The cost of Pancreatoduodenectomy – An analysis of clinical determinants

BackgroundHealth care spending is increasing the world over. Determining preventable or correctable factors may offer us valuable insights into developing strategies aimed at reducing costs and improving patient care. The aim of this study was to conduct an exploratory analysis of clinical factors influencing costs of Pancreatoduodenectomy (PD).MethodsThe financial and clinical records of 173 consecutive patients who underwent PD at a tertiary care referral centre, between January 2013 and June 2015 were analysed.ResultsComplications, by themselves, did not increase costs associated with PD unless they resulted in an increase in the duration of stay more than 11 days. Intraoperative blood transfusion (p-.098) and performance of an end-to-side PJ (p-.043) were independent factors significantly affecting costs. Synchronous venous resections significantly increased costs (p-.006) without affecting duration of stay. Advancing age, hypertension, neurological and respiratory disorders, preoperative endoscopic retrograde cholangiopancreatography (ERCP), performance of a feeding jejunostomy, and surgical complications eg PPH, POPF and DGE significantly increased the duration of stay sufficient enough to influence costs of PD.ConclusionsIt is not the merely the development, but severity of complications that significantly increase the cost of PD by increasing hospital stay. Strategies aimed at reducing intraoperative blood transfusion requirement as well as minimising the development of POPF can help reduce costs. Synchronous venous resections significantly increase costs independent of hospital stay. This study identified nine factors that may be included in the development of a preoperative nomogram that could be used in preoperative financial counselling of patients undergoing PD.     

Indirect detection of dark matter with γ rays

The details of what constitutes the majority of the mass that makes up dark matter in the Universe remains one of the prime puzzles of cosmology and particle physics today—80 y after the first observational indications. Today, it is widely accepted that dark matter exists and that it is very likely composed of elementary particles, which are weakly interacting and massive [weakly interacting massive particles (WIMPs)]. As important as dark matter is in our understanding of cosmology, the detection of these particles has thus far been elusive. Their primary properties such as mass and interaction cross sections are still unknown. Indirect detection searches for the products of WIMP annihilation or decay. This is generally done through observations of γ-ray photons or cosmic rays. Instruments such as the Fermi large-area telescope, high-energy stereoscopic system, major atmospheric gamma-ray imaging Cherenkov, and very energetic radiation imaging telescope array, combined with the future Cherenkov telescope array, will provide important complementarity to other search techniques. Given the expected sensitivities of all search techniques, we are at a stage where the WIMP scenario is facing stringent tests, and it can be expected that WIMPs will be either be detected or the scenario will be so severely constrained that it will have to be rethought. In this sense, we are on the threshold of discovery. In this article, I will give a general overview of the current status and future expectations for indirect searches of dark matter (WIMP) particles.     

Incidence of Guillain-Barré syndrome among patients with Campylobacter infection: a general practice research database study

The association between Campylobacter infection and subsequent Guillain-Barré syndrome (GBS) has been well documented. To date, however, there exists no direct estimate of the incidence of GBS among patients with Campylobacter infection. Using the General Practice Research Database, we estimate the incidence of GBS in a cohort of patients presenting with Campylobacter enteritis to be 1.17/1000 person-years, a rate 77 times greater than that in the general population. The probability that an individual who develops Campylobacter enteritis will also develop GBS during the subsequent 2-month period is <2/10,000.     

Surgical management of pituitary adenomas: does age matter?

Pituitary - Along with increased life expectancy and improvements in the diagnostic tools and techniques, the number of elderly patients with symptomatic pituitary tumors being evaluated for...     

The coronary angiography – An old-timer in great shape

The invasive coronary angiography is the gold standard in coronary artery disease evaluation. It is one of the most common operative procedures worldwide. This topic covered in detail would be extensive and the author provides his own, personal view of the indications, technique and complications of this diagnostic test. The advantages and disadvantages are provided together with the opinion about the current role of invasive coronary angiography in modern cardiology.     

Perceptions of forgetful and slow employees: does age matter?

Participants (perceivers) read a vignette describing a young or older employee (target) in a young-relevant or old-relevant work context who is either forgetful or slow. Regardless of work context, perceivers attributed older targets' forgetful and slow behavior more to internal stable causes but the identical behavior of younger targets more to internal unstable causes. Perceivers also felt less anger and greater sympathy and were more likely to recommend a promotion and raise for older than for young targets. Perceivers' anger for young and older targets was mediated by their internal unstable attributions, but their sympathy was not mediated by their internal stable attributions. Perceivers' promotion and raise recommendations were associated with the degree of sympathy they felt more for young than for older targets.