Prolonged length of stay associated with air leak following pulmonary resection has a negative impact on hospital margin.

BACKGROUND: Protracted hospitalizations due to air leaks following lung resections are a significant source of morbidity and prolonged hospital length of stay (LOS), with potentially significant impact on hospital margins. This study aimed to evaluate the relationship between air leaks, LOS, and financial outcomes among discharges following lung resections. MATERIALS AND METHODS: The Medicare Provider Analysis and Review file for fiscal year 2012 was utilized to identify inpatient hospital discharges that recorded International Classification of Diseases (ICD-9) procedure codes for lobectomy, segmentectomy, and lung volume reduction surgery (n=21,717). Discharges coded with postoperative air leaks (ICD-9-CM codes 512.2 and 512.84) were defined as the air leak diagnosis group (n=2,947), then subcategorized by LOS: 1) <7 days; 2) 7-10 days; and 3) ≥11 days. Median hospital charges, costs, payments, and payment-to-cost ratios were compared between non-air leak and air leak groups, and across LOS subcategories. RESULTS: For identified patients, hospital charges, costs, and payments were significantly greater among patients with air leak diagnoses compared to patients without (P<0.001). Hospital charges and costs increased substantially with prolonged LOS, but were not matched by a proportionate increase in hospital payments. Patients with LOS <7, 7-10, and ≥11 days had median hospital charges of US $57,129, $73,572, and $115,623, and costs of $17,594, $21,711, and $33,786, respectively. Hospital payment increases were substantially lower at $16,494, $16,307, and $19,337, respectively. The payment-to-cost ratio significantly lowered with each LOS increase (P<0.001). Higher inpatient hospital mortality was observed among the LOS ≥11 days subgroup compared with the LOS <11 days subgroup (P<0.001). CONCLUSION: Patients who develop prolonged air leaks after lobectomy, segmentectomy, or lung volume reduction surgery have the best clinical and financial outcomes. Hospitals experience markedly lower payment-to-cost ratios as LOS increases. Interventions minimizing air leak or allowing outpatient management will improve financial performance and hospital margins for lung surgery.

Disposal practices for unwanted residential medications in the United States.

The occurrence of trace levels of prescription and over-the-counter pharmaceuticals in the environment began to receive concerted attention nearly two decades ago. The public's growing awareness and concern over the presence of these chemicals, especially in drinking water, has served to catalyze considerable discussion and debate regarding the best practices for disposal of unused or unwanted medications. In the United States, the first federal guidance for consumers was issued in 2007. It recommends discarding unused pharmaceuticals to household trash, after taking precautions to mix the pharmaceuticals with an inert substance and conceal the contents from view. Providing the consumer with additional options for conscientious disposal are various community, city, and state collection events, ongoing programs, and government-funded pilot projects. These strategies include the opportunity to mail or bring unused medications to various collection points, such as pharmacies, for eventual destruction. All of these approaches to medication disposal play roles in reducing the introduction of pharmaceuticals to the environment.

Sex differences in neuronal morphology in the killifish hypothalamus.

This study examined the neuroarchitecture of the male and female killifish (Fundulus heteroclitus) hypothalamus to evaluate whether sexual dimorphism of this brain region exists in fishes as it does in mammals and other vertebrates. The rostral medulla, a brain region distinct from the hypothalamic-pituitary-gonadal axis, was also examined to determine if any observed differences were region-specific. With the use of Golgi-Cox impregnation, five dendritic characteristics were measured from neurons of both the hypothalamus and medulla including: spine density, number of branch points, dendrite length, surface area and volume. Dendritic spines are associated with excitatory synapses, and changes in density are associated with a variety of normal and pathological changes. Consistent with mammalian studies, we found that adult female killifish have 25% greater dendritic spine densities in the hypothalamus than male killifish (densities of 0.34+/-0.06 microm-1 and 0.25+/-0.08 microm-1, respectively). By contrast, no statistically significant difference between males and females was detected in spine densities in the rostral medulla. This finding supports the conclusion that hypothalamic sexual dimorphism is conserved in killifish.