Wound infection in open versus laparoscopic appendectomy. A meta-analysis.

The authors performed a meta-analysis to determine whether open or laparoscopic appendectomy would reduce wound infection incidence in adult patients with acute appendicitis. The meta-analysis included nine of seven patients from eight randomized controlled trials. Data were analyzed using the fixed effect-model method of Mantel-Haenszel. Wound infection incidence was lower in the laparoscopic group.

[Motivations of requests for human immunodeficiency virus (HIV) infection screening at the Centers of Information and Anonymous and Free-of-Charge Screening. Study of 891 cases]. / Motivations des demandes de dépistage de l'infection par le virus de l'immunodéficience humaine (VIH) dans les Centres d'Information et de Dépistage Anonyme et Gratuit (CIDAG). Etude de 891 cas.

In France, human immunodeficiency virus (HIV) testing is usually performed in centers for information and anonymous cost-free detection (Centres d'Information et de Dépistage Anonyme et Gratuit, CIDAG). In this work, we studied the reasons people ask for HIV testing at the CIDAG in Lyons. Eight hundred and ninety one people were asked to give their reasons. The response ratio was 85% and the sex-ratio 1:1. Seventy-five percent of the people were single. The main motivation was the desire to begin a relationship with another person without using condoms. Nonetheless, we were impressed by the high level of high-risk behaviors. To our knowledge, this is the first study about motivations of outpatients at the CIDAG.

[National study of screening practices for hepatitis C among hemodialysis patients. Hepatitis Group]. / Etude nationale des pratiques de dépistage de l'hépatite C chez les patients hémodialysés. Hepatitis Group.

French and American consensus conferences on hepatitis C confirmed the burden of that disease, especially in high risk populations. In France, the seroprevalence of HCV is about 20% among haemodialysed patients. This study aimed at describing the French screening practices in haemodialysed patients. In 1995, 1213 self-administered questionnaires were sent to nephrologists working in 715 dialysis units. The response rate was 48% (585/1213) and 485 questionnaires were analysed. In 98% of questionnaires nephrologists answered that they prescribed screening test. Routine screening with alanine amino-transferase (ALT) was reported in 98% of questionnaires, usually once a month (57%) or four times a year (23%). Routine anti-HCV serology was reported by 96%, usually once (28%) or twice (46%) a year. The two main annual strategies combining ALT and anti-HCV serology were 12 ALT and 2 serologies (21%), or 12 ALT and 1 serology (14%) per year. HCV RNA detection was reported mainly in the case of positive anti-HCV serology (70%). The study suggested heterogeneity in screening practices and revealed the need to determine the cost-effectiveness ratios of the various strategies.

Comparative assessment of digital and analog radiography: diagnostic accuracy, cost analysis and quality of care.

OBJECTIVE: The aim of this study was to compare digital and conventional radiography for diagnostic accuracy, direct costs, and quality of care. MATERIALS AND METHODS: Diagnostic accuracy was assessed by a critical review of the literature on sensitivity, specificity and ROC analysis of these imaging techniques and by a survey with a panel of radiologists. Direct costs and quality of care were evaluated with a before/after study of the implementation of digital radiography in a Department of Radiology in 'Hospices Civils de Lyon' (France). We included 292 patients and measured duration of examinations and direct costs of equipment, films, maintenance and depreciation. To evaluate any changes in working conditions and patient management, a questionnaire was filled out by the staff of the department. RESULTS: Diagnostic accuracy with digital radiography was equivalent to that of conventional radiography but there were wide variations depending on the type of examination. In 1993, although digital radiography resulted in savings of FF 18,000 including tax (US$ 3600) on film consumption for 1 year of examinations, there was a global additional cost of FF 253,000 (US$ 50,600) for maintenance and depreciation. Results showed a nonsignificant tendency to reduced procedure times for all examinations. Working conditions improved, including greater availability for the patient, improved safety, and increased job interest. CONCLUSION: Digital radiography can be introduced into a large hospital to improve patient and staff conditions, at a higher cost than analog radiography, and depending on the type of examinations performed by the radiology department.

[Quality assessment of the medical information on the standardized discharge summary]. / Evaluation de la qualité de l'information médicale des Résumés de Sortie Standardisés.

BACKGROUND: DRG-based management of public hospitals in France involves the use of standardised discharge abstracts for the "Medicalisation of Information Systems Program". METHODS: To assess the quality of the medical information in these abstracts, a sample of 649 abstracts for 1994 was collected from the Hospices Civils de Lyon's data base. To validate the information in these abstracts, we reviewed the medical records of each patient. RESULTS: The results showed an error rate of 32% (CI: 28-36) for the diagnosis-related group and an error rate of 40% (CI: 36-44) for the principal diagnosis. There was no significant difference between these error rates and the calculation of "Indices Synthétiques d'Activité" (French system for attributing points to hospital stays according to DRGs categories). CONCLUSIONS: The quality of the medical information for the "Medicalisation of Information Systems Program" remains a major challenge not only for budget allocation, but also for the study of the case-mix in hospitals.

Perioperative artificial nutrition in elective surgery: an impact study of French guidelines.

OBJECTIVE: In France, the consensus conference, held on 16 December 1994, produced guidelines on perioperative artificial nutrition (AN) use in patients undergoing elective surgery. The aim of this study was to assess the impact of these guidelines on practice patterns. METHODS: The study was a practice pattern study with a 'before-after' design and a control group in England. A retrospective cross-sectional sample of adult patients undergoing elective resection of the digestive tract was collected in France and England before and after the consensus conference. RESULTS: Malnourished patients received postoperative AN in 94% of 'before' cases and 82% 'after' but inadequate preoperative AN (40% 'before' and 26% 'after'). Postoperative AN appeared to be over-prescribed in non-malnourished patients without prolonged postoperative fasting (70% 'before' and 65% 'after'). In the English sample there was no significant variation in AN use between 'before' and 'after' periods. CONCLUSION: This study shows that clinical guidelines disseminated by consensus conference had a low impact on practice patterns in France and thus confirms the need to enforce the dissemination of the guidelines.

Cost-effectiveness of screening blood donors for hepatitis C and non-A, non-B, non-C hepatitis. The EATHIS Eco Research Group. European Acute Transfusion Hepatitis Interferon Study.

The current approach to screening for hepatitis C and non-A, non-B, non-C hepatitis in French blood transfusion centers involves a combination of a transaminase assay and tests for antibodies to hepatitis B core antigen (anti-HBc) and antibodies to hepatitis C virus (anti-HCV). A decision-analysis model was used to assess the cost-effectiveness ratio of this approach compared to the former approach, which included only transaminase and anti-HBc screening. Cost data were collected by a questionnaire sent to 26 centers throughout France. The average costs of diagnostic kits, equipment, staff, and administration were calculated. Estimates of prevalence and sensitivity values came from the medical literature. The cost-effectiveness ratio was expressed in French francs per infected donor detected. A sensitivity analysis of the variables in the model was performed to estimate the validity of the cost-effectiveness ratio. For 100,000 donations the incremental cost of the current approach reached FrF 2,566,111 (about US $500,000), with a marginal effectiveness of 180 donations detected. The sensitivity analysis showed the effect of prevalence on the incremental cost-effectiveness ratio. Transfusion centers may change their screening approach in areas of high or low prevalence of hepatitis C in France.

[Medical and economic evaluation of donated blood screening for hepatitis C and non-A, non-B, non-C hepatitis]. / Evaluation médico-économique du dépistage des hépatites C et non-A non-B non-C sur les dons de sang.

The aim of this study was to evaluate the cost of hepatitis C and non-A non-B non-C screening strategy in donated blood, currently used in French transfusion centres and to assess the effect in the blood transfusion centres according to the prevalence of the disease and the intrinsec values of tests. This screening strategy was based on alanine aminotransferase assay, and HBc and HCV antibodies detection. In 1993, a survey was conducted in 26 French transfusion centers to estimate the costs of the screening strategy currently used. Average expenditure on diagnostic sets, equipment, staff and administration charges for hepatitis C and non-A non-B non-C screening were calculated. From these results, we estimated the cost of the previous strategy which did not involve HCV antibody testing, so as to determine the incremental cost between the two strategies. We used clinical decision analysis and sensitivity analysis to estimate the incremental cost-effectiveness ratio with data gathered from the literature and examine the impact on blood transfusion centre. Implemented for 100,000 volunteer blood donations, the incremental cost of the new strategy was FF 2,566,111 (1992) and the marginal effectiveness was 180 additional infected donations detected. The sensitivity analysis showed the major influence of infection prevalence in donated blood on the incremental cost-effectiveness ratio: the lower the prevalence, the higher the cost-effectiveness ratio per contaminated blood product avoided.

[Perioperative artificial nutrition in elective surgery. A descriptive study of practice patterns in France]. / Nutrition artificielle périopératoire en chirurgie réglée. Etude descriptive des pratiques en France.

OBJECTIVE: To analyse the practice patterns of perioperative artificial nutrition in France before the Consensus Conference held on 16 december 1994 and to compare them with the recommendations produced by this Conference. STUDY DESIGN: Retrospective cross-sectional practice patterns study. PATIENTS: Sample of patients collected from general or digestive tract surgeons, including for each one the last two patients having had before 10 December 1994 either elective upper (oesophagectomy, duodenopancreatectomy) or elective lower (colectomy) abdominal surgery. The response rate to the 2, 150 circulated questionnaires was 14% (309), producing a sample of 601 patients (49% with upper abdominal surgery, 51% with lower abdominal surgery). RESULTS: The geographical distribution of surgeons who replied and their type of activity (private or public) was similar to the national pattern, however with some underrepresentation of the larger Paris area. The duration of pre- or postoperative artificial nutrition was bellow seven days in 36% of the cases, and above this delay in 64% of the cases. Artificial feeding rates for upper abdominal surgery, were 9 and 75%, respectively (duration of artificial feeding of 7 days and more being only considered). For lower abdominal surgery, these rates were 5 and 41%, respectively. Enteral nutrition was given in 13% of preoperative cases and 19% of postoperative ones; the others received parenteral nutrition. When compared to the recommendations by the Consensus Conference, these results show an insufficient use of preoperative artificial nutrition in patients with malnutrition (only 22% of them received it) and an excessive use in postoperative patients, particularly after lower abdominal surgery. Furthermore, the caloric intake was in accordance with the recommendations in only 20% of the cases. It was too high in 38% of the cases and insufficient in 47% of them. Similarly, the postoperative nitrogen intake complied with the recommended figures in only 5% of the cases. CONCLUSION: This study highlights large discrepancies between the recommendations by the Consensus Conference and current practice patterns. It questions the efficiency of this therapy as it is implemented today and generates high and unwarranted expenses.