Franchising Reproductive Health Services

Objectives. Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client.
Methods. Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings.
Results. Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings.
Conclusions. Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.     

A 2-µm Continuous-Wave Laser System for Safe and High-Precision Dissection During NOTES Procedures

Introduction

Lasers 2-µm in wavelength offer efficient tissue cutting with limited thermal damage in biological tissue.

Objective

To evaluate the dissection capabilities of a 2-μm continuous-wave laser for NOTES procedures.

Methods and Procedures

We conducted 18 acute animal experiments. Group 1 (three animals): transcolonic access to the peritoneal cavity (15-W transcolonic laser puncture, balloon dilation over the laser probe). Group 2 (six animals): transcolonic access with needle-knife puncture and balloon dilation. Group 3 (three animals): transgastric access to the peritoneal cavity (similar technique as group 1) followed by laser-assisted dissection of the kidney. In one animal of group 3, a therapeutic target (hematoma) was created by percutaneous puncture of the kidney. Group 4 (six animals): transgastric access (similar to the technique of group 2).

Results

Translumenal access to the peritoneal cavity was achieved in 2–3 min in group 1 (significantly shorter than with the needle-knife-assisted technique, 4–5 min, p = 0.02) and in 7–10 min in group 3 (compared to 6–17 min in group 4, p = 0.88). In group 3, laser dissection of the parietal peritoneum and of perinephric connective tissue allowed access to the retroperitoneum with complete removal of a blood collection in the animal with puncture trauma. Laser dissection demonstrated good maneuverability, clean and rapid cutting, and excellent hemostasis. Peritoneoscopy and necropsy showed no damage of targeted tissue and surrounding organs.

Conclusions

The 2-μm continuous-wave laser system showed promising capabilities for highly precise and safe dissection during NOTES procedures.     

EUS-guided angiography: a novel approach to diagnostic and therapeutic interventions in the vascular system

BACKGROUND: Indications for diagnostic and therapeutic procedures under EUS guidance continue to expand. OBJECTIVE: To assess the feasibility and safety of EUS-guided angiography in a live porcine model. SETTING: Five acute experiments under general anesthesia. DESIGN AND INTERVENTIONS: A linear echoendoscope was advanced into the stomach. Thoracic and abdominal aorta, celiac axis, superior mesenteric and splenic artery, splenic, portal, and hepatic veins were injected with contrast by using FNA needles under fluoroscopy. The animals were then killed for postmortem examination. MAIN OUTCOME MEASUREMENTS: Ability to achieve angiography without complications. RESULTS: All vessels were identified and punctured without technical difficulties. Injections of the large-caliber vessels resulted in a blush of contrast, whereas selective injection of the smaller vessels (splenic artery, hepatic veins) demonstrated clear vascular opacification. Injection of contrast was technically easiest with the 19-gauge FNA needle and most difficult with the 25-gauge needle. There were no changes in vital signs and hemodynamic parameters during vascular injection of any vessel. At necropsy, the 25-gauge FNA needle did not cause any visible vascular injury or bleeding. The 22-gauge needle left a visible puncture mark without active bleeding. In 1 of 5 pigs, the 19-gauge needle caused a localized vascular hematoma around large-caliber vessels and 150 mL of intra-abdominal blood. LIMITATION: Technical challenges remain to achieve an adequate flow rate of contrast for prolonged visualization of large vessels. CONCLUSION: EUS-guided angiography is technically easy and safe and has potential for a wide array of diagnostic and therapeutic vascular interventions.     

Comparative study of endoscopic clips: duration of attachment at the site of clip application

BACKGROUND: Several designs of endoscopic clips are now commercially available, and the indications for endoclip application are rapidly expanding. However, very limited data have been published to aid in choosing between the different types of endoclips. OBJECTIVE: To compare the duration of clip attachment between all commercially available endoclips. SETTING: Long-term experiments on 50-kg pigs under general anesthesia. DESIGN AND INTERVENTIONS: Upper endoscope was inserted into the stomach. One clip of each type (Resolution clip, TriClip, and HX-5L clip) was placed along the same gastric fold at a distance of 0.5 to 1 cm from each other. The animals were recovered. In pig nos. 1 and 2, repeat endoscopy was performed after 2 and 4 weeks. In pig nos. 3 to 5, endoscopy was repeated after 1, 2, and 5 weeks. MAIN OUTCOME MEASUREMENTS: Duration of clip retention at the site of application. RESULTS: In all animals, only the Resolution endoclip remained attached to the site of application for the entire duration of the study (4-5 weeks). No TriClips or HX-5L clips were attached at the 4- to 5-week follow-up endoscopies. Most of the TriClips (67%) detached within the first week after application. Most of the HX-5L clips (80%) dislodged within the first 2 weeks of follow-up. LIMITATIONS: The study was performed in a porcine model with a small number of animals. CONCLUSIONS: The Resolution clip has the longest duration of retention at the site of application (more than 4-5 weeks) and should be preferred when long-term attachment of endoclips is necessary.