Maternal serum alpha-fetoprotein screening: a cost-benefit analysis.

The prenatal detection of fetal neural tube defects (NTD) is now possible by means of a multi-tiered program utilizing maternal serum alpha-fetoprotein (MSAFP) screening coupled with ultrasonography and amniocentesis where indicated. This paper considers the economic consequences of screening for fetal NTD a theoretical cohort of 100,000 pregnant women at risk of having an affected fetus who would elect to terminate their pregnancies if an affected fetus were found. The cost of the program was balanced against the benefits of the program, such as the averted costs of institutionalization, medical care, and the like. The total cost of the program to screen 100,000 such women was calculated to be $2,047,780, or slightly over $20 per woman screened, while the total economic benefits exceeded $4,000,000.     

Bifocal control of myopia.

Forty-three native American bifocal wearers grouped by yearly age levels from 9 to 15 with a mixed group of 6 to 8 year olds are matched on beginning age, sex, beginning refractive error and ending age with 83 Native American control subjects. Similarly 226 Caucasian bifocal wearers are matched on the same criteria against 192 control subjects. Although the comparisons are made on each age group, the average annual rate of progression for the bifocal Native American subjects is -0.12 and -0.10 diopters in the right and left eyes respectively against a comparable rate of progression of -0.38 and -0.36 diopters for the control subjects. These differences are significant but not as significant as those found on the Causcasian subjects of -0.02 and -0.03 diopters right and left eyes against -0.53 and -0.52 diopters for the controls.     

The laparoscopic nephrectomy learning curve: a single centre's development of a de novo practice

Objective: There has been a dramatic increase in the interest and practice of laparoscopic urology, with nephrectomy having become the commonest laparoscopic urological procedure. Compared with open nephrectomy, it results in reduced morbidity and shorter convalescence times while maintaining oncological safety. However, while these results predominately stem from institutions with well developed laparoscopic programmes, little is known about the results in centres that have newly adopted this technique. The introduction of a laparoscopic urological service at the Royal Hallamshire Hospital provided an opportunity to study these factors. Methods: Since the appointment in October 2000 of a urological surgeon (N Oakley) to develop the laparoscopic service, there have been over 200 laparoscopic procedures including 121 nephrectomies performed at this centre. Full details were collected for each of these cases, and in addition, compared with retrospective data for 50 open nephrectomies performed during the same time period. Results: With increased operator experience the median operative duration, complication, transfusion, and conversion rates significantly improved. While a learning curve was evident, the overall operative complication (9%) and conversion rates (6%) were low, in addition to patient morbidity (16.5%) and mortality (0%) rates, showing that this learning curve had no deleterious effects upon patient care. The median hospital stay was four days, which reduced to three with experience and was significantly shorter than for open nephrectomy at this institution (p = 0.001). Conclusions: The development of a successful laparoscopic programme can be achieved with a comparatively short learning curve and without detriment to the patient provided the necessary steps are observed.