Costs and renumeration of osteomyelitis treatment involving free flaps: implications of return to theatre.

Aim: This study aimed to define the costs of surgical management of chronic osteomyelitis where free tissue transfer was required in addition to debridement of bone, particularly the increased costs incurred by a return to theatre. We hypothesised that there would be a significantly greater cost when patients required re-exploration for vascular compromise. Method: We retrospectively analysed the costs of a consecutive series of sixty patient episodes treated at the Bone Infection Unit in Oxford from 2012 to 2015. Treatment involved excision of osteomyelitis with free tissue transfer for immediate soft tissue cover. We compared the costs of uncomplicated cases with those who returned to theatre and determined the profit / loss for the hospital from renumeration through the UK National Health Service Tariff Structure. Results: Hospital income according to UK HRG tariff was compared to the actual cost of treatment and these 60 cases were significantly underfunded overall (P < 0.005). In just 1 case, the cost to the hospital was completely covered by tariff. Six patients (10%) returned to theatre for urgent flap re-exploration with five flaps salvaged and one failed, requiring another free flap reconstruction (1.7%). These six patient episodes had a significantly higher mean cost compared to the uncomplicated cases. The average financial loss to the hospital for patients who did return to theatre was £19401 (range £8103 to £48380) and in those who did not was £9600 (range - £600 to £23717). The case requiring further free tissue transfer cost a total of £74158, £48380 more than the hospital was paid: the most extreme discrepancy. The overall loss for this group of 60 patients was £610 090. Conclusions: Surgery for chronic osteomyelitis is multidisciplinary, complex and therefore expensive with a significant risk of complications. However, this study demonstrates that the hospital currently makes a financial loss on almost all patients but especially if flap complications occur. This study has implications for the long term viability of specialist units treating this important disease.

Ebola virus disease: Awareness among dental students in Hungary.

INTRODUCTION: The Ebola epidemic has claimed thousands of lives in Africa, and there has been a mounting pressure on the healthcare systems around the globe to prepare for the showing up of patients infected with this virus. Junior clinicians are at the forefront of medical teams, often coming into contact with patients first, during clerking and admissions. This study assesses the level of knowledge of Ebola virus disease (EVD) among dental students at Semmelweis University, Budapest, Hungary. MATERIALS AND METHODS: A cross-sectional survey of 257 dental students was carried out across five different courses. Each of the students was asked to fill out a detailed questionnaire comprising of 11 questions, to assess their knowledge about signs and symptoms, investigations, management, and sequelae of the virus and the outbreak. FINDINGS: This study highlighted that there is an overall lack of knowledge about critical aspects of EVD among dental students. We found that the participating students scored less than 60% for 8 of the 11 questions, including those assessing their recognition and subsequent management of EVD. CONCLUSION: These results are concerning and the medical universities and dental schools need to act fast to prepare the Hungary's dental (and medical) students and junior doctors for an inevitable influx of infected patients.

Time to detection in liquid culture of sputum in pulmonary MDR-TB does not predict culture conversion for early discharge.

OBJECTIVES: UK guidelines advise that patients with pulmonary MDR-TB are isolated in hospital until the results of sputum cultures are negative (culture conversion), typically after 42 days of incubation with no growth. MDR-TB patients may be isolated ≥42 days longer than is necessary for public safety, which has major implications for patients and hospitals. Our objective was to determine whether analysis of time to detection (TTD) in liquid culture could predict the earliest safe discharge date of MDR-TB patients. PATIENTS AND METHODS: Fifteen pulmonary MDR-TB patients were identified retrospectively from the London TB Register and hospital records. We performed linear regression of TTD against days elapsed between admission and sample date. If the regression line crossed the observed culture-conversion date at TTD = 42 days, the data were deemed to give 'precise prediction' of the earliest safe discharge date. RESULTS: The median length of stay was 91 days (IQR 79-131 days). Culture conversion occurred at a median of 59 days (IQR 46-86 days). Twelve patients were hospitalized beyond culture conversion, with a median overstay of 52 days (IQR 35-68 days). TTD tended to lengthen until culture conversion and, for nearly half of the patients (7/15, 47%), linear regression of TTD against time from admission gave a good fit to the data (r(2) ≥ 0.6) and supported precise prediction. However, data from the remaining patients showed considerable variation, and linear regression did not support prediction of safe discharge. CONCLUSIONS: TTD data from these pulmonary MDR-TB patients did not support a simple clinical prediction tool, but our analysis was limited by the small size of our sample.