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Complex Procedures (complex + procedure)
Selected AbstractsIs the Cost of Adult Living Donor Liver Transplantation Higher Than Deceased Donor Liver Transplantation?LIVER TRANSPLANTATION, Issue 3 2004Mark W. Russo MD Background An important long-term consideration for living-donor liver transplantation (LDLT) is the expense compared with cadaveric-liver transplantation. LDLT is a more complex procedure than cadaveric transplantation and the cost of donor evaluation, donor surgery, and postoperative donor care must be included in a cost analysis for LDLT. In this study, we compare the comprehensive cost of LDLT with that of cadaveric-liver transplantation. Methods All costs for medical services provided at our institution were recorded for 24 LDLT and 43 cadaveric recipients with greater than 1 year follow-up transplanted between August 1997 and April 2000. The donor costs include donors evaluated and rejected, donors evaluated and accepted, donor right hepatectomy costs, and donor follow-up costs (365 days postdonation). LDLT and cadaveric recipient costs include medical care 90 days pre-LDLT, recipient transplant costs, and recipient follow-up costs (365 days posttransplant) including retransplantation. Cost is expressed as an arbitrary cost unit (CU) that is a value between $500 to $1,500. Results Total LDLT costs (evaluations of rejected donors + evaluations of accepted donors + donor hepatectomy + donor follow-up care for 1 year + pretransplant recipient care [90 days pretransplant] + recipient transplantation + recipient 1-year posttransplant care)= 162.7 CU. Total mean cadaveric transplant costs (pretransplant recipient care [90 days pretransplant] + recipient transplantation [including organ acquisition cost] + recipient 1-year posttransplant care)=134.5 CU, (P = ns) Conclusions The total comprehensive cost of LDLT is 21% higher than cadaveric transplantation, although this difference is not significant. (Transplantation 2003;75:473,476.) [source] Prenatal diagnosis of Niemann,Pick diseases types A, B and CPRENATAL DIAGNOSIS, Issue 7 2002Marie T. Vanier Abstract Prenatal diagnosis of Niemann,Pick disease types A and B is routinely accomplished by sphingomyelinase assay. For Niemann,Pick type C disease, demonstration of an abnormal intracellular cholesterol trafficking is a complex procedure, and mutational analysis (NPC1 or NPC2/HE1 gene), whenever feasible, represents a major advance. Copyright © 2002 John Wiley & Sons, Ltd. [source] Universal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in JapanJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 2 2009J. Mark Ramseyer For more than four decades, Japan has offered universal health insurance. Despite the demand subsidy entailed, it has kept costs low by regulatorily capping the amounts it pays doctors, particularly for the most modern and sophisticated procedures. Facing subsidized demand but stringently capped prices on complex procedures, Japanese physicians have had little incentive to invest in specialized expertise. Instead, they have invested in small private clinics and hospitals. The resulting proliferation of primitive clinics and hospitals has cut both the number of complex modern medical procedures performed, and the number of hospitals with any substantial experience in those procedures. With a quarter of the heart disease in the United States, Japan performs less than 3 percent as many coronary bypass operations and less than 6 percent as many angioplasties. Of the 855 cities and regions in Japan, 77 percent lack any hospital with substantial experience in the sophisticated modern treatment (defined below) of cerebrovascular disease, and 89 percent lack much experience in angioplasties. In this article, I estimate one of the costs of this regulatorily-driven lack of expertise. Toward that end, I combine mortality data from 855 cities with information on local hospital expertise and local demographic composition. In the typical city, I find that the addition of one hospital with substantial experience in modern stroke treatment would cut annual stroke mortality by 7 to 16 deaths. The addition of one hospital with substantial experience in angioplasties would cut the annual deaths from heart attacks in the city by over 19. [source] Electric field controlled electrospray deposition for precise particle pattern and cell pattern formationAICHE JOURNAL, Issue 10 2010Jingwei Xie Abstract Photolithography, soft lithography, and ink jetting have been used for automated micropattern fabrication. However, most of the methods for microfabrication of surface pattern are limited to the investigation of material properties of substrates with high-cost and complex procedures. In the present study, we show a simple (single-step) yet versatile and robust approach to generate biodegradable polymeric particle patterns on a substrate using electrospray deposition through a mask. Various particle patterns including patterned dots, circles, squares, and bands can be easily formed and the features of particle patterns could also be tailored using different masks and electrostatic focusing effects. Furthermore, cell patterns can be achieved on the surface of particle patterns by blocking the areas without particle deposition on the substrate and culturing cells on the substrate. Polymeric particle patterns and cell patterns developed in this study could be used in the high throughput screening of sustained release formulations, cell-based sensing, and drug discovery. In addition to experimental results, an analysis of the associated electric field is used to investigate quantitatively the nature of focusing effect. Scaling analysis is also applied to obtain the dominate terms in electrospray deposition process. © 2010 American Institute of Chemical Engineers AIChE J, 2010 [source] Corrosion aspects of metallic implants , An overviewMATERIALS AND CORROSION/WERKSTOFFE UND KORROSION, Issue 11 2008A. Balamurugan Abstract The ability to replace or augment diseased body parts totally or partially has improved both the quality and life span of human population. The decline in surgical risks during recent decades has encouraged the development of more complex procedures for prosthetic implantation. Additionally, a variety of extracorporeal devices, such as the heart, lung and blood dialysis machines are used routinely, but these prosthetic elements have several limitations. Hence, research projects are currently underway to overcome the limitations of synthetic materials by developing formulations with varying properties, such as asymptomatic, long-term function in the human physiological environment, etc., to meet the needs of biomedical surgeons. This review focuses on the several biomaterials corrosion and its measures to prevent corrosion. [source] Hand-assisted laparoscopic lymphadenectomy: a novel approach to a difficult areaANZ JOURNAL OF SURGERY, Issue 9 2003Andrew Sutherland Background: Hand-assisted laparoscopic surgery (HALS) is an emerging technique that is gaining acceptance for a wide range of abdominal procedures. We drew upon our growing experience with hand-assisted laparoscopic and thoracoscopic surgery to manage a case that was felt to require a major thoracoabdominal incision if it were to be completed by conventional open surgery. Methods: A technique is described that combines the advantages of both laparoscopic and open surgery in the form of hand-assisted laparoscopic surgery to permit safe dissection of a retrocrural mass extending into the chest. Results: We used this technique successfully to completely resect a nodal deposit of metastatic embryonal carcinoma previously thought to be inaccessible to surgical resection. Conclusion: The use of hand-assisted laparoscopic surgery improves tactile and visual feedback for the operator. This allows complex procedures involving delicate dissection to be completed safely and with less morbidity than open surgery. [source] The capacity of dental therapists to provide direct restorative care to adultsAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2009Hanny Calache Abstract Introduction: In Victoria, dental therapists are restricted to treating patients under the age of 26 years. Removing this age restriction from dental therapists' scope of practice may assist significantly in addressing workforce shortages, particularly in rural Victoria. Objectives: This study aims to assess the capacity of dental therapists to provide direct coronal restorations (dental fillings) to patients older than 25 years, on the prescription of a dentist. Its objectives include determining the success rate of restorations placed by dental therapists six months post placement; and patients' and dental therapists' satisfaction with the services provided. Methods: The project was carried out in 2007 at the Royal Dental Hospital of Melbourne. Seven dental therapists participated in the study, placed 356 restorations (115 patients) with the support of a dentist. These restorations were reviewed six-months post placement by dentists blinded as to which restorations were placed by the dental therapists. Patients' age ranged from 26 to 82 years (82% were >40 years). Results: At six months post-treatment, 258 restorations (80 patients) were reviewed. At review, 94.6% of the restorations were successful. Patients and dental therapists were satisfied with the experience. Conclusions: The standard of restorations provided by dental therapists was considered to be at least similar to that expected of a newly graduated dentist. Implications: Broadening the dental therapists scope of practice would create opportunities to design more flexible ,oral health' clinical teams enabling dentists to provide more complex procedures for patients most in need. This is significant in the public sector and rural areas where workforce shortages are most acute. [source] Covariate Adjustment and Ranking Methods to Identify Regions with High and Low Mortality RatesBIOMETRICS, Issue 2 2010Huilin Li Summary Identifying regions with the highest and lowest mortality rates and producing the corresponding color-coded maps help epidemiologists identify promising areas for analytic etiological studies. Based on a two-stage Poisson,Gamma model with covariates, we use information on known risk factors, such as smoking prevalence, to adjust mortality rates and reveal residual variation in relative risks that may reflect previously masked etiological associations. In addition to covariate adjustment, we study rankings based on standardized mortality ratios (SMRs), empirical Bayes (EB) estimates, and a posterior percentile ranking (PPR) method and indicate circumstances that warrant the more complex procedures in order to obtain a high probability of correctly classifying the regions with the upper,100,%,and lower,100,%,of relative risks for,,= 0.05, 0.1, and 0.2. We also give analytic approximations to the probabilities of correctly classifying regions in the upper,100,%,of relative risks for these three ranking methods. Using data on mortality from heart disease, we found that adjustment for smoking prevalence has an important impact on which regions are classified as high and low risk. With such a common disease, all three ranking methods performed comparably. However, for diseases with smaller event counts, such as cancers, and wide variation in event counts among regions, EB and PPR methods outperform ranking based on SMRs. [source] Comparison of drug-eluting stents with bare metal stents in unselected patients with acute myocardial infarctionCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2007L. Iri Kupferwasser MD Abstract Objectives: The aim of this study was to compare the procedural characteristics and outcomes of patients with acute myocardial infarction treated with drug-eluting stents (DES) vs. bare metal stents (BMS). Background: DES have been shown to reduce the incidence of restenosis and target vessel revascularization (TVR) in clinical randomized studies when compared with BMS in patients undergoing elective percutaneous intervention. Limited data are available with the use of DES in patients with acute ST-segment elevation myocardial infarction. Methods: Two hundred and sixty-one consecutive patients who presented with myocardial infarction between 7/2001 and 8/2005 were studied. The procedural characteristics, 30-day and 12-month outcomes of 131 patients treated with DES were compared with 130 patients treated with BMS. Results: At 12-months follow-up DES therapy was associated with a substantial decrease in major adverse cardiovascular events (MACE) (HR 0.33; P =0.002), TVR (HR 0.19; P =0.002), and recurrent myocardial infarction (HR 0.23; P =0.051) vs. BMS therapy. Coronary interventions utilizing DES were characterized by a marked increase in the number of stent per target vessel (DES: 1.9 ± 0.9 vs. BMS: 1.38 ± 0.6, P < 0.0001), treatment of bifurcation (DES: 21% vs. BMS: 5%, P =0.0004), and multivessel intervention (DES: 22% vs. BMS: 8%, P =0.003). Conclusion: The routine use of DES in acute myocardial infarction is associated with reduced rates of MACE at 12 months vs BMS, despite a higher rate of complex procedures in the DES treated patients. In addition to its anti-restenosis effect, the improved outcome of patients treated with DES may be linked to a more complete revascularization in association with prolonged clopidogrel therapy. © 2007 Wiley-Liss, Inc. [source] Eversion thromboendovenectomy in organized portal vein thrombosis during liver transplantationCLINICAL TRANSPLANTATION, Issue 1 2004Ricardo Robles Abstract: Portal thrombosis is no longer considered a contraindication for transplantation because of the technical experience acquired in the field of liver transplantation and the development of various surgical techniques. All the same, the results obtained in portal thrombosis patients are at times suboptimal, and the surgical technique used (thromboendovenectomy or veno-venous bypass) is also controversial. Between May 1988 and December 2001, 455 liver transplants were performed, of which 32 (7%) presented portal vein thrombosis. Of these, eight belonged to the first 227 transplants (group I), and 24 to the other 228 (group II). Of the 32 cases with portal thrombosis, 20 (62%) were type Ib, seven (22%) type II/III and five (16%) type IV. Twenty-two were males (69%), with a mean age of 50 yr (range: 30,70 yr); the thrombosis in all cases developed over a cirrhotic liver: 15 cases of an ethanolic origin, 11 because of hepatitis C virus, two cases of autoimmune aetiology, one case of primary biliary cirrhosis, one case because of hepatitis B virus and two cases of a cryptogenic origin. Five cases had a history of surgical treatment for portal hypertension. The surgical method in all cases consisted of an eversion thromboendovenectomy (ETEV) under direct visual guidance, with occlusion of the portal flow using a Fogarty balloon. Once re-canalization was achieved, we performed local heparinization and end-to-end portal anastomosis. In no case was systemic post-operative heparinization performed. In the 32 cases in which thrombectomy was attempted it was achieved in 31 of them (96%), failing only in a case of type IV thrombosis, which was resolved by portal arterialization. Of the 31 successful cases, only one with type IV thrombosis re-thrombosed. The 5-yr survival rate of the patients in the series was 69%, with 10 patients dying, of whom only two from causes related to the thrombosis and the thrombosis treatment, both with type IV thrombosis. The ideal treatment for portal thrombosis during liver transplantation is controversial and depends on its extension and the experience of the surgeon. In our experience, ETEV resolves most thromboses (types I, II and III), but management of type IV, which occasionally can be treated with this technique, may require more complex procedures such as bypass, portal arterialization or cavoportal haemitransposition. [source] Trends towards increased use of the laparoscopic approach in colorectal surgeryCOLORECTAL DISEASE, Issue 10 2010J. Lengyel Abstract Aim, The aim of the study was to identify the trend towards laparoscopic resection in the practice of one surgeon and to determine whether the default approach to all colorectal procedures could be by means of minimally invasive techniques with an associated low rate of conversion. Method, A prospective database of primary colorectal resections under the care of one colorectal surgeon collected between July 2003 and December 2008 was analysed to determine the trend in the use of the laparoscopic approach and the rate of conversion of an intention-to-treat policy for laparoscopic procedures. Patients with recurrent rectal or colonic malignancy were excluded from the study. Results, A total of 598 patients underwent elective colorectal resection of which 371 (62%) were carried out laparoscopically with a rate of conversion of 3.2%. The proportion of all colorectal resections that were undertaken laparoscopically in the first 1 year was 26% (22/85) (no conversions). This proportion rose to 100% (127/127) in the fifth year of the study of which 4.0% were converted. The introduction of more complex procedures did not have an adverse effect on the trend towards more laparoscopic resections The commencement of a laparoscopic colorectal fellowship in 2006 was associated with a marked increase in the number of laparoscopic cases. Conclusion, A conscious decision to make the laparoscopic approach the default for all colorectal resections can be achieved safely with a low conversion rate. This can be achieved within the context of training a ,novice' laparoscopic colorectal surgeon. [source] | |||||||||||||||||||