500€ 11.500€
Spain private 150€
40 3
18.000€ 17.500€ 500-€
Turkey NHS 19€ 40 3 2.280€ 1.065€ 1.215-€
UK 197€ 40 3 23.640€ 37.521€ 13.881€
USA 364€
40 3
43.680€ 46.233€ 2.553€
saving
15. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Value for money
(cost of amputation standardized for UK value)
Nation
Cost
HBOT
session
Number
HBOT
sessions
NNT
Cost HBOT
to save an
amputation
Cost
amputation
Value for
money
Belgium 110€ 30 4 13.200€ 37.521€ 24.321€
Czech 70€ 30 4 8.400€ 37.521€ 29.121€
France 222€ 30 4 26.640€ 37.521€ 10.881€
Italy 81€ 30 4 9.720€ 37.521€ 27.801€
Malta 35€ 30 4 4.200€ 37.521€ 33.321€
Norway 367€ 30 4 44.000€ 37.521€ 6.479-€
Spain NHS 50€ 30 4 6.000€ 37.521€ 31.521€
Spain private 150€ 30 4 18.000€ 37.521€ 19.521€
Turkey NHS 19€ 30 4 2.280€ 37.521€ 35.241€
UK 197€ 30 4 23.640€ 37.521€ 13.881€
USA 364€ 30 4 43.680€ 37.521€ 6.159-€
saving
16. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Equity of access
Web 11%
Press 2%
Word of mouth 12% G.Ps. 10%
Specialist
Physicians 65%
2015: 1,073 patients /
17,933 HBOT sessions
NHS England Report D11X02 on
HBOT (2016): 61% of a survey
respondents (295/482) reported lacking an
in depth knowledge on HBOT. 34%
reported significant barriers to access
HBOT. 8.5% felt the barriers were
impossible to overcome
17. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
PROACTIVE INVESTMENTS
NHS England Report D11X02 on HBOT (2016): there
would be significant resource implications of expanding
the availability of HBOT to satisfy the potential demand
Decrease in
number of AKA
Number of
patients in UK
Annual UK saving
to the NHS
5% 34 £ 1 million
10% 68 £ 2 million
In a previous report (2012) the same NHS realized the saving
in case of a decreasing in the number of major amputations
18. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
PROACTIVE INVESTMENTS
Decision model
a further 19-35 HBOT
chambers (7 patients each)
would be required in Canada
HBOT STANDARD CARE
ALONE
12-year cost for
DFU patient
CND$
40,695
CND$
49,786
Quality-Adjusted
Life-Years (QALYs)
3,64 3,01
7 person
HBOT chambers
Chuck AW Int J Technol Assess Health Care 2008
19. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Conclusion
http://www.vas-int.net/no-more-vascular-amputations.html
HBOT is an adjunctive therapy
that is cost effective only in an
appropriate care pathway.
It is useful to promote the knowledge of Guidelines for
Wound Care, also supporting international programs such as
Horizon 2020: the EU Research and
Innovation programme with €80 billion of
funding available from 2014 to 2020
20. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
Acknowledgements
• Belgium: Peter Germonpré; Roland Vanden Eede
• Czech Republic: Pavel Macura
• France: Daniel Mathieu
• Malta: Ramiro Cali-Corleo
• Norway: Martin Heer
• Spain: Jordi Desola
• Turkey: Maide Cimsit; Akin Savas Toklu
• United Kingdom: Marc Glover
• USA: Caroline Fife
We wish to thank these colleagues for sharing with us the
data of their own Nation.
21. P. Longobardi
Hyperbaric & Diving Medicine
S.Anna School Adv Studies,
Pisa (I)
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