Findings of a hospital surveillance-based outcome evaluation study for Clostridium difficile-associated colitis.

We completed a prospective study of 164 patients involved in a Clostridium difficile surveillance programme, evaluating a range of variables such as disease severity, treatment regimen and known clinical risk factors, for their effect on case lethality. The aim of this study was to determine if there are any additional clinical variables worth considering for inclusion in the therapeutic decision-making process. Beyond common risk factors, secondary immunodeficiencies such as diabetes mellitus, malignancy, autoimmune disease, immunosuppressive therapy and chronic hepatitis were assessed. Overall case lethality was 23%. There was a suggestion that regular proton pump inhibitor use in past medical history might be associated with greater lethality. Immunosuppressive therapy within 1 month before the onset of diarrhoea was associated with a significant four-fold lethality increase. This last finding may have the potential to further improve therapeutic judgement if used as an explicit component of a revised scoring system. In relation to Clostridium difficile-associated colitis, immunosuppressive therapy as a red flag entity, as described here, has not been previously published.

[Experiences with the Introduction of Diagnosis Related Groups (DRG) in the Hungarian Ophthalmology]. / Erfahrungen der Umsetzung von Diagnosis Related Groups (DRG) in der ungarischen Augenheilkunde.

OBJECTIVE: The aim of our investigation is to analyse the effect of the introduction of the DRG (Diagnosis Related Groups) principle on the financing of ophthalmology care including the analysis of market share of ophthalmology. DATA AND METHODS: Data of the study derive from the financial database of the Hungarian National Health Insurance Fund Administration (OEP) containing the monthly activity reports of health care providers. The financing of acute hospital care in Hungary is based on a case-mix system called Homogeneous Disease Groups (Homogén Betegségcsoportok, HBCS). The analysis covers the period between 1995 and 2003. We used the following indicators in order to analyse the market share of ophthalmology: financial cases (patients), DRG costweights and nursing days (length of stay). RESULTS: From the DRG costweights - serving as a base value for financing - the market share of ophthalmology was 3.3 - 3.5 % in 1995 - 1996, but decreased to 2.6 - 2.7 % in 1997 - 1998, and after a gradual increase since 1999 it went up to 3.4 % in 2002 - 2003. The market share of ophthalmology from financial cases (patients) increased from 3.1 - 3.2 % in 1995 - 1996 to 3.8 - 3.9 % in 2002 - 2003. From the total number of nursing days ophthalmology had a market share of 2.4 - 2.6 % in 1995 - 1996, which showed a further decrease to 2.2 - 2.3 % in 2002 - 2003. The average length of stay in ophthalmology decreased from 8 days (1995) to 4 days (2003). CONCLUSION: The frequent changes of the Hungarian DRG system had a significant effect on the financing of Hungarian ophthalmology care. The continuous changes in the regulation of financing and reimbursement represent a big challenge for ophthalmology.

Excimer laser photorefractive keratectomy with different ablation zones.

In this study we would like to introduce the excimer laser, and to demonstrate our results and complications by using different ablation zones during photorefractive keratectomy (PRK) in the correction of myopia and astigmatismus. In 1996 we performed photorefractive keratectomy on 100 myopic eyes of 52 patients (28 females, 24 males). Mean age was 26.21 years (ranged from 19 to 54 years). The preoperative refraction ranged from -1.0 D to -18.0 Diopters. The diameter of the ablation zones were between 5 and 6.5 mm. We evaluated the results and the complications of the surgeries of 100 eyes which were performed with Schwind keratom F excimer laser. After 2 days, 1 week, 1 month, 3 months, and 6 months postoperatively we tested the best uncorrected and corrected visual acuities, and performed intraocular pressure measurement, slit lamp examination as well as corneal topography. The postoperative refractions were between +/- 0.5 to +/- 1.0 Diopters. After six months postoperatively the slit lamp examination showed that 80% of the patients had no corneal haze while 20% had stage I (Hanna) corneal haze. The smaller the diameter of the ablation zone was, the more pronounced the corneal haze and the night-glare were. The photorefractive excimer laser keratectomy is judged to be a safe method, although it might have some side-effects. The different ablation zones of this treatment means an important modification, that not only allows the method to meet the individual requirements, but reduces the chance of the complications as well. Based on the authors' experiences PRK for moderate myopia with large diameter ablation zones appears more predictable than than with smaller ablation zone diameters.

Changing concept and modern techniques in cataract surgery.

Until the middle of the 80-ies the routine method of cataract surgery was intracapsular extraction (ICCE). Approximately 10 years ago the so called extracapsular cataract extraction (ECCE) started to become more and more widely used. After extracapsular cataract extraction had come into general use, it became possible to implant the IOL behind the iris, into the left in place capsular bag of the original lens. We usually perform extracapsular cataract extraction with posterior chamber lens (PCL) implantation as a routine procedure. In the last few years phacoemulsification started to gain acceptance. During this operation one breaks the nucleus of the lens into pieces with the help of ultrasound, and this way it is possible to remove both the nucleus and the cortex of the lens through a small wound. The first step in learning phacoemulsification is to be able to create a perfectly round hole on the anterior capsule (capsulorhexis). Besides using various manual techniques we introduced diathermal capsulotomy for capsulorhexis. This latter procedure is becoming more and more popular as it is safe, easy to perform, and gives excellent result.

Different opening techniques in cataract surgery.

A retrospective study on the different opening techniques in cataract surgery at our Department in 1996 was carried out. In our everyday practice fornix based conjunctival flap and sclerocorneal oblique or vertical-oblique approach with a center at 12 o'clock was performed. In the case of hemorrhagic diathesis and secondary ACL implantation the corneal approach was preferred. After glaucomatous filtration surgery the incision was made temporally in some cases.