The impact of hospital discharge on inappropriate hospital stay

Appropriate hospital stay should be effective, efficient and tailored to patient needs. Previous studies have found that on average 20 per cent of hospital stay is inappropriate. Within obstetrics, inappropriate hospital stay consists mostly of delays in hospital discharge. The specific goals of this study were to reduce inappropriate hospital stay by fine-tuning patient logistics, increasing efficiency and providing more comfortable surroundings. New policies using strict discharge criteria were implemented. Total inappropriate hospital stay decreased from 13.3 to 7.2 per cent. The delay in discharge procedures halved. P-charts showed a decrease in inappropriate hospital stay, indicating the current process to be stable. Concludes that a significant reduction in inappropriate hospital stay was found following the implementation of innovative hospital discharge policies, indicating greater efficiency and accessibility of hospital services.     

Polymorphisms of CYP2C19 and CYP2D6 in Israeli Ethnic Groups

BACKGROUND: The cytochrome P450 isoenzymes CYP2C19 and CYP2D6 catalyze reactions involved in the metabolism of many widely used drugs. Their polymorphisms give rise to important interindividual and interethnic variability in the metabolism and disposition of several therapeutic agents and may cause differences in clinical response to some drugs. Individuals who carry two null alleles of either gene are known as poor metabolizers (PMs), while those who carry more than two copies of the functional CYP2D6 gene are ultrarapid metabolizers (UMs). AIM: The aim of the current study was to genotype Israelis from four different ethnic backgrounds with respect to CYP2C19 and CYP2D6. STUDY DESIGN: Polymorphisms of the CYP2C19 and CYP2D6 genes were determined by genotyping the four ethnic groups using PCR and/or restriction fragment length polymorphism (RFLP) analysis. The groups consisted of three Jewish communities, Yemenite Jews (n = 36), Sephardic Jews (n = 47), Ethiopian Jews (n = 28), and one Arabian population, Bedouins (n = 50). RESULTS: CYP2C19*2 allele frequencies ranged from 12.0 to 19.6% among the four ethnic groups. Within the study population, the CYP2C19*3 gene was only found in one Bedouin individual, in the heterozygous state (CYP2C19*1/*3). In each group, one individual was homozygous for CYP2C19*2, and were predicted to be PMs. The data revealed a high prevalence of CYP2D6*2, *4, *10, *41, and gene duplication, followed by *5 and *17, while *3 was very rare. The frequencies of the CYP2D6*4, *10, and *17 alleles and CYP2D6 gene duplication were significantly different among the four groups. However, the CYP2D6*2, *3, and *5 and *41 alleles showed similar frequencies in the four groups. Four (8.5%) Sephardic Jews and one (2.0%) Bedouin were found with the genotype CYP2D6*4/*4 (two null alleles), and were thus presumably PMs. A total of 15 individuals, distributed in all groups, were found with functional CYP2D6 gene duplications. The frequencies of predicted UMs (duplication of CYP2D6) were 17.8% (5/28) and 12.8% (6/47) in Ethiopian Jews and Sephardic Jews, respectively, which were higher than that of Yemenite Jews (5.6%, 2/36) and Bedouins (4.0%, 2/50). CONCLUSIONS: This is the first study of the CYP2D6 gene polymorphism in Israeli ethnic groups, either Jewish or Arab. Furthermore, this is also the first study of the CYP2C19 gene polymorphism in Jewish or Arab subgroups living in Israel. The frequencies of various alleles for the CYP2D6 gene are significantly different among the ethnic groups in Israel. These new findings may have important clinical implications in administrating drugs metabolized by CYP2D6 and for CYP2D6-related adverse drug reactions in the Israeli population.     

Radiation dose, chemotherapy and risk of soft tissue sarcoma after solid tumours during childhood

Soft tissue sarcoma (STS) is one of the most frequent second primary cancer that occurs during the first 20 years following treatment for a solid cancer in childhood. Our aim was to quantify the risk of STS as a second malignant neoplasm and to investigate its relationship with radiotherapy and chemotherapy. A cohort study of 4,400 3-year survivors of a first solid cancer diagnosed during childhood in France or the United Kingdom, between 1942 and 1985, was followed 15 years on average. In a partially nested case-control study, we matched 25 cases of STS and 121 controls for sex, type of first cancer, age at first cancer and duration of follow-up. Sixteen STS occurred in the cohort, as compared to 0.3 expected from the general population (Standardized Incidence Radio, SIR = 54 (95%CI: 34-89)). The SIR was 113 (95% CI: 62-185) after chemotherapy plus radiotherapy (13 STS), whereas it was 28 (95%CI: 2-125) after chemotherapy alone (1 STS) and 19 (95%CI: 3-60) after radiotherapy alone (2 STS). After adjustment for treatment, there was no evidence of variation in the annual excess of incidence or in the SIR with either age at first cancer or time since 1st cancer. In the case-control study, the risk of a STS was increased with the square of the dose of radiation to the site of STS development and with the administration of Procarbazine. The increased risk of soft tissue sarcoma that occurred after childhood cancer is independently related to exposure to radiotherapy and Procarbazine. A closer surveillance of children treated with this treatment combination is strongly recommended.     

Lower limb venous haemodynamic impairment on dependency: quantification and implications for the "economy class" position

The role of stasis in venous disease is undisputed, yet surprisingly, its haemodynamic quantitation remains largely undefined. We investigated the phenomenon of venous stasis in the lower limb upon sitting and standing and project its implications to economy class aircraft passengers. 26 normal limbs, 13 subjects, age 29-54, selected after duplex, plethysmography and ABPI, had peak[V(peak)], mean[V(mean)] and minimum[V(min)] velocities, volume-flow[Q(venous)], pulsatility index [PI(venous)] and diameter obtained on horizontal, sitting (as in economy aircraft seats) and standing with duplex, at popliteal, femoral[FV] and common femoral[CFV]veins [differences in median %]. V(peak), V(mean) and Q(venous) decreased from horizontal to sitting in the CFV [57%, 71%, 31%, respectively], FV [51%, 70%, 34%] and popliteal [31%, 58%, 42%] (all, p<.001). V(peak),V(mean) and Q(venous) decreased further from sitting to standing in the CFV [26%, 44%, 25%, respectively], FV [21%, 42%, 27%] and popliteal [14%, 42%, 20%] (all, p <.001). Diameter, V(min) and PI(venous) increased from horizontal to sitting in the CFV [50%, 63%, 38%, respectively], FV [39%, 23%, 66%] and popliteal [21%, 14%, 84%] (all, p <.001)]. Diameter, V(min) and PI(venous) increased further from sitting to standing in CFV [10%, 22%, 19%, respectively; p =.004], FV [12%, 68%, 2%[ns]; p <.001)] and popliteal [14%, 50%, 24%; p =.017]. In all postures: V(peak), V(mean), Q(venous) and diameter at CFV exceeded FV (p <.025) and popliteal (p <.001) ones; also those at FV exceeded the popli-teal ones (p =.003), except for the diameter on horizontal. V(min) in popliteal was higher than in CFV (p =.003) or FV (p <.025), on horizontal and standing. PI(venous) in CFV was lower than in FV or popliteal (p <.025) on sitting. Right to left differences non-significant. [Wilcoxon(+Bonferroni) test: significance at p <.025] A shift from horizontal to sitting generates a most significant attenuation in Q(venous),V(peak) and V(mean) linked to a reciprocal increase in V(min), PI(venous) and vein diameter, with further exacerbation on standing. V(peak),V(mean) and Q(venous) decline with distance from groin enhancing venous stasis in the periphery. By restricting activation of the natural venous pumps, sitting cramped during long flights may protract the status of haemodynamic stagnation sustained on dependency which paired with marked venous dilatation generates a milieu that may promote thrombogenesis.     

Traitement chirurgical des fistules rectovaginales hautes

The surgical approach to complex rectovaginal fistulas varies and depends on a number of factors, including the aetiology of the fistula, its site and, most importantly, its association with Crohn’s disease. A variety of surgical options exists, such as local repair procedures (advancement flap and muscle transposition) and abdominal procedures (rectal excision with temporary or permanent stoma). Faecal diversion is a determinant factor for healing. After preoperative evaluation of the best treatment options, most fistulas can be successfully repaired in two-thirds of patients.     

Endonasal sinus surgery with endoscopic control for recurrent sinusitis in children (author's transl)

Since 1976, 35 transnasal operations of the maxillary sinus with endoscopic control were performed in children as treatment for chronic sinusitis. After luxation of the inferior turbinate, a mucosal flap was developed to expose the lateral bony nasal wall. A sinus fenestra was then created to allow endoscopic control of the antrum during the operation. Gross pathological alterations of the mucosa were removed while most of the lining mucosa was preserved for recovery. 30 of the 35 children were followed from 4--18 months after surgery. 28 were without any discomfort. Although X-ray studies in many of the patients revealed mucosal swelling four weeks after surgery, the maxillary sinuses were well aerated 8 weeks after operation. Transnasal sinusotomy under endoscopic control is considered to be the treatment of choice for chronic sinusitis in adults and can now also be considered to be the treatment for similar disease in children.     

Attitude of Pilsen primary school teachers in dental traumas

Abstract – Dental injuries are rather common during sport activities and at schools where children spend most of their time every day. The purpose of this study was to evaluate the knowledge of primary school teachers in Pilsen, Czech Republic, of how to provide first aid in cases of one of the most serious dental injuries, the tooth avulsion. To this end, a questionnaire which contained nine questions about avulsion of permanent teeth was prepared. The questionnaires were distributed in nine primary schools in Pilsen where almost 300 teachers are employed. Seventy‐four percent of the teachers replied. Sixty‐eight percent had never received any information about providing first aid in cases of dental injuries and 81% would place the avulsed tooth in a dry handkerchief until the transfer of the patient to dentist. Prevention of tooth injuries is very important, as they may result even in tooth loss. This demands an effort to properly inform and educate sport trainers and primary school teachers about providing first aid in dental trauma situations; this effort should be intensive and continuous.