Laparoscopic-assisted colectomy: a comparison of dissection techniques.

BACKGROUND AND OBJECTIVES: Mobilization of the colon and dissection of the mesentery are difficult laparoscopic techniques. Traditional methods have been used for this dissection, but often with great difficulty. The ultrasonically activated shears, when introduced in 1993, had the possibility to make this dissection less technically difficult. This is a retrospective review of the use of these shears for these techniques during laparoscopic-assisted colectomy. MATERIALS AND METHODS: Eighty-five patients underwent a laparoscopic-assisted right hemicolectomy or sigmoid resection. Colon mobilization and mesenteric dissection were completed intracorporeally. Complications, operative time, estimated blood loss, and length of stay were compared for resections completed with and without the ultrasonically activated shears. RESULTS: Thirty-six patients had laparoscopic-assisted colectomy without the shears, and 49 patients had the procedure with the shears. There were no complications due to the ultrasonic energy. Use of the shears resulted in shorter operative times (170 min. vs. 187 min., p=0.1989), similar median blood loss (98 mL vs. 95 mL, p=0.7620), and shorter lengths of stay (4.3 days vs. 6.9 days, p=0.0018). CONCLUSIONS: The ultrasonically activated shears are safe and effective for colon mobilization and mesenteric division. The use of the shears may result in shorter operative times and shorter lengths of stay.     

Increasing incidence of hip fractures in Finland

Summary The incidence of hip fracture in Finland was studied for the year 1988. During 1988, 6139 patients were treated for a fresh hip fracture. Three out of four hip fracture patients were women, and the occurrence of cervical fractures was 2.8 times and that of trochanteric fractures 2.5 times more common in women than in men. The incidence rates of hip fractures per 100000 were 174 in women, 70 in men and 123 in the whole population. The mean hospitalization time for fresh hip fractures was 33 days for cervical fractures and 38 days for trochanteric fractures. The costs of primary hospitalizations due to fresh hip fractures in 1988 were estimated at US $ 66 million.     

Drug utilisation pattern and off-label use of medicines in Estonian neonatal units

Objectives  

To characterise neonatal hospital drug use and to compare the availability of drug information between Estonian Summaries of Product Characteristics (SPCs) and other sources.     

Winners and Losers in Health Insurance: Access and Type of Coverage for Women in Same-Sex and Opposite-Sex Partnerships

Using data from the American Community Survey, 2009 (N = 580,754), we compared rates of health insurance coverage and types of coverage used between women in same-sex and opposite-sex partnerships. This large, national dataset also allowed us to investigate regional variation in insurance coverage for women in same-sex partnerships by comparing “gay-tolerant” states versus other states. Multivariate analyses revealed that women in same-sex partnerships consistently had lower rates of health insurance coverage than married women in opposite-sex partnerships, but always more than unmarried women in opposite-sex partnerships. We also found that state-level variation in gay tolerance did not contribute to the access or type of coverage used by women in same-sex partnerships.     

Impact of the May 12, 2008, earthquake on blood donations across five Chinese blood centers

BACKGROUND: On May 12, 2008, a severe earthquake struck China's Sichuan Province. The nationwide outpouring of charity resulted in a surge of subsequent blood donations. The quantity and quality of these donations were examined in comparison with routine donations. STUDY DESIGN AND METHODS: Whole blood and apheresis donations from five geographically different blood centers collected within 1 week postearthquake were compared with those collected during the rest of the year. Regional differences, demographic characteristics, first‐time and repeat donor status, and infectious disease screening markers associated with these donations were compared by earthquake status using chi‐square statistics. Poisson regression analysis examined the number of daily donations by earthquake status after adjusting for center, day of week, and seasonal variations. RESULTS: The number of daily donations across five blood centers increased from 685 on a typical day to 1151 in the postearthquake week. The surge was observed in both sexes and across different education levels, age, and ethnicity groups and three blood centers and was significant after adjusting for confounding covariates. The influx of first‐time donors (89.5%) was higher than that of repeat donors (34%). There was a significant change in the overall screening reactive marker rates excluding alanine aminotransferase (2.06% vs. 1.72%% vs. 4.96%). However, when the individual screening test was analyzed separately, no significant differences were found. CONCLUSION: Timely donations in response to a disaster are crucial to ensure emergency blood transfusion. The dramatically increased postearthquake donations suggest that Chinese blood centers are capable of handling emergency blood needs. Measures to maintain blood safety should be taken in times of emergency.     

Cost and Mortality Analysis of an Intermediate Respiratory Care Unit. Is It Really Efficient and Safe?

IntroductionHistorically, it has been assumed that Intermediate Respiratory Care Units (IRCU) were efficient, because they saved costs by reducing the number of admissions to intensive care units (ICU), and effective, because they specialized in respiratory diseases.MethodsThe number of IRCU admissions and mortality rate, historically and in 2016, were evaluated. For 2016, the grouped Related Diagnostic Groups (DRGs) were also described, and the savings achieved under all budgetary headings by avoiding UCI stays were calculated. A multivariate analysis was performed to associate costs with mean weights and complexity, and multiple logistic regression was performed on all patients admitted from 2004 to 2017 to describe the variables associated with mortality in our unit.ResultsAn IRCU generates savings of €500,000/year by reducing length of ICU stay. Analysis of the 2016 cohort shows that costs correlate with mean weight and mortality, and consequently complexity. The multivariate logistic regression analysis of the 2004–2017 cohort found respiratory frequency, leukopenia, anemia, hyperkalemia, and acidosis to be the variables best associated with mortality. The area under the curve for the logistic model was 0.75.ConclusionThe IRCU analyzed in our study was efficient in terms of ‘avoided costs’ and savings associated with complexity. Our results suggest that IRCUs have a lower mortality rate than other similar units, and are therefore a safe environment for patients.