Prosthetic cardiac pacers in community hospitals: a physician's experience

This report deals with 53 patients treated with prosthetic cardiac pacers solely by one “interested” physician at the community level over a period of 5 years and 2 months.The 5-year mortality rate was 41.5 per cent; (15.1 per cent cardiogenic and 26.4 per cent noncardiogenic). A complication rate of 28.2 per cent with one fatality (1.9 per cent) due to a faulty pacemaker was experienced. These results compare favorably with a similar medically treated group, who had an immediate in-hospital cardiogenic mortality of 35 per cent. Contrary to other reports, premature battery depletion was not found in this series.This community study compares favorably to several university studies, who report a complication rate of 63 per cent, a mortality rate of 6.7 per cent versus 28.2 and 1.9 per cent, respectively, as experienced in this group. This study indicates that community standards are equal to or superior to university standards in this particular mode of therapy.     

The economic impact of incorporating flexible endoscopy into a community general surgery practice

Background Flexible endoscopy is a vital component of gastrointestinal surgery. It has and will replace many of the surgical procedures now commonly performed. Flexible endoscopy, unfortunately, is not an integral part of surgical residency training based on resident operative experience as reported by the Residency Review Committee. Moreover, general surgeons have deferred the practice of flexible endoscopy to the gastroenterologists because of concerns over turf battles and referral patterns. The purpose of this study was to assess the overall case load and the economic impact of flexible endoscopy on the practice of general surgery in a community hospital setting.Methods This retrospective review was performed over a 6-month period. The total cases and the total billings of inpatient and outpatient procedures for a group practice of five general surgeons in a community hospital were evaluated. The billings were the actual charges based on current procedural terminology (CPT) codes for these procedures using the Medicare fee schedule.Results Of the 2,159 procedures performed, 1,154 involved flexible endoscopy cases accounting for 54% of all cases (1,154 of 2,159) performed from February 1, 2003 to July 31, 2003. Flexible endocopy accounted for 43% of the total charges. A. total of 46 surgical procedures and 216 future endoscopies were generated from the flexible endoscopic procedures. Future endoscopic cases were for surveillance of colonic neoplasia and Barrett’s esophagus.Conclusions Flexible endoscopy contributed to a major portion of the caseload and revenue generated by the general surgery group studied. The overall impact of flexible endoscopy is even greater than reported because of the future endoscopic surveillance cases or surgical interventions generated on the basis of endoscopic findings.     

Fundamentals of clinical economics in health interventions

Health economics is a science of efficient use of medical resources. Economic evaluation deals with both inputs or costs and outputs or consequences and is done when there are choices. The inputs or costs can be direct, indirect or intengible. The consequences can be measured as natural health units or utilities which aggregate multiple health units or quality adjusted life years. In the current health care scenario in India the cost data is usually lacking. An exact way for estimating the cost is elicitation of opportunity cost which is the value of time or input at its highest. The total cost is, the cost of producing a particular quantity of the output and is made up of fixed and variable costs. Fixed costs do not vary with the quantity of output but variable costs do. In India, the total cost of health care provided by a multidisciplinary team can be estimated either by the ‘per diem’ approach which assumes no cost sharing by the departments, or by the allocation method which takes into account the quantity of service provided by each department and costs them individually. Cost effectiveness or utility and cost-benefit analysis are considered complete economic evaluation. Analyses are done from a pre-specified perspective which could be patients’, payers’, providers’ or societal. Costs incurred at a later time are discounted. Such evaluations help us make informed decision to choose between various health interventions. Their increasing use in health research in the developing countries is needed.     

医院的社会资本及其经济功效

随着医疗改革进程的加快，医院面临着各方面的压力，而要保持充分的竞争力和可持续发展，就必须积累更多的资本。社会资本是一种和物质资本、人力资本相对应的新的资本形式，对于医院的发展具有获取和动员社会资源，并使其转化为经济价值、节约交易成本、提高管理效率、提升社会声誉等多种功效。     

The psychological,social, and economic impact of stillbirth on families

This article reviews the current state of psychological, social, and economic research into the impact of stillbirth on families. We argue that whereas the knowledge we have of the experiential aspects of stillbirth is increasing, there is still much that remains to be uncovered especially in respect of the impact that seeing the baby may have on mental health. Moreover, the experience of particular social groups merits further work, most notably regarding same-sex couples and surrogates, mothers and fathers drawn from Black and Minority Ethnic groups as well as those from lower socio-economic groups. Particular attention needs to be paid to the economic impact of stillbirth on families, whether this is from a perspective that focuses on the family or the wider society in which they live.     

Major gastrointestinal hemorrhage associated with pancreatic pseudocyst

Although the pancreas is not a frequent source of major gastrointestinal hemorrhage, bleeding in patients with pancreatitis is not an uncommon complication. In patients with bleeding who are known to have pancreatitis or a pseudocyst, this organ must be considered a possible site of hemorrhage.It is recommended that celiac axis and superior mesenteric artery angiography be performed prior to barium contrast studies.If bleeding is originating from a pancreatic pseudocyst, aggressive surgical intervention should be undertaken. Three cases are described in which prompt operation was successful.Intracystic suture-ligation of the bleeding vessel together with cystogastrostomy was performed in two cases. One case of bleeding from a pseudocyst in the head of the pancreas and involving the gastroduodenal artery was treated by excision of the cyst and head of the pancreas.     

Absence of subchronic oral toxicity and genotoxicity of rice koji with Aspergillus terreus

Koji products have been considered as an effective fermented food consumed in East Asia with many health benefits. Particularly, rice koji with Aspergillus terreus (RAT) has been reported to be able to prevent hyperlipidemia and hepatic steatosis through regulating cholesterol synthesis. Despite its biological activities, there is a lack of comprehensive information to give an assurance of its safety. Therefore, the objective of this study was to perform a series of toxicological studies (repeated dose oral toxicity and genotoxicity) according to test guidelines published by the Organization for Economic Cooperation and Development. Along with acute toxicity study using rats and beagle dogs, a 13-week toxicity study revealed no clear RAT-related toxic changes, including body weight, mortality, hematology, serum biochemistry, organ weight, and histopathology after oral administration at doses of 500, 1000, and 2000 mg/kg BW. The no-observed-adverse-effect level of RAT was considered to be more than 2000 mg/kg BW/day in rats of both genders. In addition, potential genotoxicity was evaluated using a standard battery of tests (Ames test, chromosome aberration assay, and micronucleus assay) which revealed that RAT showed no genotoxicity. Accordingly, these results suggest that RAT is a safe and non-toxic functional food for human consumption at proper dose.     

Crude 4-methylcyclohexanemethanol (MCHM) did not cause skin irritation in humans in 48-h patch test

Crude 4-methylcyclohexanemethanol (MCHM) is an industrial chemical used to wash and clean coal. On January 9th, 2014 approximately 10,000 gallons of a mixture containing crude MCHM were released into the Elk River near Charleston, West Virginia, contaminating the local water supply. Following the spill, residents reported numerous health complaints, and sought medical attention for ailments including rashes and itching. The relationship between the complaints and the spill were unknown, as such symptoms are reported frequently in the background. In this study, the primary irritation potential of crude MCHM was evaluated in 206 individuals who underwent 48?hour semi-occluded patch testing. MCHM concentrations assessed in this study were 1, 5, 15, and 100?ppm. No appreciable skin reactions were observed in individuals at any concentration. Three of the five concentrations evaluated were above the highest measured concentration of MCHM in the tap water of residents in West Virginia (3.7?ppm). The results of this study suggest that crude MCHM would not be a dermal irritant for the vast majority, if not all, potentially exposed persons at the concentrations in the water reported after the spill.     

肿瘤新兴技术水平扫描报告分析及启示

目的系统分析EuroScan发布的肿瘤新兴技术水平扫描报告,为我国新兴卫生技术评估提供借鉴。方法明确检索词获取EuroScan 2013年1月1日-2017年5月31日发布的肿瘤新兴技术水平扫描报告,制定报告的纳入及排除标准,设计资料提取表提取信息,对纳入报告进行描述性分析。结果纳入293份报告,其中241份针对药品,52份针对器械和其他诊疗技术。技术接受水平扫描的最主要原因是可为患者提供额外或新的备选诊疗方案,扫描过程中需要基于多维度的信息对技术影响进行分析和预测。结论肿瘤新兴技术水平扫描工作由专业机构在技术生命周期早期开展,从多个维度对技术进行早期评估。建议构建国家级本土化新兴卫生技术水平扫描系统,加强国际合作网络建设,促进国际机构间合作交流,公开报告,确保新兴技术各维度信息可追溯,为新兴卫生技术的准入和推广应用提供决策支持。