ABSTRACT
In the Saguenay-Lac-Saint-Jean region of Quebec, 83% of the populationâ¯≤20â¯years (nâ¯â â¯59,500) was immunized in 2014 with the four-component Serogroup B meningococcal vaccine to control a long-lasting outbreak caused by a virulent ST-269 Serogroup B Neisseria meningitidis clone. Following the campaign, invasive meningococcal B disease (B-IMD) incidence fell sharply in the target population from 11.4/100,000 in 2006-2014 to 0.4/100,000 in 2014-2018 (pâ¯<â¯0.0001). Five B-IMD cases occurred in the region from July 2014 to June 2018, including one vaccinated child, one unvaccinated young adult and 3 unvaccinated elderly adults. Estimate of direct vaccine protection was 79% [95%CI:-231%;99%]. The overall campaign impact in the region taking into account the decrease in B-IMD incidence at provincial level was a 86% [95%CI:-2%;98%] decrease in B-IMD risk. The campaign impact was mostly seen in the target age-group suggesting no herd effect among unvaccinated older adults.
Subject(s)
Immunization Programs , Meningitis, Meningococcal/prevention & control , Neisseria meningitidis, Serogroup B/immunology , Vaccination , Adult , Aged , Disease Outbreaks , Female , Humans , Male , Middle Aged , Outcome Assessment, Health Care , Quebec/epidemiology , Vaccination/methods , Young AdultABSTRACT
OBJECTIVE: Sugammadex reverses neuromuscular blockade by chemical encapsulation of nondepolarizing neuromuscular blocking drugs (rocuronium and vecuronium). The imprint of this new molecule has recently been supplemented with a section on haemostasis notifying a longer clotting time without documented clinical consequences. This has resulted in recommendations on the use of sugammadex in the presence of coagulation disorders (pharmacologically-induced or not). The objective of this study was to analyze the experience gathered with this molecule on clinically-evaluated bleeding. No study on this subject is currently available. METHODS: This is a retrospective study over 1 year between August 2009 and August 2010. All patients with laparotomies for cancer surgery requiring suction drains were included. Patients were allocated to groups according to the type of reversal (without sugammadex versus sugammadex 2 or 4 mg/kg). The endpoint was clinically-evaluated postoperative bleeding (reoperation for haemostasis, blood-stained laparotomy dressings in the post-anaesthesia care unit [PACU], cumulative volume collected in suction drains upon arrival in PACU and then after 2 hours and the next morning at 6a.m). RESULTS: One hundred and ninety-three patients were included in three groups, 78 in the group "without sugammadex", 95 in "sugammadex 2mg/kg" and 20 in "sugammadex 4 mg/kg". There were no reoperations for haemostasis. The comparison among different groups for the endpoint of bleeding showed no significant difference. CONCLUSION: In this retrospective study performed in patients at high risk of postoperative bleeding, sugammadex at doses of 2 and 4 mg/kg was not associated with increased bleeding. This study, the first in this field, suggests that future prospective investigations should target patients receiving 4 or 16 mg/kg of sugammadex and/or with documented preoperative abnormal coagulations tests.
Subject(s)
Postoperative Hemorrhage/chemically induced , gamma-Cyclodextrins/adverse effects , Adult , Aged , Androstanols/antagonists & inhibitors , Critical Care , Dose-Response Relationship, Drug , Drainage , Endpoint Determination , Female , Hemostasis , Humans , Laparotomy , Male , Middle Aged , Neoplasms/surgery , Neuromuscular Blockade , Neuromuscular Nondepolarizing Agents/antagonists & inhibitors , Postoperative Hemorrhage/diagnosis , Retrospective Studies , Rocuronium , Sugammadex , Vecuronium Bromide/adverse effects , gamma-Cyclodextrins/administration & dosage , gamma-Cyclodextrins/therapeutic useABSTRACT
OBJECTIVES: Despite the implementation of prospective payment approach in France, induced legal abortion are still paid by capitation. Our aim was to evaluate the real cost of induced abortion in a public hospital in France. MATERIALS AND METHODS: This study took place during the year 2008 in a public health hospital. Induced abortion cost was calculated according to national study cost's recommendations. The cost drawn from this was compared to what is paid by the medical insurance for spontaneous abortion. RESULTS: Induced abortion calculated cost was 562 , the capitation amount was 286.86 , the spontaneous abortion compensation amount was 645 . CONCLUSION: Induced abortion should be paid by a prospective payment evaluation similar to diagnosis related groups approaches rather than a capitation payment, in order to reduce misstatements.
