Cost Effectiveness and Impact in Quality of Care of a Pediatric Multidisciplinary Stone Clinic.

Herein, we assess the cost-effectiveness of a multidisciplinary clinic for children with urinary stones. The clinic's primary goals were to decrease unnecessary visits, imaging, and costs while optimizing the quality of care. METHODS: Between October 2012 and January 2016, children with complex stone disease, previously treated in urology and/or nephrology clinics, were seen at a triannual pediatric combined stone clinic. We compared the number and cost of ultrasounds, emergency room (ER) visits, and stone surgeries performed before and after each patient's initial evaluation. All patients received satisfaction surveys. RESULTS: Among the 79 patients, 27 were seen at least twice in the combined clinic and followed multiple times in either urology or nephrology clinics. The mean number of ER visits per patient per year significantly decreased from 0.29 ± 0.36 to 0.10 ± 0.15 (P = 0.002). The mean cost of ER visits went from CAD$ 23.44 ± 28.80 to CAD$ 4.14 ± 12.18 (P = 0.002). Likewise, the mean annual number and cost of stone-related surgeries significantly decreased [(0.38 ± 0.63 versus 0.20 ± 0.32 after the MSC started (P = 0.026) and mean annual cost of surgeries went from CAD$ 182.97 ± 301.49 to CAD$ 41.59 ± 110.97 (P = 0.022)]. Among the survey responses returned, 75% of families believed the clinic was time-saving. CONCLUSIONS: Despite a small sample size, the number of ER visits and stone-related operations significantly decreased after the initial combined clinic intervention. Longer-term data will hopefully confirm if the positive findings continue.

Digitization of the Nissen-Riesen chimpanzee radiological growth series.

Longitudinal morphological growth data of apes are incredibly difficult to obtain. Long life histories, combined with practical and ethical issues of obtaining such long-term data have resulted in few longitudinal data sets in chimpanzees of known chronological ages. One classic, long-term growth study of chimpanzees was that of Drs Nissen and Riesen initiated at the Yale Laboratories of Primate Biology in 1939. Through that study, whole-body radiological images were taken on a regular basis from a "normative" group of chimpanzees from birth to adulthood. Here we have digitized the known remaining radiographs from that growth study, many of which are deteriorating, and uploaded the data set to the free, online database MorphoSource. The database comprises 3,568 X-ray images of 15 of the 16 chimpanzee subjects in the normative group and 1 individual from an experimental group. Herein, we briefly review the historical context of this study and specific details of the data set.

Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair.

INTRODUCTION: Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. METHODS: This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at p<0.05. RESULTS: Over a 14-month period, 96 patients underwent hypospadias repair (81 in Group A, 15 in Group B 5). No significant difference was noted between groups for overall ER return rate (RR 0.46, 95% CI 0.21, 1.0). However, the number of ER visits for wound check not requiring intervention was significantly lower in Group A than in Group B (RR 0.14, 95% CI 0.035, 0.56); likewise, a higher number of ER visits requiring intervention was noted in Group A compared with Group B, although statistically this was not significant (RR 1.67, 95% CI 0.23, 12.21). CONCLUSIONS: Email communication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.