Should the management approach to the anterior abdominal stab wound be different in patients with self-inflicted abdominal injury?

BACKGROUND: Self-inflicted injury is a leading cause of death worldwide. It is hypothesized that due to instincts for self-preservation, the severity of abdominal injury would be decreased following suicidal self-stabbing in comparison to stab wounds from assault, and therefore a more conservative management might be considered. METHODS: All patients with isolated abdominal stab wound (SW) admitted to 19 Trauma Centers in Israel between the years 1997 and 2018 were included in the study. Patients with self-inflicted abdominal SW (Group I) were compared to victims with abdominal SW following assault (Group II). RESULTS: Group I included 9.4% (314/3324) of patients eligible for this study. Compared to Group II, Group I patients were older (median: 39 years, IQR 28,52 vs. 24 years, IQR 19,33; p<0.001), had more females (28.7% vs 4.9%, p <0.001), had longer length of hospitalization (median: 3 days vs. 2 days; p<0.001), underwent surgery more frequently (55.4% vs. 37.4%; p<0.001), and had higher mortality (2.9% vs. 0.7%; p=0.003). Possible covariates for mortality were examined and following logistic regression, self-inflicted injury remained associated with higher death rates compared to assault (OR 4.027, CI95% 1.380, 11.749; p=0.011). CONCLUSION: In this study, patients with isolated self-inflicted abdominal injuries had higher mortality and more frequently underwent abdominal surgery.

Health system reform in the Czech Republic. Policy lessons from the initial experience of the general health insurance company.

The Czech Republic is among the most aggressive of the former Warsaw Pact countries in encouraging competition and free-market reform. This aggressiveness was extended into the health care sector when, in 1992, a mandatory employment-based health insurance system was introduced. The move from a controlled socialist structure to an insurance-based, fee-for-service model occurred in a short time. Health care spending increased 50% in 2 years and now approaches that of many industrialized nations. Claims for reimbursements are increasing at a rate of 5% to 7% per quarter. Market incentives have changed behaviors within the medical community. Newly privatized physicians generate greater volume and consume more resources than those continuing as state employees. Policy issues requiring further evaluation include supply, distribution, and relative valuation of physician services; clinical resource allocation; and cost containment.

Antagonistic effect of some starter cultures on enterobacteriaceae (E. coli).

The ability of Lactobacillus jensenii and Streptococcus 17SB to inbhibit Escherichia coli was demonstrated. The practical application of the inhibition was examined. Possible roles for several factors in the mechanism of inhibition by Lactobacillus jensenii and Streptococcus 17SB are briefly discussed. The effects of pH reached and acids produced by starters on the growth of Escherichia coli are described.