Reducing construction accidents by increasing safety for various construction firms have always been major issues that have had an impact on various construction projects. Many research indicates a close focus on the difficulties of... more
Reducing construction accidents by increasing safety for various construction firms have always been major issues that have had an impact on various construction projects. Many research indicates a close focus on the difficulties of reducing construction accidents and increasing safety in construction projects by locating the optimal safety investments in precautionary safety equipment and activities used within any construction project. The construction industry has been using some mathematical models to obtain the optimal safety investment. For instance, Behavior-Based Safety is one of the many techniques used in the industry to increase safety due to its role of observing and reporting the workers' behaviors to eliminate accidents and increase project safety. The main objective of this study is to support reducing construction accidents by increasing safety awareness as well as comparing the cost of construction accidents with the cost of safety investments in a construction field. This research paper will discuss the effectiveness of the safety measurements on a construction project as well as compare the direct and indirect accident costs to the safety investments to increase safety in any construction field. This research aims to show that good safety management of a construction site can prevent accidents, reducing the cost of accidents and increasing project profits.
Background: Atrial fibrillation (AF) affects 46.3 million people; its prevalence has tripled over the last 50 years. AF leads to formation of blood clots increasing four‑fold the risk of a stroke. Preventive anticoagulant therapy with... more
Background: Atrial fibrillation (AF) affects 46.3 million people; its prevalence has tripled over the last 50 years. AF leads to formation of blood clots increasing four‑fold the risk of a stroke. Preventive anticoagulant therapy with warfarin has been well established for over 50 years but has efficacy and safety limitations. New anticoagulants do not require laboratory monitoring of prothrombin time, have low risk of adverse events, yet are more costly. Methods: This non‑interventional (Act 378/2007 Coll.) retrospective‑prospective single‑arm cohort study consisted of 3 visits. The primary objective was to compare the total direct cost of treatment with warfarin and apixaban. Patients with non‑valvu‑ lar AF were enrolled at the time of discontinuation of warfarin and switching to apixaban. Costs were derived from the care provided and the list of medical procedures (Decrees 268/ 2019 Coll.). Satisfaction was assessed using SAFUCA® questionnaire. Results: Between February 2017 and June 2019, 499 patients were enrolled in 29 Czech internal medicine clinics. The mean age of the patients was 73.6 ± 10.2 years, 36.5% were at high risk of bleeding (HAS‑BLED score). Previous warfarin treatment lasted 5.9 ± 2.7 months, 63% were unable to achieve target prothrombin time, 18% switched due to adverse reactions. New apixaban treatment was followed for the first 6 months. Treatment with warfarin was associated with higher rates of major bleeding and adverse events (22 vs. 2), stroke (17 vs. 0), ischemic heart attack (11 vs. 0), and minor bleeding (173 vs. 2). The average daily cost following the switch to apixaban decreased from CZK 65.2 to CZK 4.8 (p <0.001). The price of anticoagulant treatment was considered, there was an insignificant increase from CZK 68.1 to CZK 71.7 (p = 0.509). Satisfaction increased significantly after 3 months, notably in the subjective evaluation of efficacy, comfort, impact on quality of life and the occur‑ rence of side effects. Conclusion: Switching patients with unsatisfactory outcomes on warfarin to apixaban resulted in lower risk of serious isch‑ emic events, bleeding and side effects, and higher patient satisfaction. From the pharmacoeconomic perspective, apixaban is a better choice in this population as it brings higher efficacy and better safety within comparable overall direct costs.
