Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research

Advances in Health Sciences Education - Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical...     

Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin

Background: Postoperative thromboembolic disease has been suggested to occur with higher frequency during laparoscopic cholecystectomy than during other laparoscopic procedures or conventional cholecystectomy. The aim of this prospective study was to evaluate the occurrence of deep vein thrombosis (DVT) in laparoscopic cholecystectomy patients, whether they were treated with low-molecular-weight heparins or not. Methods: All 238 laparoscopic cholecystectomy patients included in the study underwent pre- and postoperative venous duplex scanning of both legs. Subcutaneous Nadroparin was administred to 105 patients. The remaining 133 patients did not receive pharmacologic prophylaxis. The different risk factors for thromboembolic disease were distributed evenly between the two groups, except for the duration of general anesthesia. Results: No patient had postoperative clinical manifestations of DVT or pulmonary embolism. In five patients, DVT was detected at duplex scan approximately 10 days after surgery. Four DVTs were found among the 133 patients who did not receive Nadroparin (1.68%). In the group with pharmacologic prevention, one patient manifested a DVT (0.42%), giving a total DVT incidence of 2.10% after laparoscopic cholecystectomy. The difference between the two groups was not significant (p = 0.27), but the results seem to indicate a tendency toward a lower incidence in the Nadroparine group. Conclusions: In the light of the study results, it seems advisable to use thromboembolic prophylaxis during laparoscopic cholecystectomy.     

Melanoma: A protective role of pregnancy? A case report and review of literature

Melanoma is actually one of the most common malignancies to be diagnosed during pregnancy. Nevertheless, the role of the pregnancy hormones on the melanoma course is not yet completely clear. We present the case of melanoma in a pregnant woman, with a particularly fulminant postpartum development. This raised the question of a possible protection by the pregnancy hormones against melanoma.     

The risk of upcoding in casemix systems: a comparative study

With the introduction of a diagnosis related group (DRG) classification system in the Netherlands in 2005 it has become relevant to investigate the risk of upcoding. The problem of upcoding in the US casemix system is substantial. In 2004, the US Centres for Medicare and Medicaid estimated that the total number of improper Medicare payments for the Prospective Payment system for acute inpatient care (both short term and long term) amounted to US$ 4.8 billion (5.2%). By comparing the casemix systems in the US, Australian and Dutch healthcare systems, this article illustrates why certain casemix systems are more open to the risk of upcoding than other systems. This study identifies various market, control and casemix characteristics determining the weaknesses of a casemix reimbursement system to upcoding. It can be concluded that fewer opportunities for upcoding occur in casemix systems that do not allow for-profit ownership and in which the coder's salary does not depend on the outcome of the classification process. In addition, casemix systems in which the first point in time of registration is at the beginning of the care process and in which there are a limited number of occasions to alter the registration are less vulnerable to the risk of upcoding. Finally, the risk of upcoding is smaller in casemix systems that use classification criteria that are medically meaningful and aligned with clinical practice. Comparing the US, Australian and Dutch systems the following conclusions can be drawn. Given the combined occurrences of for-profit hospitals and the use of the secondary diagnosis criterion to classify DRGs, the US casemix system tends to be more open to upcoding than the Australian system. The strength of the Dutch system is related to the detailed classification scheme, using medically meaningful classification criteria. Nevertheless, the detailed classification scheme also causes a weakness, because of its increased complexity compared with the US and Australian system. It is recommended that researchers and policy makers carefully consider all relevant market, control and casemix characteristics when developing and restructuring casemix reimbursement systems.