Hypoglossal Nerve Stimulator Implantation in an Ambulatory Surgery Center Versus Hospital.

OBJECTIVES/HYPOTHESIS: Hypoglossal nerve stimulator (HGNS) implantation is highly effective in treating obstructive sleep apnea (OSA) in select patient populations that are intolerant of continuous positive airway pressure. Implantation surgery is traditionally performed in hospital outpatient departments (HOPD) due to concern about anesthetic effects and airway manipulation in an OSA population. In this study, we examined complications and efficiency of HGNS implantation in an ambulatory surgery center (ASC) versus HOPD. STUDY DESIGN: Retrospective cohort study. METHODS: Patients with HGNS implantation performed between May 2015-January 2021 at our HOPD or ACS were included. Patient-related characteristics, surgical times, and postoperative complications were obtained via chart review. Reimbursement data on a national level for Medicare patients were calculated based on publicly available data from the Center for Medicare Services. Patient characteristics, surgical times, and complications were summarized as medians with interquartile ranges (IQRs) and proportions in each surgical setting group as appropriate. These were compared between surgical setting groups via Wilcoxon rank-sum testing and χ2 testing. RESULTS: A total of 122 patients were included. Patients in the HOPD group had significantly higher median apnea-hypopnea index (AHI) (42.0 [IQR 27.9-51.0]) compared to the ASC group (31.0 [IQR 21.0-44.2], P = .005). The intervals between in-room and case start, case finish and out-of-room, and time in the postoperative area were significantly shorter in the ASC group compared to the HOPD group. Reimbursement on a national level was estimated at 18% lower for patients with surgery performed at the ASC. There was no significant difference in postoperative complications. CONCLUSIONS: HGNS implantation in an ASC is safe and more efficient than in a HOPD, and may also be more cost-effective. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:706-710, 2022.

Developing a template matching algorithm for benchmarking hospital performance in a diverse, integrated healthcare system.

Template matching is a proposed approach for hospital benchmarking, which measures performance based on matching a subset of comparable patient hospitalizations from each hospital. We assessed the ability to create the required matched samples and thus the feasibility of template matching to benchmark hospital performance in a diverse healthcare system.Nationwide Veterans Affairs (VA) hospitals, 2017.Observational cohort study.We used administrative and clinical data from 668,592 hospitalizations at 134 VA hospitals in 2017. A standardized template of 300 hospitalizations was selected, and then 300 hospitalizations were matched to the template from each hospital.There was substantial case-mix variation across VA hospitals, which persisted after excluding small hospitals, hospitals with primarily psychiatric admissions, and hospitalizations for rare diagnoses. Median age ranged from 57 to 75 years across hospitals; percent surgical admissions ranged from 0.0% to 21.0%; percent of admissions through the emergency department, 0.1% to 98.7%; and percent Hispanic patients, 0.2% to 93.3%. Characteristics for which there was substantial variation across hospitals could not be balanced with any matching algorithm tested. Although most other variables could be balanced, we were unable to identify a matching algorithm that balanced more than ∼20 variables simultaneously.We were unable to identify a template matching approach that could balance hospitals on all measured characteristics potentially important to benchmarking. Given the magnitude of case-mix variation across VA hospitals, a single template is likely not feasible for general hospital benchmarking.

Screening and management of postoperative hypoparathyroidism-induced hypocalcemia in thyroidectomized patients in the endocrine ward compared with the surgical ward.

Transient hypoparathyroid-associated hypocalcemia is a common side effect after thyroidectomy. Not only may it be life-threatening, but it also can distinctly affect length of hospital stay and treatment costs. Screening and treatment practices are suspected to differ between clinicians in endocrine and surgical wards. We therefore compared discipline-related differences in screening and treatment of hypocalcemia as well as the length of hospital stay of patients after thyroidectomy. Data from 170 patients treated with total thyroidectomy in the Department of Otolaryngology (n = 29), General Surgery (n = 49) and Endocrinology (n = 92) were analyzed, and measurements of postoperative calcium and parathyroid hormone, calcium at time of discharge, percentage of discharge with a calcium level <1.9 mmol/L (defined as severe hypocalcemia), treatment of hypocalcemia, and duration of hospitalization were compared between disciplines. Postoperative calcium levels were measured in 97.8% of patients in endocrine wards compared with 83.3% in surgical departments (p = 0.001), and discharge with a calcium level <1.9 mmol/L was statistically more frequent in surgical vs. endocrine wards. Additional to calcium supplementation, active vitamin D was administered in 95% of patients treated in endocrine wards vs. 35% in surgical wards. Length of hospitalization was 8.12 (±6.62) days (endocrinology) to 10.55 (±9.39) days (surgical wards) (p = 0.05). Monitoring of calcium levels is an important indicator of the quality of postoperative care after thyroidectomy. To prevent postoperative hypocalcemia-induced complications and to reduce the length of hospital stay, an interdisciplinary approach for the management of hypocalcemia after thyroidectomy might be a promising model for future treatment concepts.

Use of palliative care and hospice among surgical and medical specialties in the Veterans Health Administration.

IMPORTANCE: Many hospitals have undertaken initiatives to improve care during the end of life, recognizing that some individuals have unique needs that are often not met in acute inpatient care settings. Studies of surgical patients have shown this population to receive palliative care at reduced rates in comparison with medical patients. OBJECTIVE: To determine differences in the use of palliative care and hospice between surgical and medical patients in an integrated health care system. DESIGN, SETTING, AND PARTICIPANTS: Veterans Health Administration (VHA) enrollment data and administrative data sets were used to identify 191,280 VHA patients who died between October 1, 2008, and September 30, 2012, and who had an acute inpatient episode in the VHA system in the last year of life. Patients were categorized as surgical if at any time during the year preceding death they underwent a surgical procedure (n = 42,143) or medical (n = 149,137) if the patient did not receive surgical treatment in the last year of life. MAIN OUTCOMES AND MEASURES: Receipt of palliative or hospice care and the number of days from palliative or hospice initiation to death were determined using VHA administrative inpatient, outpatient, and fee-based encounter-level data files. RESULTS: Surgical patients were significantly less likely than medical patients to receive either hospice or palliative care (odds ratio = 0.91; 95% CI, 0.89-0.94; P < .001). When adjusting for demographics and medical comorbidities, this difference was even more pronounced (odds ratio = 0.84; 95% CI, 0.81-0.86). Yet, among patients who received hospice or palliative care, surgical patients lived significantly longer than their medical counterparts (a median of 26 vs 23 days, respectively; P < .001) yet had similar relative use of these services after risk adjustment. CONCLUSIONS AND RELEVANCE: In the VHA population, surgical patients are less likely to receive either hospice or palliative care in the year prior to death compared with medical patients, yet surgical patients have a longer length of time in these services. Determining criteria for higher-risk medical and surgical patients may help with increasing the relative use of these services. Potential barriers and differences may exist among surgical and medical services that could impact the use of palliative care or hospice in the last year of life.

[Antibiotic prophylaxis and therapy of pancreatonecrosis in multifield surgical hospital].

The article is based on an analysis of results of complex treatment of 497 patients with pancreatonecrosis at the period from 2010 to 2014. All patients were admitted to the surgical departments of Republican hospital No 2 and Centre of Emergency Medicine of Republic of Sakha (Yakutia). The investigation allowed adaptation and development of antibiotic prophylaxis and therapy management in pancreatonecrosis in multifield surgical hospital. More than 80% of patients avoided a contamination of necrotic destruction zones. The level of lethality was reduced in group of patients with infectious complications of pancreatonecrosis from 45.8% to 37.7%.

[Preoperative chemotherapy in the surgical treatment of colorectal liver metastases]. / Preoperatív kemoterápia a colorectalis májáttétes betegek sebészi kezelésében.

INTRODUCTION: The only curative treatment of colorectal liver metastases (CRLM) is surgical resection. Preoperative/neoadjuvant chemotherapy can be used for resectable, for borderline resectable or even for irresectable CRLM patients. PATIENTS: Data of CRLM patients treated with surgical resection at the Uzsoki Hospital were analysed. Patients were classified into two groups, (A) who received preoperative chemotherapy before hepatic resection, and (B) who received no chemotherapy before resection. RESULTS: Between 01.01.2007. and 31.12.2010. 128 CRLM patients were treated with hepatic resection. 68 patients (53%) received chemotherapy before hepatic resection, 60 patients (47%) were resected without neoadjuvant chemotherapy. There was no significant difference in the complications between the groups (p = 0.39). Median overall survival was 41 months. The progression free survival (PFS) at 3 and 5 years were 25%, the 3 and 5 year overall survival (OS) were 55% and 31%. Both PFS and OS were significantly worse in the chemotherapy group (p = 0.014, p = 0.015). The subgroup of patients receiving bevacizumab containing preoperative chemotherapy has significanly better PFS than patients receiving only cytotoxic chemotherapy (p = 0.004). CONCLUSION: Surgical resection of CRLM patients results good survival data even in non-selected patients, although the very long survival results reported in the literature couldn't have been reproduced in this patient population. When preoperative chemotherapy was combined with bevacizumab, survival was similar to the upfront resected patients.

Are alcohol-related acute surgical admission rates falling?

BACKGROUND: Alcohol-related admissions (ARA) represent a significant burden on hospital resources. The study objectives were to assess alcohol-related acute surgical admissions to a District General Hospital over a 5-year period, to determine the cost of these admissions and to consider strategies to affect future admission rates. METHODS: A prospective observational study was completed from October 2007 to March 2008. A daily review of acute surgical admissions determined whether alcohol was a factor for patients admitted. Data recorded included patient demographics, clinical presentation, investigations and final outcomes. This data was then compared with a previously completed prospective study between November 2002 and March 2003. RESULTS: Overall emergency surgical admissions during the study period were 1,125 (10.4%) compared to 838 (11.02%) in 2002. There was a 1.1% reduction in ARA from 9.5% (80/838) in 2002 to 8.4% (94/1,125) in 2007. The majority of ARA were male (82.8%) and 59.8% of ARA were under 40 years of age. ARA secondary to road traffic collisions (RTC) were reduced in 2007 compared to 2002 (12.5% to 8.5%). However, head injuries (30.0% to 48.9%) and pancreatitis (3.8% to 19.1%) secondary to alcohol had increased (p=0.27). 79.3% of admissions occurred out of hours. Although use of plain x-rays had decreased (70% to 54.3%, p=0.018), CT imaging (11.3% to 20.2%, p=0.67) and upper GI endoscopy had increased (2.5% to 7.4%, p=0.82). Blood alcohol levels increased with 83.0% of patients in 2007 compared to 60.9% in 2002 admitted with a level greater than 151mg/100mls (p=0.10). The overall cost of ARA over one year was calculated at £341,796. CONCLUSION: Alcohol-related admissions have reduced at this District General Hospital. However, despite recent government initiatives it still remains unclear how these factors affected ARA, as blood alcohol levels, alcohol-related head injuries and pancreatitis admissions all increased. Our findings highlight the relevance of the implementation of an inpatient alcohol policy combined with the availability of an alcohol liaison nurse in all acute surgical units.

Development of expertise in the detection and classification of non-polypoid colorectal neoplasia: Experience-based data at an academic GI unit.

At its core, quality improvement in gastrointestinal (GI) practice relies on continuous training, education, and information among all health care providers, whether gastroenterologists, GI trainees, endoscopy nurses, or GI pathologists. Over the past few years, it became clear that objective criteria are needed to assess the quality of colonoscopy, such as cecum intubation rate, quality of bowel preparation, withdrawal time, and adenoma detection rate. In this context, development of competence among practicing endoscopists to adequately detect and treat non-polypoid colorectal neoplasms (NP-CRNs) deserves special attention. We describe a summary of the path to develop expertise in detection and management of NP-CRNs, based on experience at our academic GI unit.

Use of complementary and alternative medicine by patients admitted to a surgical unit in Scotland.

INTRODUCTION: Within the UK there are 50,000 practitioners of complementary medicine. Five million people have consulted such practitioners in one year. The aim of this study was to explore the use of complementary and alternative medicine (CAM) in patients attending general, vascular and cardiothoracic units at a regional Scottish centre. PATIENTS AND METHODS: A questionnaire was administered to 450 patients attending the units over an 8-week period. The questionnaire consisted of demographic sections, a listing of 48 herbal preparations and alternative therapies, reasons for use and opinions on efficacy. RESULTS: A total of 430 patients completed questionnaires (95%); age and sex were equally distributed over the sample. Of respondents, 68% (291 patients) had ever used CAM; 46% had used CAM in the preceding year. Half had used herbal preparations only, 13% non-herbal treatments and 35% both types of therapy. Only 10% were using CAM for the condition that led to their hospital admission. Two-thirds failed to inform their family physician about their use of CAM. CONCLUSIONS: Despite concerns regarding the efficacy, safety and cost-effectiveness of complementary medicine, use amongst surgical patients is common.

Pronóstico del melanoma cutáneo según el servicio quirúrgico: estudio comparativo en un hospital de tercer nivel / Prognosis for cutaneous melanoma according to surgical department: comparative study at a tertiary care hospital

Introducción. El tratamiento quirúrgico del melanoma depende de dermatólogos y cirujanos generales o plásticos. Se desconoce si el tratamiento del melanoma por unos u otros especialistas determina un pronóstico distinto para estos pacientes. Material y métodos. Se analizaron de forma retrospectiva las características epidemiológicas, clínico-histológicas y evolutivas de todos los pacientes diagnosticados de melanoma en el Hospital Gregorio Marañón durante un periodo de 10 años (1994-2003). Se observaron las diferencias existentes en función del servicio hospitalario en el que fueron atendidos (dermatología, cirugía general y cirugía plástica). Resultados. Más del 90 % de los pacientes con melanoma fueron atendidos por el Servicio de Dermatología. El espesor tumoral y la presencia de ulceración histológica fueron significativamente superiores en los melanomas atendidos por cirujanos generales y plásticos (p < 0,05). Las diferencias en la supervivencia global media (105, 55 y 77 meses) y el tiempo libre de enfermedad (88, 24 y 51,3 meses) en los melanomas operados por dermatólogos, cirujanos generales y plásticos, respectivamente, fueron significativas (p < 0,001). Conclusiones. El presente estudio confirma las diferencias significativas en las características clínico-histológicas y el pronóstico vital de los pacientes con melanoma cutáneo atendidos por diferentes especialistas. Los atendidos por cirujanos generales o plásticos suelen ser melanomas de mayor tiempo de evolución y, por tanto, de mayor espesor y frecuencia de ulceración que los atendidos por dermatólogos, lo que determina una supervivencia inferior. Una formación médico-quirúrgica adecuada convierte al dermatólogo en el especialista más adecuado para su diagnóstico y tratamiento precoz

Introduction. Surgical treatment of melanoma is performed by dermatologists and general or plastic surgeons. It is not known whether the type of specialist treating the melanoma results in a different prognosis for these patients. Material and methods. A retrospective study was carried out on the epidemiological, clinical/histological and evolutional characteristics of all patients diagnosed with melanoma at Hospital Gregorio Marañón over a 10-year period (1994--2003). The differences by hospital department where the patients were treated (dermatology, general surgery and plastic surgery) were noted. Results. Over 90 % of the patients with melanoma were treated by the Dermatology Department. The thickness of the tumors and the presence of histologic ulceration were significantly higher in the melanomas treated by general and plastic surgeons (p < 0.05). The differences in overall average survival (105, 55 and 77 months) and disease-free time (88, 24 and 51.3 months) in the melanomas operated on by dermatologists, general surgeons and plastic surgeons, respectively, were significant (p < 0.001). Conclusions. This study confirms that there are significant differences in the clinical and histological characteristics and the life prognosis of patients with cutaneous melanoma treated by different specialists. The melanomas treated by general or plastic surgeons have usually been developing for a longer time, and therefore are thicker and more often ulcerated than those treated by dermatologists, resulting in a lower survival period. With appropriate medical and surgical training, dermatologists are the most suitable specialists for early diagnosis and treatment

[Analysis of nursing records in a surgical ward of a public teaching hospital]. / Análise dos registros de enfermagem em uma unidade cirúrgica de um hospital-escola público.

This article presents a systematic descriptive and retrospective study on nursing notes on patients admitted to the surgical ward of a teaching hospital in Londrina, Paraná, Brazil, which aimed at their systematic analisys. Results show that the largest number of notes was made during the morning shift, and most of them were made by nurse auxiliaries. As to basic needs, psychobiological records were the most frequent, whereas there no psychospiritual records were found. It was concluded that nursing notes must be improved, and take into account integral care of patients.

The pattern of orthopedic admissions in Tikur Anbessa University Hospital, Addis Ababa.

A one-year (April 1st 2003-March 31st 2004) prospective descriptive study of orthopedic admissions to Tikur Anbessa University Hospital (TAUH) was made in order to determine the burden of musculoskeletal conditions together with the present provision of care. A total of 824 patients were admitted of whom 576 were males and 248 females (M:F 2.3:1). The median age was 15 years (range 3 months to 80 years). Trauma was the cause for admission in 507 (61.5%), with road traffic accidents accounting for 211 (41.6%) and a fall for 195 (38.5%). 'Elective' patients waited for an average of 33.5 days for their admission. The mean duration of stay in hospital between admission and elective operation was 11.7 days. The post-operative stay was 20.6 days and the average length of hospital stay of all patients admitted was 35.4 days. The bed occupancy rate was 97.4% with an average time between the discharge of one patient and the admission of another (turnover interval) of 24 hours. Eighty-seven percent of the patients (97/112) who had previously visited a traditional healer presented with a chronic infection, a neglected or a complicated fracture or an advanced tumor. Eleven patients died (1.4%). Health education in the community and of traditional healers, together with a reduction of road traffic accidents would significantly reduce morbidity and mortality in Ethiopia. Major attempts must be made to reduce both the length of time patients wait for elective surgery after being admitted and their post-operative stay in order to serve more people. But it is vital to continue to teach conservative management of fractures as these will be the only methods available for the foreseeable future in hospital outside the centers of excellence. A series of specific recommendation are made to improve our care of orthopedic and trauma patients. We also suggest a broad based community study with an orthopedic input, which would help to produce a better profile and sound decisions to enable this to be achieved.

Creating an emergency general surgery service enhances the productivity of trauma surgeons, general surgeons and the hospital.

BACKGROUND: Several models that integrate trauma and emergency general surgery (EGS) have been proposed to provide a diverse and challenging operative practice for trauma surgeons and improve recruitment. In July 2002, our institution established a 24/7 EGS consult service, staffed primarily by critical care/trauma surgeons (CCTS). The objective of this report was to evaluate the impact of this new service on CCTS, general surgeons (GS) and the hospital. METHODS: All admissions to CCTS and GS from July 1, 2000 to June 30, 2003 were reviewed by querying hospital and physician databases for demographics, diagnoses, operative intervention(s), and resource utilization. Data were analyzed using nonparametric methods. RESULTS: [See ]. 9,405 admissions were identified, with GS and EGS admissions increasing over time. In July 2002, EGS became a separate service and captured 26% of GS admissions. Hospital-wide trauma admissions remained stable despite a slight decrease in trauma admissions to CCTS. A decrease in trauma operations by CCTS was offset by an increased EGS operative volume. EGS included "bread and butter" GS procedures including appendectomies and cholecystectomies and complex surgical procedures. EGS patients were often sicker with more than 50% requiring ICU admission compared with GS admissions of which only 10% required ICU care.(Table is included in full-text article.) CONCLUSIONS: Departmental restructuring to include an EGS service: 1) increased CCTS volume despite decreased CCTS trauma admissions and operations; 2) increased elective GS volume; 3) generated increased use of ICU and operating room resources; and 4) demonstrated that CCTS with broad operative GS backgrounds and critical care knowledge can effectively staff an EGS service.

Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization.

BACKGROUND: Previous research has shown that persons undergoing certain high-risk surgical procedures at high-volume hospitals (HVHs) have a lower risk of postoperative death than those undergoing surgery at low-volume hospitals (LVHs). We estimated the absolute number of operative deaths that could potentially be avoided if 5 major surgical procedures in Ontario were restricted to HVHs. METHODS: We collected data on all persons who underwent esophagectomy (613), colon or rectal resection for colorectal cancer (18 898), pancreaticoduodenectomy (686), pulmonary lobectomy or pneumonectomy for lung cancer (5156) or repair of an unruptured abdominal aortic aneurysm (AAA) (6279) in Ontario from Apr. 1, 1994, to Mar. 31, 1999. We calculated the excess number of operative deaths (defined as deaths in the period from the day of the operation to 30 days thereafter), adjusted for age, sex and comorbidity, among the 75% of persons treated in LVHs, as compared with the 25% treated in the highest-volume quartile of hospitals. Bootstrap methods were used to estimate 95% confidence intervals (CIs). RESULTS: Of the 31 632 persons undergoing any of the 5 procedures, 1341 (4.24%) died within 30 days of surgery. If the 75% of persons treated at the LVHs had instead been treated at the HVHs, the annual number of lives potentially saved would have been 4 (95% CI, 0 to 9) for esophagectomy, 6 (95% CI, 1 to 11) for pancreaticoduodenectomy, 1 (95% CI, -10 to 13) for major lung resection and 14 (95% CI, 1 to 25) for repair of unruptured AAA. For resection of colon or rectum, the regionalization strategy would not have saved any lives, and 17 lives (95% CI, 36 to -3) would potentially have been lost. INTERPRETATION: A small number of operative deaths are potentially avoidable by performing 4 of 5 complex surgical procedures only at HVHs in Ontario. In determining health policy, the most compelling argument for regionalizing complex surgical procedures at HVHs may not be the prevention of a large number of such deaths.

Análisis del motivo de consulta y estadio de las mujeres con cáncer de mama en el servicio de cirugía del Hospital del Salvador / Analysis of consultation reason and stage of women with breast cancer in surgical service at El Salvador hospital

El objetivo de este trabajo fue conocer el motivo de consulta y estadio en que consultan las pacientes portadora de cáncer de mama, en el Servicio de Cirugía de nuestro Hospital. Todas las pacientes con esta patología que consultaron en nuestro Servicio entre el 1º de julio de 1997 y el 30 de junio de 2000, ingresaron a un protocolo de seguimiento. Ingresaron 86 pacientes, con una media de edad de 59 años (rango 28 a 98 años).Los motivos de consulta fueron: nódulo mamario palpable 48,8 por ciento (n=42), tumor con deformación de la mama 28 por ciento (n=24), por hallazgos en tamizaje mamográfico 8,1 por ciento (n=7), nódulo axilar 7 por ciento (n=6), alteraciones de la unidad aréola-pezón 2,3 por ciento (n=2), alteraciones de la piel 2,3 por ciento (n=2), dolor 2,3 (n=2), síntomas asociados a metástasis 1,2 por ciento 1,2 por ciento (n=1). El tiempo de evolución de los síntomas previo a la primera consulta fue promedio de 9,7 meses (rango de 1 a 60 meses). La confirmación diagnóstica se realizó por trucut o biopsia incisional en el 24,4 por ciento de los casos (n=21), y por biopsia excisional en el 75,6 por ciento de los casos (n=65). El estadio al momento del diagnóstico fue: estadio 0 en el 7 por ciento de los casos (n=6), I en 14 por ciento (n=12), IIA en 23,2 por ciento (n=20), IIB en 16,3 por ciento (n=14), IIIA 8,1 por ciento (n=7), IIIB en 9,3 por ciento (n=8), IV en 15,1 por ciento (n=13), y no determinable en 7 por ciento (n=6). El cáncer de mama sigue diagnosticándose tardíamente en nuestro país, existiendo una alta proporción de pacientes que son pesquisadas en estados avanzados de la enfermedad

[Patients with diagnosed colonic diverticulitis admitted to a department of surgery]. / Pasienter med diagnosen colondivertikulitt innlagt i kirurgisk avdeling.

In 1995-96, 148 patients with the diagnosis diverticulitis of the colon were admitted a total of 176 times to the Department of Gastroenterologic Surgery at Ullevaal Hospital in Oslo. Data on treatment and outcome were recorded retrospectively from patient files. 92% of the hospitalisations were emergency cases of abdominal pain. In 113 hospitalisations, patients were initially treated with intravenous antibiotics, aspiration of the stomach, later oral antibiotics. No deaths were recorded. In 8 out of 64 patients (13%) hospitalised with diverticulitis for the first time, the diagnosis could not be verified by coloscopy or bowel enema. In 63 hospitalisations (36%), the patients underwent surgery. Hartmann's procedure was performed in 31 out of 49 emergency cases. 22 patients undergoing surgery in an emergency setting had perforated diverticulitis; 5 of these patients died within 15 days. 14 patients had planned surgery with bowel resection and 15 patients had a planned closing of the stoma. Two of these 29 patients died post-operatively. Acute diverticulitis is a serious condition, especially when the bowel has perforated. Complications develop both after emergency and elective surgery. We recommend careful selection of patients.

Blood transfusion practice in Belgium. As assessed by a national survey.

In April 1995 the Ministry of Public Health invited all Belgian hospitals to participate to a survey on the use of blood transfusion. The questionnaire presented two parts, the first one devoted to products transfused and the second one to the transfusion organisation in the hospital. 71 hospitals answered: 7 university and 64 general hospitals. All hospitals reported the use of red cells, 31 of them still used whole blood. Surgical departments transfused the greatest absolute amount of units, but the highest intensity (units/bed/year) was observed in intensive care units. 52 hospitals mentioned the use of autologous predeposit. The highest consumption of platelets occurred in medicine but intensive care showed the highest intensity of platelet transfusion. In 41 hospitals platelets were obtained by cytapheresis. The number of plasma units transfused was highly correlated with the quantities of packed red cells and whole blood transfused. Ten hospitals didn't report the use of any blood conservation technique. Returning unused units to the blood bank was allowed in 80% of the hospitals, their return to the transfusion center was permitted in 65% of the hospitals. A transfusion committee existed in only 11 hospitals. Transfusion should be improved by a better education of all physicians and nurses involved with transfusion and by improving standardisation, by better documentation, better reporting and information of all health care workers involved.

[Sterilization of women. Waiting lists, surgical techniques and type of anesthesia]. / Sterilisering av kvinner. Ventelister, operasjonsteknikk og anestesiform.

The surgical and anaesthesiological techniques of tubal sterilization in Norway were studied by means of questionnaire. All hospitals returned the questionnaire. 94% of the operations were performed by gynaecologists, and in 99% of the cases by bipolar or endothermal laparoscopy. Local analgesia was used in one of the 60 hospitals. There were significant regional differences in sterilization rates and waiting time. We found no simple relation between sterilization technique and waiting lists.

[Colles' fracture. Therapeutic results and use of resources. A comparative study between 2 departments in the same county]. / Fractura Collesi. Behandlingsresultater og ressourceforbrug. En sammenlignende undersøgelse imellem to afdelinger i et amt.

A comparison between the functional end results of Colles' fractures, treated in two different hospitals, was performed by a follow up study of 100 patients from each hospital 18-24 months after fracture. The difference between the requirements of resources in the two hospitals were mainly: treatment of patients as outpatients or during admission and the method of anaesthesia. No significant difference in functional end result between the two groups was found. It was concluded that local anaesthesia in the fracture haematoma often is insufficient and is unpleasant for the patient. A more effective anaesthesia which can be applied polyclinically is preferable, as anaesthesia, which demands admission to the hospital, is an expensive solution and does not give a better functional end result. The "sandwich" type plaster of Paris bandage is more comfortable, safer to use with outpatients and is therefore preferable to the circular plaster of Paris bandage.