Sensitivity and specificity of patient-entered red flags for lower back pain

Background Context

Red flags are questions typically ascertained by providers to screen for serious underlying spinal pathologies. The utility of patient-reported red flags in guiding clinical decision-making for spine care, however, has not been studied.

Determinants of variation in the cost of inpatient stays versus outpatient visits in hospitals: a multi-country analysis

Information on hospital costs is key to many types of economic and financial analyses, yet many countries lack reliable estimates due partly to the time and resources required to undertake detailed costing studies. Accordingly, some analysts have used simple rules of thumb to estimate hospital unit costs, e.g., total hospital costs are allocated between departments assuming that the cost of an inpatient day equals a fixed number of outpatient visits. This paper first explores the extent to which these simple rules apply within and across countries. It then identifies determinants of variation in the relationship between the cost of outpatient visits and inpatient days, then uses the estimated relationship to calculate average costs of inpatient and outpatient stays for countries where data are not yet available. Cost information from 832 hospitals in 28 countries are used. We show that simple rules of thumb do not prove to be an accurate basis for cost estimates. The ratio of inpatient to outpatient unit costs varies with GDP per capita, hospital size, ownership, and occupancy rate. We show how the estimated relationship can be used to calculate a mean cost of inpatient stays and outpatient visits, taking into account differences in the levels of key determinants, and argue that, in the absence of a representative sample of hospital costing studies, this method can be used to estimate unit costs in the interim. Moreover, we suggest that the observed great variation in unit costs for similar hospitals in the same country means that this method might well be preferable to basing policy advice on the results of costing studies that cover only one, or a few hospitals, which might well be outliers.     

Single photon emission computerized tomography (SPECT) scan–positive facet joints and other spinal structures in a hospital-wide population with spinal pain

Background contextThe current criterion standard for zygapophyseal (facet) joint pain diagnosis is placebo-controlled triple comparative local anesthetic facet joint or medial branch blocks. Single photon emission computerized tomography (SPECT) scanning is a less invasive modality that has been widely used in patients with spinal pain for the diagnosis of facet joint arthritis. Previous studies have shown that SPECT results correlate well with response to facet joints steroid injections.PurposeTo evaluate the prevalence of SPECT scan–positive facet joints and other spinal areas in different age groups in a hospital-wide population with spinal pain.Study designRetrospective study.MethodsThis study included 534 patients who underwent a SPECT scan for spinal pain over 7.5 years in our hospital. All referrals from all doctors for any cervical or lumbar spinal pain were included, and the results were reviewed.ResultsA total of 486 patients (91.1%) had at least one positive abnormality on SPECT scan; 81.3% had increased uptake in different structures and regions of the spine. This included 42.8% increased uptake in the facet joint 29.8% in the vertebral bodies/end plates, and 5.9% in sacroiliac joints. The prevalence of increased uptake in the lumbosacral and cervical spine was 44% and 37%, respectively. When patients were divided into five age groups (below 40, 40–49, 50–59, 60–69, and 70 years and older), there was a significantly higher increased prevalence in advancing age groups.ConclusionsIn a hospital-wide population with spinal pain, there is a 42.88% prevalence of increased uptake in the facet joint on SPECT. The incidence increases significantly with advancing age. SPECT can play a role in investigating patients with spinal pain.     

Occupational exposures to aluminum and iron and risk of lung epithelium atypia in sudan

This study investigated the risk of lung cytological atypical changes in regards to occupational exposure to aluminum and iron. Detailed job histories were elicited from 130 incident cases with confirmed exposure to aluminum (50) or iron (80) and 157 population controls (nonexposed). Cytological atypia in sputum (dysplasia) was identified in four cases and none of controls (RR =10.8550; 95% CI = 0.5898 to 199.7815, P = 0.1086), hence, metaplasia was observed among 15 (11.5%) of the cases and 10 (6%) of controls (RR = 1.8115; 95% CI = 0.8424–3.8956; P = 0.1283). Evidences of viral infection were observed in 18 (14%) of the cases and 8 (5%) of controls (RR = 2.7173; 95% CI = 1.2213–6.0460; P = 0.0143). Moniliasis was observed in 28 (22%) of the cases and 19 (12%) of controls (RR = 1.6632; 95% CI = 0.9728–2.8435; P = 0.06). Cross‐categorizations of aluminum exposure and iron use suggest greater risk associated with iron exposure than aluminum in these workers. Diagn. Cytopathol. 2013. © 2012 Wiley Periodicals, Inc.     

Protective effect of silymarin during coronary artery bypass grafting surgery

BACKGROUND:

An inflammatory response and systemic oxidative stress are directly caused by coronary artery bypass grafting (CABG) surgery. Cytokines, such as interleukin (IL) 1β, IL-6 and tumour necrosis factor-α (TNF-α), can also be stimulated. Reducing the release of pro-inflammatory cytokines plays an important role in limiting the postoperative inflammatory response. Silymarin has strong anti-inflammatory, antioxidant and cytoprotective properties.

OBJECTIVE:

To investigate the protective anti-inflammatory and antioxidant properties of silymarin against the inflammation and oxidative stresss inherent to CABG surgery.

METHODS:

Of the 102 patients undergoing elective first-time CABG surgery that were recruited, 50 (49.02%) received silymarin treatment and 52 (50.9%) were controls. Plasma cytokine levels (IL-1β, IL-6 and TNF-α) were measured preoperatively, 6 h and 24 h after CABG surgery. C-reactive protein (CRP) levels, trolox equivalent antioxidant capacity (TEAC) and glutathione (GSH) and malondialdehyde (MDA) levels were analyzed.

RESULTS:

Postoperative cytokine levels in the silymarin group were significantly lower compared with preoperative levels, and were significantly lower compared with postoperative control group levels. The area under the curve for cytokines and CRP for the silymarin group were significantly lower compared with preoperative levels, and were significantly lower compared with postoperative control group levels. Postoperative levels of TEAC and MDA in the silymarin-treated group were significantly lower than in the control group. GSH levels were significantly elevated in the silymarin group compared with control. No side effects or mortality were associated with the use of silymarin.

CONCLUSION:

The anti-inflammatory and antioxidant effects of silymarin treatment provided protection against reperfusion injury and inflammation after CABG surgery.