Private Medical Centers Research Articles

Spanish study of anticoagulation in haemodialysis.

This study’s objectives were to determine which anticoagulation methods are commonly used in patients who are undergoing haemodialysis (HD) in Spain, on what criteria do they depend, and the consequences arising from their use. Ours was a cross-sectional study based on two types of surveys: a "HD Centre Survey" and a "Patient Survey". The first survey was answered by 87 adult HD units serving a total of 6093 patients, as well as 2 paediatric units. Among these units, 48.3% were part of the public health system and the remaining 51.7% units were part of the private health system. The patient survey analysed 758 patients who were chosen at random from among the aforementioned 78 HD units. A) HD Centre Survey: The majority of adult HD units (n=61, 70.2%) used both kinds of heparin, 19 of them (21.8%) only used LMWH and 7 of them (8%) only used UFH. The most frequently applied criteria for the use of LMWH were medical indications (83.3% of HD units) and ease of administration (29.5%). The most frequently used methods for adjusting the dosage were clotting of the circuit (88.2% of units), bleeding of the vascular access after disconnection (75.3%), and patient weight (57.6%). B) Patient Survey: The distribution of the types of heparin used was: UFH: 44.1%, LMWH: 51.5%, and dialysis without heparin in 4.4% of patients. LMWH was more frequently used in public medical centres (64.2% of patients) than in private medical centres (46.1%) (P<.001). LMWH was more frequently used in on-line haemodiafiltration (HF) than in high-flux HD (P<.001). Antiplatelet agents were given to 45.5% of patients, oral anticoagulants to 18.4% of patients, and both to 5% of patients. Additionally, 4.4% of patients had suffered bleeding complications during the previous week, and 1.9% of patients suffered thrombotic complications. Bleeding complications were more frequent in patients with oral anticoagulants (P=.001), although there was no association between the type of heparin and the occurrence of bleeding or thrombotic complications. We are able to conclude that there is a great amount of disparity in the criteria used for the medical prescription of anticoagulation in HD. It is advisable that each HD unit revise their own results as well as those from other centres, and possibly to create an Anticoagulation Guide in Haemodialysis.

Epidemiology and clinical features of pediatric psoriasis in tertiary referral psoriasis clinic

Few epidemiological studies of pediatric patients with moderate to severe psoriasis have been available despite there being no approved systemic therapy for these patients. The aim of the present study was to elucidate clinical features of pediatric psoriasis in a tertiary referral psoriasis clinic. We analyzed the clinical data of 358 patients under 18 years of age referred to our clinic from other private clinics and medical centers. Our data showed a male :female ratio of 1.06:1 and a peak age of onset of 10-11 years. Of the patients, 32.4% had a positive family history. The most prevalent phenotype was plaque type (67.3%) and the mean Psoriasis Area and Severity Index score was 17.2 ± 12.7. The most frequently affected body part was the trunk (69.5%), followed by the legs (65.3%). Exposure to sunlight and summer season improved psoriatic lesions, while stress and winter season aggravated the clinical course. Only 26.0% of patients received systemic therapy or phototherapy during the therapeutic course. Oral acitretin (11.2%) was most frequently used followed by ultraviolet B phototherapy (7.3%). The childhood group (<13 years) showed higher prevalence of guttate and generalized pustular phenotypes and more severe clinical course compared with the adolescent group (13-18 years). In conclusion, our patients showed distinctive features in clinical phenotypes, disease severity and affected body parts compared with previous reports. We also found that clinical application of systemic therapies were limited considering the severe disease state of our patients, demanding a need for more research on treatment of pediatric psoriasis.

Statistical analysis of waste generation in healthcare services: a case study

In the present study, the amounts of medical waste materials, sharps, liquid waste, hazardous waste, household waste and recyclables generated from 375 healthcare services including private hospitals, state hospitals, university hospitals, private medical centres, dialysis centres, cottage hospitals and private dentist surgeries were determined, and the relation between the amount of the waste and the bed capacities, inpatient and outpatient numbers were evaluated. The amount of regulated medical waste corresponded to 28.8% of the total waste streams collected from the healthcare services, and the major producers were private hospitals. The major producers of hazardous waste were state hospitals with a generation rate of 57.9%. The main results of the study indicate that the quantities of the waste streams generated from healthcare services in accordance with the outpatient number gave more appropriate results than the other evaluation methods. Furthermore, evaluation based on the bed capacities gave reasonable results except for recyclables and hazardous waste. As a result of the evaluation of the medical waste generation rate with bed capacities, the generation rate was determined as 2.11 ± 3.83 kg bed(-1) day(-1) and this rate was 1.45 ± 9.84 kg outpatient(-1) day(-1) for the evaluation by outpatient numbers. The observed significant P values (P > 0.05) indicate that the evaluation of the waste streams in healthcare services based upon outpatient numbers did not show any reasonable change according to service category.

Study of Clinicopathological Profile of Sporadic Cases of Colorectal Cancer.

ABSTRACTObjectivesColorectal cancer (CRC) is the third leading cause of cancer-related deaths in the world. This study was carried out to see the epidemiological and clinicopathological profile of sporadic cases of CRC in Bangladesh.Materials and methodsThe patients diagnosed to have colorectal carcinoma in two private medical centers of Bangladesh from January 2012 to December 2014 were enrolled in this study. Demographic data, clinical presentations, site of lesions, and histological types were analyzed.ResultsTotal 158 patients were included in this study. The mean age was 50.77 years and male to female ratio was 1.55:1. Rectal bleeding was the commonest symptom irrespective of age and sex followed by abdominal pain (33, 20.9%), weight loss (29, 18.3%), abdominal mass (26, 16.4%), and altered bowel habit (22, 13.9%). Common histological type was adenocarcinoma (156, 98.7%).ConclusionColorectal cancer commonly affects males >40 years of age. Most common site of involvement is rectum, which is followed by left colon.How to cite this articleSaha M, Shil BC, Saha SK, Banik RK, Perveen I, Chowdhury MKS, Nazmul Islam ASM, Saifullah ANM. Study of Clinicopathological Profile of Sporadic Cases of Colorectal Cancer. Euroasian J Hepato-Gastroenterol 2016;6(2):134-136.

The Uruguayan Registry for Peutz-Jeghers Syndrome: Clinical and Genetic Results and Report of a Novel Mutation

Purpose: Peutz-Jeghers syndrome (PJS) is a hereditary disorder characterized by intestinal polyps, mucocutaneous pigmentation and increased risk for cancer. It is caused by mutations of the serine threonine kinase 11 (STK11) gene. Uruguay is a South American country with 3 million inhabitants. The aim of this study was to collect and analyze epidemiological, clinical and genetic data from all patients with PJS in Uruguay. Methods: Data were analyzed until May 2009 for the purpose of this study. Data was obtained from public and private medical centers or submitted by treating physicians. Patients were contacted personally or through their treating clinicians. Clinical data were input into a digital chart and updated annually. Sequencing of the STK11 gene in one member of each available family was performed to look for the presence of gene mutation. Results: 25 cases in 11 unrelated families were registered (15 males, 10 females). The average age at time of diagnosis was 18.28 years (range 2-65). Currently, there are 17 individuals with PJS alive. In 16, annual follow up has been completed. Average age for all-causes of death was 41 years, being cancer the most frequent cause. All patients had characteristic PJS pigmentation. All affected patients who had evaluation of the gastrointestinal tract had polyps (n=22). Polyps were most frequent in the small bowel and colon. Eighteen cases (72%) required urgent surgery due to intestinal obstruction secondary to the presence of polyps. Eleven cases (44%) had anemia. Five cases (20%) in 3 families had a seizure disorder. Seven patients (28%) developed cancer and two patients had more than one cancer, with breast being the most frequent site. A mutation in the STK11 gene was found in 8 of the 9 families analyzed. Deletion of all or part of the STK11 gene was identified in 5 patients from 5 families. Other mutations seen included c.666delC (1 family), IVS2+1 A>G (1 familiy), and M136K (1 familiy). No partial/whole gene deletion or other mutation was identified in 4 patients. To our knowledge, the M136K missense mutation in the STK11 gene has not been reported previously in the literature. Conclusion: The analysis of the Uruguayan Registry for Peutz-Jeghers patients showed a high chance of emergent surgery by intestinal obstruction, high prevalence of epilepsy, high risk of cancer and shortened life expectancy. A mutation in the STK11 gene was present in the 89% of families analyzed, and a novel, and previously undescribed mutation, was detected in one. Disclosure: Dr Tchekmedyian - no disclosures, Dr Thomas McGarrity - no disclosures, Sherri Bale-employee:GeneDx. This company provides genetic testing in Peutz - Jeghers Syndrome. Christopher I. Amos - no disclosures, Dr Joaquin Berrueta - no disclosures, Dr Natalie Nabon - no disclosures, Dr Henry Cohen - no disclosures.

개인 의료기관에 내원한 고혈압 및 당뇨병환자에게 실시한 건강교육이 치료 순응도에 미치는 영향

To provide fundamental educational materials for the effective management of patients with high blood pressure and diabetes in korea, and to expand the scope of such educational businesses the survey was administered between September 2007 and February 2008 to 1,213 consenting patients suffering from high blood pressure and diabetes in private medical centers within Daejeon in Korea. The patients were provided with standardized education materials and were monitored whether they were conducting a controlled management of their blood pressure and diabetes level as well as monitoring changes in their daily routine. Out of the 1,213 patients, 51.3% of the patients suffered only from high blood pressure, 26.3% suffered only from diabetes and 22.4% suffered from both high blood pressure and diabetes (Condor difference was not considered in this research). Physical education was the most commonly used education upon visitation to these medical centers, which was then followed by eating habits and weight management, respectively. The education demanded and preferred from the patients was similar to the education provided during the visitations. 56.7% of the medical doctors responded that the majority of the patients were passive in controlling and managing their illnesses. 63.7% of the participants believed that the education provided through this research was effective.

Impact of a ‘rescue course’ of antenatal corticosteroids: a multicenter randomized placebo-controlled trial

Previous studies using repetitive courses of antenatal corticosteroids (ACS) have demonstrated marginal or no benefit and concern over potential risk. No prior prospective or randomized studies have evaluated the option of a single rescue course of ACS on neonatal outcome. A multicenter randomized double-blind placebo-controlled trial was performed from May 2003 through February 2008 in 18 private (15) and university (3) medical centers. Patients with singletons or twins < 33 weeks who had completed a single course of ACS before 30 weeks and at least 14 days before inclusion, and were judged to have a recurring threat of preterm delivery in the coming week, were included. Patients were randomized to receive a single rescue course of betamethasone, 2 12-mg doses 24 hours apart, or placebo. Exclusion criteria included: premature rupture of membranes, advanced dilation (> 5 cm), chorioamnionitis, and other steroid use. In all, 437 patients were randomized (223 rescue steroid group and 214 placebo group). A total of 55% of patients in each group delivered at < 34 weeks. There was a significant reduction in the primary outcome of composite neonatal morbidity < 34 weeks in the rescue steroid group vs placebo (43.9% vs 63.6%; odds ratio, 0.45; 95% confidence interval, 0.27-0.75; P = .002) and significantly decreased respiratory distress syndrome, ventilator support, and surfactant use. Perinatal mortality and other morbidities were similar in each group. Including all neonates in the analysis (regardless of gestational age at delivery) still demonstrated a significant reduction in composite morbidity in the rescue course group (32.1% vs 42.6%, odds ratio, 0.65; 95% confidence interval, 0.44-0.97; P = .0034) and improvement in respiratory morbidities. Administration of a single rescue course of ACS before 33 weeks improves neonatal outcome without apparent increased short-term risk.

X-PAT: A Multiplatform Patient Referral Data Management System for Small Healthcare Institution Requirements

We present X-PAT, a platform-independent software prototype that is able to manage patient referral multimedia data in an intranet network scenario according to the specific control procedures of a healthcare institution. It is a self-developed storage framework based on a file system, implemented in eXtensible Markup Language (XML) and PHP Hypertext Preprocessor Language, and addressed to the requirements of limited-dimension healthcare entities (small hospitals, private medical centers, outpatient clinics, and laboratories). In X-PAT, healthcare data descriptions, stored in a novel Referral Base Management System (RBMS) according to Health Level 7 Clinical Document Architecture Release 2 (CDA R2) standard, can be easily applied to the specific data and organizational procedures of a particular healthcare working environment thanks also to the use of standard clinical terminology. Managed data, centralized on a server, are structured in the RBMS schema using a flexible patient record and CDA healthcare referral document structures based on XML technology. A novel search engine allows defining and performing queries on stored data, whose rapid execution is ensured by expandable RBMS indexing structures. Healthcare personnel can interface the X-PAT system, according to applied state-of-the-art privacy and security measures, through friendly and intuitive Web pages that facilitate user acceptance.

Total Hip Arthroplasty is Less Painful at 12 Months Compared with Hemiarthroplasty in Treatment of Displaced Femoral Neck Fracture

The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes (DFACTO) study compared total hip arthroplasty (THA) to hemiarthroplasty in the treatment of displaced femoral neck fractures. This study was designed as a prospective, randomized clinical trial. The study was conducted in five US academic and private medical centers. Patients were composed of independent, mentally competent individuals, >50 years old who suffered a displaced femoral neck fracture without existing arthritis at the hip. Forty-one patients were enrolled. Functional outcomes and quality of life were assessed at 6 and 12 months post-fracture using the SF-36, Western Ontario and McMaster University Osteoarthritis Index (WOMAC), the Harris Hip Score, and the Timed "Up & Go" Test (TUG test). Groups were equivalent at baseline in terms of age, comorbid conditions, and functional status. At 6 months, there were no significant differences between the groups using the outcome measures or overall rates of complications. There was one dislocation in the THA group (5.8% of patients). At 12 months, the THA group reported significantly less pain (53.2 +/- 10.2) than the hemiarthroplasty group (42.4 +/- 11.5) using the SF-36 (p = 0.02). Using the TUG Test, we observed a greater proportion of THA patients remain functionally independent 1 year after surgery compared the hemiarthroplasty group (p = 0.08, controlling for age and sex). These differences in pain and functional outcomes suggest THA is a viable treatment option for the active elderly displaced femoral neck fracture population.

The Patient Safety in Surgery Study: Background, Study Design, and Patient Populations

The purpose of this article is to describe the background, design, and patient populations of the Patient Safety in Surgery Study, as a preliminary to the articles in this journal that will report the results of the Study. The Patient Safety in Surgery Study was a prospective cohort study. Trained nurses collected preoperative risk factors, operative variables, and 30-day postoperative mortality and morbidity outcomes in patients undergoing major general and vascular operations at 128 Veterans Affairs (VA) medical centers and 14 selected university medical centers between October 1, 2001 and September 30, 2004. An Internet-based data collection system was used to input data from the different private medical centers. Semiannual feedback of observed to expected mortality and morbidity ratios was provided to the participating medical centers. During the 3-year study, total accrual in general surgery was 145,618 patients, including 68.5% from the VA and 31.5% from the private sector. Accrual in vascular surgery totaled 39,225 patients, including 77.8% from the VA and 22.2% from the private sector. VA patients were older and included a larger proportion of male patients and African Americans and Hispanics. The VA population included more inguinal, umbilical, and ventral hernia repairs, although the private-sector population included more thyroid and parathyroid, appendectomy, and operations for breast cancer. Preoperative comorbidities were similar in the two populations, but the rates of comorbidities were higher in the VA. American Society of Anesthesiologists classification tended to be higher in the VA. The National Surgical Quality Improvement Program methodology was successfully implemented in the 14 university medical centers. The data from the study provided the basis for the articles in this issue of the Journal of the American College of Surgeons.

Chikungunya-type fever outbreak: some aspects related to this new epidemic in Jaffna district, northern Sri Lanka

Chikungunya, a disease caused by alpha virus and transmitted by Aedes mosquitoes, had seldom been heard by the people of Jaffna until early November 2006, although a chikungunya-type fever epidemic was reported in western Sri Lanka in 1965 [1-3]. While few samples have been confirmed for the presence of CHIK virus, widespread of chikungunya-type fever outbreaks have been reported from many parts of the country since September 2006. Similar outbreaks of CHIK virus have also been reported from many states of India including Tamil Nadu since December 2005 [4-6]. In Sri Lanka, Mannar district, which lies very close (32km) to Rameshwaram island of Tamil Nadu, was the area to first experience the fever outbreak. It has been estimated that the ongoing fever epidemic in Jaffna district has affected thousands of people between November and mid December 2006 (personal communicationDPDHS Office, Jaffna). It is difficult to establish the origin and mode of spread of CHIK fever to Jaffna because this epidemic occurred when the main land route (A-9) between Jaffna and the rest of the country remained closed since August 2006 owing to renewed armed conflict. Only sea and air transport facilities are available to facilitate public movement between Jaffna and the rest of the country. The closure of the main highway has hindered the availability of food and drugs in the market. Even the available items are sold for higher prices, creating an additional burden for ordinary people to meet daily requirements and raising concerns about nutrition and health. Although the disease has affected a large number of people, there are no facilities in Jaffna Teaching Hospital to diagnose CHIK fever. According to the health authorities in Jaffna, a few samples sent by air to the Medical Research Institute were confirmed for CHIK virus. A study was carried out under these circumstances in a highly affected village in Jaffna district to assess the severity of the fever as well as public attitudes and responses toward the epidemic. A structured questionnaire-based study was carried out in mid December 2006. Entire households in Inuvil-West (09°43’N:80°01’E), a residential rural area located 7km away from Jaffna city, were visited during this study. The suspected chikungunya-type fever cases were initially reported from this locality and almost the entire village was affected by the disease. There is a single Government Central Dispensary in addition to a privately owned hospital and a few small medical centers. The questionnaire was composed of multiple choice questions and an interview. There are four major parts: a) demographic information, b) symptoms and manner of treatment for chikungunya fever, c) knowledge about chikungunya, mosquitoes and mosquito-borne diseases, and d) attitude and practice to prevent mosquito bites. Basically the structured questionnaire was formulated to elucidate information on: monthly income, educational background, number of family members affected by fever, symptoms, manner of treatment (from government hospitals or private medical centers), recovery, how much was known about chikungunya, mosquitoes and their role in disease transmission, severity of the mosquito menace, mosquito biting time, and type of personal protective measures taken against mosquito bites. The questionnaires were written in Tamil (native language) and administered to heads of households from 0900 h to 1300 h. If no male head of household was available, a female head of household was interviewed. Larval surveys were also carried out in houses of all the respondents to obtain the following Aedes larval indices a) House Index (HI) the percentage of houses or premises with one or more habitats positive for Aedes larvae, b) Container Index (CI) the percentage of water holding containers positive for Aedes larvae, and c) Breteau Index (BI) the number of positive containers per 100 houses [7]. One hundred sixty two heads of households (67 males and 95 females), consisting 653 individuals, were interTropical Medicine and Health Vol. 35 No. 3, 2007, pp. 249-252 Copyright 2007 by The Japanese Society of Tropical Medicine

Fertilization and pregnancy outcome after intracytoplasmic injection with fresh or cryopreserved ejaculated spermatozoa

To assess fertilization, implantation, and pregnancy rates in patients undergoing ICSI using fresh and cryopreserved sperm from ejaculated semen samples. Retrospective study. Academic and private medical centers. One hundred fifty-eight patients. Intracytoplasmic sperm injection. Fertilization, implantation, and pregnancy rates were evaluated; 61 cycles of ICSI were performed with cryopreserved and 79 cycles of ICSI were performed with fresh spermatozoa. Also, we divided the outcomes according to the semen characteristics, normozoospermia, oligozoospermia, asthenozoospermia, and oligoasthenozoospermia. Overall, normal-fertilization rates were higher using fresh sperm (73.8%) compared with cryopreserved sperm (68.7%). Cycles performed in patients with normozoospermia or oligozoospermia had similar fertilization, implantation, and pregnancy rates using fresh or cryopreserved sperm. When asthenozoospermic and oligoasthenozoospermic semen samples were used, the normal-fertilization rate was higher with fresh sperm compared with cryopreserved sperm. However, implantation and pregnancy rates were similar in fresh and cryopreserved sperm samples from patients with asthenozoospermia or oligoasthenozoospermia. Semen with abnormalities in the motility may be more susceptible to sperm cryopreservation damage, resulting in lower fertilization rates. However, once the oocyte is fertilized, implantation and pregnancy rates are similar to those in patients with oligozoospermia and normozoospermia.

Cervical Cancer: The Indian Perspective

Cancer of the uterine cervix is the commonest gynaecologic cancer in India, with most women presenting with disease extending beyond the cervix. The majority of women belong to the lower socioeconomic status, are rural, aged between 35 and 64 years and highly noncompliant for complete treatment and follow-up. Opportunistic screening with cytology, colposcopy and test for Human Papilloma Virus and appropriate treatment are available on payment at urban private medical centres but are not available at urban and rural government health centres that are accessed by women of the lower socioeconomic status. The Government's investment in health is 0.9% of the GDP. Thus cytology screening as a government health measure is not feasible. The ‘social vaccine’ of health empowerment along with visual inspection and appropriate referral by the rural and urban health personnel (Department of Health and Family Welfare); with an additional input of health awareness and motivation by Anganwadi Workers (Department of Women and Child Development), elected women representatives in the Panchayats (Department of Rural Development and Panchayati Raj) and non-governmental development agencies could be a collaborative effort towards “downstaging” cervical cancer. This could lay the foundation for the introduction of cytology screening when resources are available.

Household triggers of bronchospasm in children aged less than two years with hyperreactive airway: &lt;i&gt;a multicentre experience&lt;/i&gt;

Aims and Objective : Bronchospasm is rarely seen in children less than two years of age unless they are genetically predisposed to allergy and atopy. Hyperreactive airway presenting with bronchospasm in such children is commonly misdiagnosed and managed as chest infections. This study therefore aims at examining the trigger factors of bronchospasm in these children. Setting/Method : The study was carried out in two private medical centres in Ilorin between June 2002 and May 2003. All children below the age of 2 years presenting with cough and breathlessness of sudden onset with audible wheeze were screened historically for the trigger factors of bronchospasm in their environment. Result : Nine hundred and twenty eight patients were recruited for the study over the one year period. The mean age of the children was 5.4 ± 1.3 months (range: 3 weeks to 24 months). There are two peaks of seasons during which the condition is common (July to September, and January to March). There is a male preponderance with a M:F ratio of 1.3:1. The presenting symptoms were cough (100%), breathlessness (100%), expiratory wheeze (97%), restlessness (65%), sleeplessness (63%), excessive sweating (57%), excessive crying (45%), family history of asthma / allergy / atopy (42%), inability to eat / suck (33%), running nose (31%), abdominal pain in the older infant (27%), vomiting (13%),and exhaustion (7%). The observed clinical signs are: tachypnoea (100%), recessions (100%), rhonchi (100%), dehydration (27%), cyanosis (5%), and hepatomegaly (3%) identified trigger factors include: insecticide spray in 36%, fumes from frying oil in 12%, smoke from kerosene stove in 10%, firewood smoke in 8%, dust in 9%, exposure to cold air and fan in 9%, perfume spray in 8%, mosquito coil smoke in 3%, and kerosene aspiration in 1%. All the children responded well to nebulised salbutamol, while only 7% required the addition of steroid and other supportive care where necessary. Conclusion : Identified household trigger factors of bronchospasm in children less than two years of age include: insecticide spray, fumes, smoke from stove and firewood, and exposure to cold air. The elimination of these factors from the environment of the affected child would go a long way in preventing the attacks. Keywords : infants, bronchospasm, trigger factors, nebulised salbutamol Sahel Medical Journal Vol. 8(3) 2005: 55-59

Laparoscopic Antireflux Surgery

Although the long-term results of open fundoplication for gastroesophageal reflux disease are well documented, few reports exist on the long-term results of laparoscopic fundoplication. Retrospective study with clinical evaluation or mailed survey for patients unable to return to the hospital center. Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals). Between January 1992 and December 1998, 2684 patients with gastroesophageal reflux disease underwent laparoscopic fundoplication in 31 hospital centers. Outcome data covering a period of 5 or more years after surgery were available for 1340 patients: 711 who underwent complete fundoplication, 559 who underwent partial posterior fundoplication, and 70 who underwent partial anterior fundoplication. Evaluation of clinical and quality-of-life actions used to treat the symptoms of gastroesophageal reflux disease. The overall residual severe dysphagia rate was 5.1% (n = 68). A further surgical procedure was required for 59 patients (4.4%) for a total of 63 interventions. Subsequent operation was performed laparoscopically in 32 cases (50.8%). Twelve of these procedures were for the repair of a paraesophageal hiatus hernia, 11 were for dysphagia (4 because of a tight esophageal hiatus and 7 for conversion of Nissen fundoplication to a posterior partial fundoplication procedure), 31 were for recurrent reflux (wrap undone), 2 were for intestinal obstruction (adhesiolysis), 1 was for incisional hernia, 1 was for abdominal abscess (drainage), and 1 was for gastroparesis (pyloroplasty). The recurrence rate was 10.1% (n = 136), and 122 patients (9.1%) resumed taking antisecretory medication. Gas bloat syndrome was present in 101 patients (7.5%). A total of 93.1% of the patients were satisfied (Visick classification, grades 1 and 2) and 6.9% were unsatisfied, with no difference among the 3 procedures. After 5 years of experience, laparoscopic fundoplication remains an effective antireflux procedure.

Patient throughput: New terminology, same problem

Inpatient capacity has become an issue for most hospitals across the United States. Community, private, and academic medical centers have all experienced problems coordinating admissions with patient discharges. The result has been clogged emergency departments, overcrowded postanesthesia care units (PACUs), delayed admissions from clinics and physician offices, and delayed transfers from health care facilities to hospitals. The resulting impact on patient satisfaction is obvious when the care they seek is delayed or interrupted by a prolonged wait for admission to an acute care facility. This bottleneck of admissions arriving before discharges can occur has resulted in a new term in the health care setting: throughput. Inpatient capacity has become an issue for most hospitals across the United States. Community, private, and academic medical centers have all experienced problems coordinating admissions with patient discharges. The result has been clogged emergency departments, overcrowded postanesthesia care units (PACUs), delayed admissions from clinics and physician offices, and delayed transfers from health care facilities to hospitals. The resulting impact on patient satisfaction is obvious when the care they seek is delayed or interrupted by a prolonged wait for admission to an acute care facility. This bottleneck of admissions arriving before discharges can occur has resulted in a new term in the health care setting: throughput.

Risk Factors for Postoperative Infectious Complications in Noncolorectal Abdominal Surgery

Infectious complications are the main causes of postoperative morbidity in abdominal surgery. Identification of risk factors, which could be avoided in the perioperative period, may reduce the rate of postoperative infectious complications. A database was established from 3 prospective, randomized, multicenter studies. Multivariate analysis was performed using nonconditional logistic regression expressed as an odds ratio (OR). Multicenter studies (ie, private medical centers, institutional hospitals, and university hospitals). From June 1982 to September 1996, a database was established containing the information of 4718 patients who underwent noncolorectal abdominal surgery. The dependent variables studied included surgical site infection (SSI) (divided into parietal and deep infectious complications with or without fistulas) and global infectious complications (SSI and extraparietal and abdominal infectious complications). The rate of global infectious complications was 13.3%; SSI, 4.05%; parietal infectious complications, 2.2%; deep infectious complications with fistulas, 2.18%; and deep infectious complications without fistulas, 1.38%. In multivariate analysis, the following 7 independent risk factors for global infectious complications have been identified: age (60-74 years, OR, 1.64; >or=75 years, OR, 1.45); being underweight (OR, 1.51); having cirrhosis (OR, 2.45), having a vertical abdominal incision (OR, 1.66); having a suture placed or an anastomis of the bowel (OR, 1.48) in the digestive tract; having a prolonged operative time (61-120 minutes, OR, 1.66; 121 minutes, OR, 2.72); and being categorized as having a class 4 surgical site (ie, obese patients or having a risk factor of a healing defect) (OR, 1.66). Ceftriaxone sodium therapy was identified as a protective factor (OR, 0.43). In multivariate analysis, the following 5 independent risk factors for SSI have been identified: the existence of a preoperative cutaneous abscess or cutaneous necrosis (OR, 4.75), having a suture placed or an anastomosis of the bowel (OR, 1.82) in the digestive tract, having postoperative abdominal drainage (OR, 2.15), undergoing a surgical procedure for the treatment of cancer (OR, 1.74), and receiving curative anticoagulant therapy (OR, 3.33) postoperatively. Our data show that risk factors for SSI and for global infectious complications are disparate. Indeed, only the placement of a suture or having an anastomosis of the bowel in the digestive tract is a risk factor for both SSI and global infections. Some of these factors may be modifiable before or during the surgical procedure to reduce the infection rate or to prevent postoperative complications.

A Randomized Study Comparing Endometrial Cryoablation and Rollerball Electroablation for Treatment of Dysfunctional Uterine Bleeding

Study Objective To determine the effectiveness of endometrial cryoablation in comparison with rollerball electroablation. Design Prospective, randomized study (Canadian Task Force classification I). Setting Ten university and private medical centers in the United States. Patients Two hundred seventy-nine women with menorrhagia due to benign causes. Intervention Endometrial ablation using a Her Option cryoablation device in 193 women and rollerball electroablation in 86. Measurements and Main Results Women treated by cryoablation received significantly less general anesthesia (46%) than those treated by electroablation (92%). Subjects maintained menstrual diaries for at least one cycle before and for 12 months after the procedure. Success was defined as reduction of menstrual bleeding to a score of 75 or less in the absence of retreatment. Success rates in the cryoablation and electroablation groups were 77.3% and 83.8%, respectively. Bleeding declined by 92% and 94%, respectively. Both procedures led to significant improvements in a broad range of symptoms including menses-related pain, mood, and overall improvement in quality of life. Conclusion Endometrial cryoablation is a safe and effective procedure in treatment of dysfunctional uterine bleeding. Its advantages include technical ease of performance, direct ultrasonographic view of depth of ablation, little anesthetic, and avoidance of potential complications related to distention media.

Factores de riesgo coronario en la adolescencia. Estudio FRICELA

In a grou of adolescents, to examine the prevalence of behaviors and risk factors that predispose to coronary heart disease and ascertain their associations. A population of 2,599 adolescents, age 12 to 19 years, both sexes, was studied. The study sites were 30 public or private medical centers located in the Federal District and 12 provinces of Argentina. Teenagers with hypercholesterolemia had a greater body mass index, higher incidence of hypertension, and more frequent sedentary lifestyle. There was a positive correlation between hypertension, body mass index, and family history of hypertension, and a negative correlation with physical exercise. Obesity in the young correlated with obesity in their parents. At the age of 19 years, 42% consumed alcohol and 28% smoked. The association between smoking and alcohol consumption was very high (p < 0.0001). The smoking habits of parents strongly influenced their children. Early inculcation of a healthy lifestyle, consisting of regular physical exrcise, a healthy diet, and no smoking, could be the most important behavorial and risk factor interventions in the effort to curtail atherosclerosis in adults.

Measuring the efficiency of dental departments in medical centers: a nonparametric analysis approach.

Data envelopment analysis (DEA), a cross-sectional study design based on secondary data analysis, was used to evaluate the relative operational efficiency of 16 dental departments in medical centers in Taiwan in 1999. The results indicated that 68.7% of all dental departments in medical centers had poor performance in terms of overall efficiency and scale efficiency. All relatively efficient dental departments were in private medical centers. Half of these dental departments were unable to fully utilize available medical resources. 75.0% of public medical centers did not take full advantage of medical resources at their disposal. In the returns to scale, 56.3% of dental departments in medical centers exhibited increasing returns to scale, due to the insufficient scale influencing overall hospital operational efficiency. Public medical centers accounted for 77.8% of the institutions affected. The scale of dental departments in private medical centers was more appropriate than those in public medical centers. In the sensitivity analysis, the numbers of residents, interns, and published papers were used to assess teaching and research. Greater emphasis on teaching and research in medical centers has a large effect on the relative inefficiency of hospital operation. Dental departments in private medical centers had a higher mean overall efficiency score than those in public medical centers, and the overall efficiency of dental departments in non-university hospitals was greater than those in university hospitals. There was no information to evaluate the long-term efficiency of each dental department in all hospitals. A different combination of input and output variables, using common multipliers for efficiency value measurements in DEA, may help establish different pioneering dental departments in hospitals.