A spatial analysis of voting on health care issues: United States House of Representatives, 96th Congress,First Session

This study examines the spatial patterns of Congressional voting on health issues. Thirteen roll call votes on health care issues occuring during the 1st Session of the 96th Congress are factor analyzed. This analysis shows that health care questions cluster around two major issues: health care regulation and health care spending. The factor scores for each Representative are mapped, and a regression model is developed relating health care voting to characteristics of the Representative, the Congressional district, and the hospitals in that district. The most important findings were: (1) support for both health care spending and regulation is strongest in the Northeast and upper Midwest. (2) Although Representatives from most of the Southern states are opposed to health care regulation, they generally favor health care spending. (3) Representatives from a few of the Southern states, however, do not fit this generalization. (4) Although Representatives from the Pacific Coast states are the strongest proponents of regulation, they are opposed to spending. (5) Opposition to health care spending is particularly strong among Representatives from suburban districts.     

Correction of hemocoagulation disorders in complicated forms of acute cholecystitis

The comparative analysis of the low-molecular-weight heparin Clexane influence and the unfractionated heparin on the parameters of blood coagulation homeostasis in 70 patients with complicated forms of acute cholecystitis. The tendency for hypercoagulation is observed. Prophylactic use of Clexane in patients with complicated forms of acute cholecystitis, in comparison with unfractionated heparin, is accompanied by the decrease of coagulating potential of blood.     

Lung nodules in pediatric oncology patients: a prediction rule for when to biopsy

Purpose

The purpose of the study was to develop a prediction rule regarding the factors that most accurately predict the diagnosis of a malignancy in a lung nodule in the pediatric oncology patient.

Methods

A retrospective review of pediatric oncology patients that underwent lung nodule resection between 1998 and 2007 was performed. Multivariable logistic regression was used to create a prediction rule.

Results

Fifty pediatric oncology patients underwent 21 thoracotomies and 48 thoracoscopies to resect discrete lung nodules seen on computed tomographic scans during workup for metastasis or routine surveillance. The mean nodule size was 10.43 ± 7.08 mm. The most significant predictors of malignancy in a nodule were peripheral location (odds ratio [OR], 9.1); size between 5 and 10 mm (OR, 2.78); location within the right lower lobe (OR, 2.43); and patients with osteosarcoma (OR, 10.8), Ewing sarcoma (OR, 3.05), or hepatocellular carcinoma (OR, 2.38).

Conclusions

Lesions that are between 5 and 10 mm in size and peripherally located in patients with osteosarcoma, Ewing sarcoma, or hepatocellular carcinoma are most likely to be malignant. Use of a prediction rule can help guide clinical practice by determining which patients should undergo surgical resection of lung nodules and which patients may be closely observed with continued radiologic studies.     

Hysteroscopic Sterilization in Patients with a Mirena Intrauterine Device: Transition from Extended Interval to Permanent Contraception

ObjectiveTo estimate the feasibility and elucidate the benefits of performing hysteroscopic sterilization in patients who have a Mirena intrauterine device (IUD) in place.DesignRetrospective case-controlled study with 3:1 ratio (Canadian Task Force Classification II-2).SettingProcedures were performed in an outpatient or office setting affiliated with an academic medical center. Hysterosalpingograms were obtained and interpreted jointly by an investigator and a radiologist using standard protocol.PatientsSubjects included all patients undergoing hysteroscopic sterilization July 2007 thru December 2008 with a Mirena IUD in place. Patients without an IUD served as a comparison group.InterventionsAll procedures were performed with a 4.2-mm Bettocchi continuous-flow hysteroscope with saline solution insufflation. Delivery catheters were passed through a 5F operative channel. Essure implants were positioned and released per standard protocol. IUD devices were removed after confirmation of bilateral tubal occlusion.Measurements & Main ResultsThere were 12 patients currently using a Mirena IUD for contraception who elected to undergo hysteroscopic sterilization. Procedures were performed in the usual manner. Chart review identified the most recently treated patients without an IUD in place matched for age and body mass index to study patients. Recorded details included age, body mass index, parity, procedure time, placement success, and tubal occlusion. There were no significant differences between the groups with respect to any metric except completion of the 3- month hysterosalpingogram.ConclusionHysteroscopic sterilization can be performed successfully with a Mirena IUD in place. Advantages include flexibility in timing of the procedure, assurance of contraception until confirmation of tubal occlusion, and increased likelihood of appropriate follow-up.