RESUMEN
INTRODUCTION: The analysis of cost effectiveness in hospitals is as difficult as treating the patients properly. We are yet not able to answer the simple question of what costs are caused by a certain diagnosis and its treatment during an average hospital stay. METHODS: To answer some issues of the global problem of cost effectiveness during hospitalisation, we analysed the costs and the cost structure of a normal obstetrical hospital stay during an uncomplicated vaginal delivery and a planned caesarean section. Cost data was collected and summarized from the patients file, the hospital's computer system gathering all cost centres, known material expenses and expenses of non obstetrical medical services. RESULTS: For vaginal deliveries/planned caesareans we can calculate with a surplus of about 83Euro/1432Euro. About 45% of the summarized costs are calculated on a reliable database. DISCUSSION: The introduction of the DRG based clearing system in Germany has aggravated the discussion on cost effectiveness. Our meticulous work-up of expenses excluded personal precautionary costs and personnel costs of documentation because no tools are described to depict such costs. If we would add these costs to the known expenses of our study, we strongly suspect that hospital treatment of vaginal deliveries or planned caesarean sections is not cost effective.
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Cesárea/economía , Parto Obstétrico/economía , Hospitalización/economía , Adolescente , Adulto , Análisis Costo-Beneficio , Costos y Análisis de Costo , Grupos Diagnósticos Relacionados , Femenino , Humanos , Cuerpo Médico de Hospitales/economía , Embarazo , Adulto JovenRESUMEN
AIM: The aim of this study was the evaluation of four ultrasound modalities (transabdominal, perineal, transvaginal and transrectal) to examine placenta praevia or low lying placenta. METHOD: We prospectively investigated 24 patients after 25 weeks of their pregnancy with suspected placenta praevia or low lying placenta. We analysed picture quality and compared the results of all four scanning modalities with the actual diagnosis made at delivery. RESULTS: The abdominal and perineal approach provided significantly poorer scanning quality (good or moderate in 79/38 %) as compared to the transvaginal and transrectal approach (good or moderate in 83/97 %). We can state similar results concerning accuracy of the diagnosis (abdominal/perineal 42/21 %, transvaginal/transrectal 67/86 %). DISCUSSION: Our study supports the diagnostic superiority of transvaginal ultrasound in the diagnosis of placenta praevia in comparison to the abdominal/perineal view. We also show that transrectal scanning is at least equivalent in quality and safety without the imminent risks of transvaginal manipulation and infection. CONCLUSION: The evaluation of the transrectal approach proved equivalent to the standard transvaginal approach in depiction quality and diagnostic safety. Thus, with less potential trauma to the pregnancy, it is a reasonable alternative.
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Placenta Previa/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Femenino , Humanos , Placenta Previa/diagnóstico , Embarazo , Segundo Trimestre del Embarazo , Reproducibilidad de los Resultados , Ultrasonografía Prenatal/normasRESUMEN
OBJECTIVE: To evaluate an ultrasound training system designed to standardize teaching and learning of gynecological sonography using a virtual model. METHODS: The 'virtual patient' was based on a three-dimensional freehand ultrasound system that allows two-dimensional sonographic offline investigations of previously recorded cases, imitating a real gynecological scan. In the first test phase designed to check the congruence of real and virtual scans, 25 doctors experienced in ultrasound examined three virtual cases. During the second test phase we assessed whether training with the virtual patient helped to establish a satisfactory practical knowledge of gynecological ultrasound. This phase was carried out with 24 medical students without ultrasound experience. RESULTS: All 25 doctors successfully investigated the three cases and generated an accurate diagnosis for the first and second cases. In the third case 14 doctors made the correct diagnosis (uterus bicornis). The measurements of endometrial thickness and the diameter of a fibroid yielded acceptable results compared with the original investigation. After a short standardized video-based instruction, all 24 medical students were able to perform a basic transvaginal scan and to inspect the uterus, ovaries and the urinary bladder. Measurements of endometrial thickness by all students deviated minimally from the actual measurement. CONCLUSIONS: Training with the virtual patient appears to be comparable to performing a live gynecological ultrasound investigation and allows standardized ultrasound teaching and learning.
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Simulación por Computador , Educación de Postgrado en Medicina/métodos , Ginecología/educación , Ultrasonido , Humanos , Enseñanza/métodos , Materiales de EnseñanzaRESUMEN
In this article, we describe a large five-generation family with characteristics of the Saethre-Chotzen syndrome as well as of the blepharophimosis ptosis epicanthus inversus syndrome. Segregating with their phenotype is a deletion of the chromosome 7p21 TWIST gene locus. The TWIST gene indeed is involved in Saethre-Chotzen syndrome, a craniosynostosis syndrome further characterized by specific facial and limb abnormalities. However, only two members of our family exhibited craniosynostosis. This report demonstrates that the genetics of craniofacial anomalies are less straightforward than they sometimes appear to be. Not only craniosynostosis, but also subtle facial deformities could be indicative of an abnormality of the TWIST gene. In conclusion, the clinical spectrum of genetic abnormalities of the TWIST gene is highly variable. We therefore recommend that genetic analysis of the TWIST gene locus, including fluorescence in situ hybridization, should be considered in familial cases of facial and eyelid abnormalities without the presence of craniosynostosis.
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Acrocefalosindactilia/genética , Eliminación de Gen , Proteínas Nucleares/genética , Factores de Transcripción/genética , Acrocefalosindactilia/patología , Oído/anomalías , Anomalías del Ojo/genética , Composición Familiar , Humanos , Cariotipificación , Linaje , Proteína 1 Relacionada con TwistRESUMEN
AIM: The current standard treatment of breast abscesses is surgical incision and drainage. This method, however, frequently yields poor cosmetic results. Sonographically guided percutaneous aspiration of breast abscesses and local antibiotic treatment need to be considered as an interesting alternative. The present study aimed to compare these treatment alternatives. METHOD: The patient population analysed comprised 24 patients with 28 breast abscesses who presented to the Department of Obstetrics and Gynaecology of Munich University Hospital Grosshadern between 12/1997 and 9/2002. 25 % of these patients (6/24) suffered from a puerperal and 75 % (18/24) from a non-puerperal breast abscess. The study group of surgically treated patients comprised 15 women (16 abscesses). Ten patients (10 abscesses) were treated with the novel, minimally invasive method. The treatment success was statistically analysed using chi (2)- and t-Tests (p < 0,05). RESULTS: The minimally invasive approach did not extend the length of intravenous antibiotic treatment or hospital stay and did not lead to an increase in the need for analgesic drugs. We encountered recurrent abscesses in 31 % (5/16) of the surgical treatment group, yet none in the group undergoing minimally invasive treatment. The aesthetic-cosmetic as well as the functional result in lactating patients was satisfactory in all cases. CONCLUSION: Sonographically guided percutaneous aspiration of breast abscesses represents a less invasive and very promising alternative to surgical incision, showing the following advantages: no general anaesthesia required, a superior cosmetic result and shorter hospitalisation. The method was highly accepted by all patients treated.
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Absceso/diagnóstico por imagen , Enfermedades de la Mama/diagnóstico por imagen , Enfermedades de la Mama/patología , Absceso/patología , Absceso/cirugía , Adulto , Biopsia con Aguja , Enfermedades de la Mama/cirugía , Femenino , Humanos , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Trastornos Puerperales/diagnóstico por imagen , Trastornos Puerperales/patología , Trastornos Puerperales/cirugía , UltrasonografíaRESUMEN
The transport of dynamic ultrasound (US) pictures as video files or streams no longer presents a problem. Despite teleconferencing, this method of transfer provides no active influence on the data sent for the receiving expert. We are evaluating a software-based 3-D US system that provides the new opportunity of an active US re-evaluation of a virtual patient. The 3-D volumes can be reanalyzed, time- and examiner-independent, wherever the device is installed. To test the clinical feasibility of this virtual US investigation, we installed the device in a peripheral hospital and in our US unit. The transfer of the volume (about 10 to 15 MB) could be done with two parallel Integrated Services Digital Network (ISDN) lines with a conduction capacity of 128 KB/s. In this basic assessment, the transmission of US volumes of patients proved to be easy in the acquisition, quick in off-line transmission and reliable in off-line re-evaluation of the data.