Universal pre-storage leukoreduction--A defensible use of hospital resources: the Yale-New Haven Hospital experience.

In conclusion, as of 2004, it appears that in the United States in some hospitals, the use of LR blood products will probably remain as SLR rather than PSULR, due primarily to economic pressures. While some blood centres are slowly converting to ULR, there remains a mix of negative and positive feelings among physicians that make adoption of a national PSULR Standard of Care difficult. What is clear is that leukoreduction filters will cost more than the 170 um screen ("clot") filter. The use of PSULR to decrease the incidence of FNHTR, to decrease the incidence of HLA alloimmunization, and its use in lieu of CMV-seronegative blood products is well supported in the medical literature. However, this issue will probably continue to be revisited and debated for some time before a national standard policy for PSULR is adopted. Finally, we believe that despite increasing economic pressures and worsening budgetary constraints, the decision to adopt PSULR should rest primarily on medical reasons: as a means of improving patient care. In the view of the authors, pre-storage universal leukoreduction qualifies as a significant and medically justifiable improvement in the care of all hospital patients.

Reengineering a database for clinical trials management: lessons for system architects.

This paper describes the process of enhancing Trial/DB, a database system for clinical studies management. The system's enhancements have been driven by the need to maximize the effectiveness of developer personnel in supporting numerous and diverse users, of study designers in setting up new studies, and of administrators in managing ongoing studies. Trial/DB was originally designed to work over a local area network within a single institution, and basic architectural changes were necessary to make it work over the Internet efficiently as well as securely. Further, as its use spread to diverse communities of users, changes were made to let the processes of study design and project management adapt to the working styles of the principal investigators and administrators for each study. The lessons learned in the process should prove instructive for system architects as well as managers of electronic patient record systems.

Surgical clips: a cause of late recurrent gallstones.

The formation of gallstones around surgical clips after cholecystectomy is a rare complication, with only seven reported cases in the English literature since its initial description in 1979. Three other cases report clip migration into the common bile duct and obstruction. We report a recent experience with "clip cholelithiasis." A 78-year-old female, 16 years following cholecystectomy, presented with a several-month history of colicky abdominal pain worsened by meals, and a 1 week history of jaundice, anorexia, nausea, and vomiting. An abdominal ultrasound demonstrated dilatation of the biliary tree without visible choledocholithiasis. Endoscopic retrograde cholangiopancreatography demonstrated a 1.5-cm radiolucent stone in the common bile duct containing a central surgical clip. She was successfully treated with endoscopic sphincterotomy and stone retrieval. The first report of clip cholelithiasis occurred in 1979. Six additional cases have been reported as well as three cases of clip migration without stone formation into the common bile duct. The incidence of clip cholelithiasis may increase in frequency with the increased use of metallic clips during laparoscopic cholecystectomy. The occurrence of cholelithiasis around inert metals is rare and may be prevented using absorbable clips; however, stone formation is also reported around absorbable materials.