Volume 194 - Issue 11
In Other Journals
Author: Sophie McNamara
Med J Aust 2011; 194 (11): 611. || doi: 10.5694/j.1326-5377.2011.tb03119.x
Published online: 6 June 2011
Published online: 6 June 2011
Reducing costs of surgical vampires
As governments worldwide struggle to balance their health care budgets, a US study has found that a simple and almost free intervention can significantly reduce spending on routine blood tests. Researchers calculated the weekly costs of complete blood cell counts and chemistry panel tests for all non-intensive care unit patients at Rhode Island Hospital for 11 consecutive weeks. Each week an announcement was made to surgical staff and attending physicians of the total dollar value of these tests, as well as the charges per patient per day. The paper, called “Surgical vampires and rising health care expenditure”, reports that the baseline phlebotomy charges were $147.73 per patient per day. During the intervention, the costs dropped as low as $108.11 per patient per day, with almost $55,000 saved over 11 weeks. In an editorial on the research, Dr A Benedict Cosimi (Department of Surgery, Massachusetts General Hospital) writes that the study is “convincing evidence that cost consciousness can provide a potent weapon for reducing some of the wasteful medical spending”.
Arch Surg 2011; 146: 524-527
Antioxidants up in smoke
Doctors trying to encourage parents to quit smoking can point to new evidence which shows that second-hand smoke is bad news for children. Using data from a national health survey, American researchers analysed the serum cotinine levels of 2218 American children, aged 6–18 years, to determine their level of exposure to second-hand smoke. The children’s micronutrient levels, including vitamins C, E, A, B6, B12, betacarotene and folate, were also analysed. The study found that higher cotinine levels were strongly associated with lower levels of antioxidant micronutrients and folate, even after controlling for dietary intake and supplementation. Non-antioxidant micronutrients such as vitamins B6, B12 and D were not affected. Researchers commented that parents should be counselled on these specific risks from second-hand smoke exposure.
Nicotine Tob Res 9 May 2011 (Advance Access)
Sweet solution to chronic infections
Chronic and recurrent bacterial infections are often caused by bacterial persisters: bacteria that survive an antibiotic onslaught by going into metabolic hibernation. While the patient initially appears to be cured, the infection recurs when the persisters “wake up”. Now a team of American biological engineers have developed a sweet and simple solution to boost the efficacy of antibiotics by targeting these persisters. The team found that adding glucose, mannitol, fructose or pyruvate to gentamicin, an antibiotic, reduced Escherichia coli persister viability by three orders of magnitude. Treating Staphylococcus aureus with fructose plus gentamicin also rapidly killed persisters. The mechanism of action appears to be that the sugar acts as a stimulant, generating proton-motive force, to increase the uptake of the antibiotic. It’s just like Mary Poppins (almost) said: a spoonful of sugar makes the medicine work.
Nature 2011; 473: 216-220
Stenting v surgery: which is safer for women?
Women with carotid stenosis may face more risks from stenting than from surgery, according to a study of 2502 patients from 117 centres in the US and Canada. Women who underwent carotid artery stenting had twice the rates of adverse events (stroke, heart attack and death) than women who had carotid endarterectomy (6.8% vs 3.8%); however, for men, the two procedures posed similar risks. The main contributor to the high rate of adverse events for women after stenting was the prevalence of strokes. However, researchers in the Carotid Revacularization Endarterectomy versus Stenting Trial said that more data are needed to determine whether the differential risk should affect clinical management of carotid stenosis for women.
Lancet Neurology 9 May 2011 (Online)
Fewer mastectomies with aromatase inhibitors
A new US study has confirmed that using aromatase inhibitors pre-surgery can reduce the need for mastectomy for patients with stage 2 or 3 oestrogen-receptor (ER) positive breast cancer. Patients with these larger tumours sometimes undergo chemotherapy to reduce tumour size before surgery. Aromatase inhibitors are a low toxicity alternative that reduce the amount of oestrogen in the body, to stop or slow the growth of ER-positive tumours. The study found that of 159 post-menopausal women who were candidates for mastectomy at baseline, 81 were able to undergo breast-conserving surgery after 16 weeks’ treatment with aromatase inhibitors. The research compared three different aromatase inhibitors (exemestane, letrozole and anastrozole).
J Clin Oncol 9 May 2011 (online)