The effect of waiting time on health and quality of life outcomes and costs of medication in hip replacement patients: a randomized clinical trial.

OBJECTIVE: To evaluate the effect of waiting time on health and quality of life outcomes and costs of medication in total hip replacement (THR) patients in a randomized clinical trial. METHODS: 395 THR patients were recruited into the study. When placed on the waiting list, patients were randomized into a short (< or =3 months) or a non-fixed waiting time (NFWT) (>3 months) group. In the final analyses 309 patients (179 women) with a mean age of 65 years were included. Health-related quality of life (HRQoL) (generic 15D), and pain and function (modified Harris Hip Score (HHS)) were calculated when placed on the waiting list, at hospital admission, and at 3 and 12 months postoperatively. The costs of disease-specific medication were calculated at the same measurement points. All analyses were performed using the intention-to-treat (ITT) principal. RESULTS: Of the recruited patients, 309 (78%) completed the follow-up (short group 140 and non-fixed group 169 patients). The mean waiting time was 74 days in the short and 194 days in the NFWT groups. In the ITT analyses there were no statistically significant differences between the groups in the weekly use and costs of medication, HRQoL or HHS at baseline, at admission, or 3 or 12 months after surgery. The only difference was in total medication costs during the waiting time period, at EUR 83 and 171, respectively. CONCLUSIONS: The length of the waiting time did not generate different effects on the studied health and quality of life outcomes of the randomized groups. However, those in short waiting time group reached earlier better HRQoL.

Costs of an outbreak of meticillin-resistant Staphylococcus aureus.

An outbreak of meticillin-resistant Staphylococcus aureus (MRSA) occurred in surgical and internal medicine units of a 1752-bed Finnish tertiary care hospital during 2003-2004. In order to analyse the costs of this 14-month outbreak, patients were categorized as follows: patients with MRSA infections; patients with MRSA colonization; patients exposed to MRSA but whose MRSA status remained inconclusive; and exposed patients who were negative for MRSA. We reviewed a sample of patients' charts to determine the types of clinical infections and interviewed staff about the practical implementation of control measures. The number of patients and patient-days involved in the outbreak were identified from the hospital's databases, with the administrative database supplying unit costs of work and materials. Loss of income due to closed beds was analysed. A total of 266 MRSA-positive patients (114 with infections and 152 colonized) and 797 patients exposed to MRSA were identified (11,744 contact isolation days). There were 1240 patients negative after screening (9880 contact isolation days). Total additional costs of MRSA were 386,062 euro (70% for screening and 25% for contact isolation). Costs due to meticillin resistance in treatment of MRSA infections were 16,000 euro. The income loss for this hospital due to closed beds was 1,183,808 euro. The high cost of MRSA screening underlines the importance of appropriate screening methods. Our model of analysing costs might be useful for other hospitals after adapting variables such as local control measures.

Somatic embryogenesis and regeneration of flowering plants in rose.

Somatic embryos of the cut rose cultivars 'Domingo' and 'Vickey Brown' were obtained from callus derived from leaf explants on half strength Murashige and Skoog medium with low concentrations of kinetin and 1-naphthyl acetic acid or 2-naphthyloxyacetic acid. Somatic embryos were first observed after 6 to 12 weeks of culture on callus formed at the basis or midrib of the leaf. Embryos could be grown to phenotypically true to type greenhouse plants.

Studies on growth and cardenolide production of Digitalis lanata tissue cultures.

Digitalis lanata cell cultures grown as small undifferentiated aggregates in suspension culture can be redifferentiated into green embryos that produce cardenolides. The possibility of using a statistical (Box-Wilson) experimental design to study the effects of four different variables on growth, differentiation, and cardenolide production of D. lanata tissue cultures are investigated. The results of the analyses were processed by linear regression analysis. Mathematical models explaining the effects of the variables were developed. The concentration of maltose and the NO(3) (-)--NH(4) (+) ratio were found to be significant variables for both growth and cardenolide production. The size of the inoculum was also important.