Computer-aided system for health economic evaluation

Background  Health policy makers are usually stranded by the complicated infrastructure and intensive computation related to economic evaluation.
Objectives  It is therefore valuable to develop a computer-aided tool to help health personnel to perform economic evaluation with ease.
Method  The infrastructure for economic evaluation was first designed. Markov process with micro-simulation was applied to model the disease natural history or lifetime sequale to project the effectiveness by comparing all possible decisions. All the essential elements of economic evaluation together with sensitivity analysis are encoded in this computer-aided software written with SAS Screen Control Language in user-defined menu style.
Illustration  Screening versus no screening for colorectal cancer was used as an example.
Conclusion  The computer-aided model for economic evaluation was developed in this study. It is anticipated that the flexibility and user-defined menu style facilitate the wide application of economic evaluation to health care intervention program.     

Effect in cat locus coeruleus lesions on the response of cerebral blood flow and cardiac output to altered paCO2

In pentobarbital-anesthetized cats, over arterial p_aCO₂ values of 20–60 mm Hg, cerebral blood flow (CBF, Xenon) and cardiac output (CO, thermal dilution) show positively inflected curves with slopes significantly greater than zero. To examine the role of the locus coeruleus (LC) in these responses, bilateral stereotactic thermo-coagulation lesions of the LC were made. The effect of lesions confirmed to involve the LC bilaterally (n= 10), were compared with the effects of misdirected lesions placed in the cerebellum abd lateral to the LC (n= 10) and sham lesions (n= 10). Ted days after the lesioning procedure, the animals were re-anesthetized with pentobarbital and p_aCO₂ response curves were determined for CBF and CO prior to and following intravenous administration of propranolol (1 mg/kg, i.v.). The results obtained with the sham-operated animals and the animals with lesions outside of the LC were indistinguishable. Bilateral LC lesions had no significant effect on normocapnic CBF as compared to control animals. They did, however, significantly reduce the slope of the CBF p_aCO₂ response curve. Propranolol produced a significant reduction in CBF in lesioned and non-lesioned animals measured at all levels of pCO₂ and did not alter the slope of the pCO₂ response curve for any group as compared to predrug values. Bilateral lesions of the LC did not significantly alter either normacapnic CO or the slope of the CO-p_aCO₂ relationship, but did reduce the elevation in mean arterial blood pressure otherwise observed during hypercarbia. Measurement of norepinephrine levels in cortex indicate a close indicate a correlation between the ability of the lesion to reduce norepinephrine content and produce the observed physiological effects. The results of these experiments suggest that the hypercapnic response of CBF, but not CO to arterial p_aCO₂ is modulated by systems which traverse the dorsal brainstem. The role of the locus coeruleus-catecholamine cell bodies in this effect, however, must be considered speculative until further transmitter-selective interventions are carried out.     

Time Course and Role of Morphine Dose and Concentration in Intrathecal Granuloma Formation in Dogs: A Combined Magnetic Resonance Imaging and Histopathology Investigation

Background: Intrathecal morphine infusion leads to intrathecal granulomas. In dogs, the authors examined time course of granuloma formation and the role of concentration in granuloma development.

Methods: Dogs were prepared with lumbar intrathecal catheters and vest-mounted pumps. To define the time course of granuloma formation, serial magnetic resonance imaging was performed in animals receiving 10 or 31 days of morphine infusion (12.5 mg/ml at 40 [mu]l/h). At these times, morphine was removed from the infusate, and further magnetic resonance images were acquired over 14-35 additional days. To assess dose versus concentration, dogs received 28-day infusions of vehicle, 12 mg morphine/day as 12.5 mg/ml at 40 [mu]l/h, or 1.5 mg/ml at 334 [mu]l/h (12 mg/day) for 28 days. Additional dogs received 3 mg/day as 12.5 mg/ml at 10 [mu]l/h.

Results: Serial magnetic resonance images in dogs receiving morphine (12.5 mg/ml at 40 [mu]l/h) revealed pericatheter-enhancing tissues as early as 3 days with a prominent signal by 10 days. Removal of morphine reduced the mass volume within 7 days. At a fixed infusion rate, the incidence of granuloma formation with the continuous intrathecal infusion of morphine ranged from 0 in vehicle-treated dogs to 100% in dogs treated with 12.5 mg/ml at 40 [mu]l/h (12 mg/day). Infusion of 12 mg/day at 1.5 mg/ml (334 [mu]l/h) resulted in granuloma in one of four animals. The authors found that infusion of morphine in different concentrations at a fixed rate resulted in a dose-dependent increase in concentration, with the granuloma-producing, dose-yielding lumbar cerebrospinal fluid morphine concentrations around 40 [mu]g/ml.     

Spontaneous closure of vesicovaginal fistulas after bladder drainage alone: review of the evidence

A vesicovaginal fistula may occur as a surgical complication, the result of obstructed labor, or a late manifestation of radiotherapy. Surgical treatment includes many routes and techniques, with a success rate reaching 100%. The spontaneous closure of vesicovaginal fistulae following [corrected] bladder drainage alone for varying periods has been reported by many. The factors favoring the success of this conservative method have not been well examined [corrected] In this investigation [corrected] all articles referring [corrected] to this modality were reviewed [corrected] The parameters studied included etiology, size, interval from [corrected] causative insult to drainage, and duration of drainage. The incidence of spontaneous closure of fistulae [corrected] after bladder drainage alone ranged between [corrected] 0 and 100%. Among all assessed criteria, the interval to drainage seems to have the best correlation with success. This finding [corrected] is most likely explained on the basis of the epithelialization of the fistulous tract with time, preventing spontaneous healing. In the view of the retrospective nature of the reviewed articles, the absence of a detailed classification system, and the heterogeneity of the treatment in question, no solid conclusion regarding management recommendations can be drawn.     

Neuropsychiatric correlates of traumatic brain injury (TBI) among Australian prison entrants

Primary objective: To investigate the association between reported past traumatic brain injury (TBI) and demographic, neuropsychiatric and criminographic parameters among individuals recently received into custody.

Research design: A random sample of men recently received into the New South Wales (Australia) criminal justice system were screened for a history of TBI and the details of up to five separate TBI episodes were obtained. We also screened for depression, psychosis, personality disorder, drug and alcohol use, and 'social connectedness'.

Main outcome and results: Among the 200 study participants, 82% reported past TBI. TBI was associated with a history of engagement in contact sports, school expulsion, daily illicit drug use, depression and psychosis.

Conclusions: Past TBI is common among prisoners entering the criminal justice system and, amongst other correlates, appears to be highly associated with increased rates of major mental illness.