A systematic review to assess cost effectiveness of enhanced recovery after surgery programmes in colorectal surgery.

AIM: Enhanced recovery after surgery (ERAS) programmes have been shown to reduce length of stay and peri-operative morbidity. However, there are comparatively few data on their cost effectiveness. The object of this systematic review was to appraise the current literature to determine the cost effectiveness of ERAS and to characterize how cost is reported and evaluated. METHOD: An electronic database search identified studies comparing ERAS with standard peri-operative care in colorectal surgery where an evaluation of cost effectiveness was a primary or secondary outcome. Cost data were converted to euros to enable a more standardized comparison of the studies. There were no limits on study design. RESULTS: Seven articles were included in the analysis. The reporting and evaluation of cost data were inconsistent. Reported cost for ERAS ranged from €1989 to €12,805 per patient. Although not all statistically significant, all studies demonstrated cost reductions with ERAS compared with non-ERAS although they were highly variable, ranging from €153 to €6537 per patient. CONCLUSION: Although the review has shown ERAS to be cost effective, there are some important inconsistencies and deficiencies regarding the reporting of data. Authors should therefore be encouraged to report cost data to supplement the literature detailing clinical efficacy.

Techniques for selection of industrially important microorganisms.

The screening of microorganisms for the production of useful products continues to be an important aspect of biotechnology. Although advances in instrumentation, genetics, and microbial physiology are having an impact, screening programs are still primarily based on so-called classical techniques of enrichment and mutagenesis. One area that needs strengthening is the advancement of knowledge in microbial physiology. Recent surveys indicate that industry leaders see trained microbial physiologists as being the limiting factor in development of biotechnology in the coming decade. The largest impediment to development of new screening techniques is the ironic lack of programs specifically directed at developing new techniques. Too much emphasis is placed on using available techniques and relying on sheer labor and screening of vast numbers of organisms to produce novel products. In this respect, the Japanese are the exception and have proven that the establishment of new programs is worth the cost and effort. They are undoubtedly the world leaders in development of screening techniques and consequently the discovery of novel products. The isolation of microbes from novel and extreme environments holds tremendous promise in two areas. First, as Omura (46) and others (9, 48, 65) state, novel organisms will yield novel products. Second, such organisms serve as models for the understanding of structure and function that will facilitate the genetic manipulation of organisms and advance our ability to engineer novel enzymes. Hopefully such advances will enable genetic and protein engineering to have a greater impact on screening programs and techniques in the future. The earth holds a vast amount of varied and unique environments, from natural extremes such as high-altitude deserts and thermal springs, to manmade environments such as industrial-waste-treatment facilities, from which, with the appropriate methods and techniques, we may isolate and evaluate new potential products.

A comparative study of virulent and avirulent strains of Chromobacterium violaceum.

A clinical isolate and a soil isolate of Chromobacterium violaceum were compared to determine differences in virulence-related characteristics. Purified lipopolysaccharide (endotoxin) from the virulent, clinical strain was more reactive than that from the avirulent soil strain as determined by the Limulus amebocyte lysate assay. There were no differences in hemolysin or cyanide production between the two strains. The virulent strain was more resistant to phagocytosis and intracellular killing by human polymorphonucleocytes. The clinical strain showed a superoxide dismutase activity 30% higher and a catalase activity fivefold higher than the activities of the soil-isolated strain. The clinical strain also was capable of producing approximately twice as much hydrogen peroxide during growth as compared with the soil isolate. This study suggests that virulence of C. violaceum may be, at least in part, associated with endotoxin, and some protection of the virulent, clinical strain from phagocytic attack is afforded by elevated levels of superoxide dismutase and catalase.