A simple "passive awareness" intervention to decrease the cost of thoracoscopic lobectomy.

In thoracic surgery, disposable instruments are significant drivers of cost. There is variation in disposable instrument use among surgeons. It was hypothesized that a "passive awareness" intervention (displaying a pricing list of disposable instruments in the operating theater) would decrease operative costs. A current price list of disposable instruments used in thoracoscopic lobectomy was displayed in the thoracic surgery operating theater. Consecutive patients who underwent thoracoscopic lobectomy 6 months prior to price list display (Period 1) and 6 months following price list display (Period 2) were analyzed. Descriptive statistics were used to describe case distribution and lobectomy costs. T test and linear regression were used to examine the impact of surgeon, lobe removed, and time period. Over the study period, 71 patients underwent thoracoscopic lobectomy (Period 1: n = 36, Period 2: n = 35). Median per-lobectomy disposables cost decreased from $2063.22 (Interquartile range [IQR] $788.49) in Period 1 to $1885.92 (IQR $552.26) in Period 2; p = 0.03. There was a significant reduction in the median number of "high cost disposables" between Periods 1 and 2 (5.5-5.0, respectively; p = 0.04). In multiple linear regression, there was a decrease in total per-lobectomy cost of $286.21 (p = 0.03) and a decrease in stapler cartridge cost of $266.89 (p = 0.03) when controlling for surgeon and lobe. There was a significant reduction in disposable instrument expenditure per thoracoscopic lobectomy following posting of instrument costs in the operating theater. These findings suggest that a simple passive awareness intervention is effective in influencing surgeon behavior to reduce disposable instrument costs.

Malignant mesothelioma in situ.

AIMS: The existence of malignant mesothelioma in situ (MIS) is often postulated, but there are no accepted morphological criteria for making such a diagnosis. METHODS AND RESULTS: Here we report two cases that appear to be true MIS on the basis of in-situ genomic analysis. In one case the patient had repeated unexplained pleural unilateral effusions. Two thoracoscopies 9 months apart revealed only visually normal pleura. Biopsies from both thoracoscopies showed only a single layer of mildly reactive mesothelial cells. However, these cells had lost BRCA1-associated protein 1 (BAP1) and showed loss of cyclin-dependent kinase inhibitor 2 (CDKN2A) (p16) by fluorescence in-situ hybridisation (FISH). NF2 was not deleted by FISH but 28% of the mesothelial cells showed hyperploidy. Six months after the second biopsy the patient has persisting effusions but no evidence of pleural malignancy on imaging. The second patient presented with ascites and minimal omental thickening on imaging, but no visual evidence of tumour at laparoscopy. Omental biopsy showed a single layer of minimally atypical mesothelial cells with rare tiny foci of superficial invasion of fat. BAP1 immunostain showed loss of nuclear BAP1 in all the surface mesothelial cells and the invasive cells. There was CDKN2A deletion, but no deletion of NF2 by FISH. CONCLUSIONS: These cases show that morphologically bland single-layered surface mesothelial proliferations with molecular alterations seen previously only in invasive malignant mesotheliomas exist, and presumably represent malignant MIS. More cases are need to understand the frequency of such changes and the time-course over which invasive tumour develops.

The prognostic value of BRAF mutation in colorectal cancer and melanoma: a systematic review and meta-analysis.

BACKGROUND: Mutation of BRAF is a predominant event in cancers with poor prognosis such as melanoma and colorectal cancer. BRAF mutation leads to a constitutive activation of mitogen activated protein kinase pathway which is essential for cell proliferation and tumor progression. Despite tremendous efforts made to target BRAF for cancer treatment, the correlation between BRAF mutation and patient survival is still a matter of controversy. METHODS/PRINCIPAL FINDINGS: Clinical studies on the correlation between BRAF mutation and patient survival were retrieved from MEDLINE and EMBASE databases between June 2002 and December 2011. One hundred twenty relevant full text studies were categorized based on study design and cancer type. Publication bias was evaluated for each category and pooled hazard ratio (HR) with 95% confidence interval (CI) was calculated using random or fixed effect meta-analysis based on the percentage of heterogeneity. Twenty six studies on colorectal cancer (11,773 patients) and four studies on melanoma (674 patients) were included in our final meta-analysis. The average prevalence of BRAF mutation was 9.6% in colorectal cancer, and 47.8% in melanoma reports. We found that BRAF mutation increases the risk of mortality in colorectal cancer patients for more than two times; HR = 2.25 (95% CI, 1.82-2.83). In addition, we revealed that BRAF mutation also increases the risk of mortality in melanoma patients by 1.7 times (95% CI, 1.37-2.12). CONCLUSIONS: We revealed that BRAF mutation is an absolute risk factor for patient survival in colorectal cancer and melanoma.

A social science data-fusion tool and the Data Management through e-Social Science (DAMES) infrastructure.

The last two decades have seen substantially increased potential for quantitative social science research. This has been made possible by the significant expansion of publicly available social science datasets, the development of new analytical methodologies, such as microsimulation, and increases in computing power. These rich resources do, however, bring with them substantial challenges associated with organizing and using data. These processes are often referred to as 'data management'. The Data Management through e-Social Science (DAMES) project is working to support activities of data management for social science research. This paper describes the DAMES infrastructure, focusing on the data-fusion process that is central to the project approach. It covers: the background and requirements for provision of resources by DAMES; the use of grid technologies to provide easy-to-use tools and user front-ends for several common social science data-management tasks such as data fusion; the approach taken to solve problems related to data resources and metadata relevant to social science applications; and the implementation of the architecture that has been designed to achieve this infrastructure.