Cooperative medical insurance and the cost of care in Shandong, PR China: perspectives of patients and community members

Published online before print August 10, 2010This research was conducted to identify the cost of care associated with utilization of village clinics and membership of the New Cooperative Medical Scheme (NCMS) in 2 counties of Shandong province, PR China. A total of 397 community members and 297 patients who used the village clinics were interviewed. The average cost for primary care treatment of 1 episode of illness was about 55 yuan (about US$8). Although more than 50% of people had NCMS membership, many consider the monetary reimbursements as insufficient. The low insurance reimbursement rates and inability to pay out-of-pocket expenses compromise access to care. Delays can cause more serious illnesses with potential to overburden the secondary care at the township and county hospitals. Those rural people who have not yet enjoyed the benefits of China's economic development may not benefit from recent health care reform and finance mechanisms unless schemes such as the NCMS provide more substantial subsidies.Mohammad Afzal Mahmood, Alexandra Raulli, Wang Yan, Han Dong, Zhang Aiguo, and Dong Pin

Financial aspects of sentinel lymph node biopsy in early breast cancer

Aim. At present, early breast cancer is treated with conservative surgery of the primary lesion (BCS) along with axillary staging by sentinel lymph node biopsy (SLNB). Although the scintigraphic method is standardized, its surgical application is different for patient compliance, work organization, costs, and diagnosis related group (DRG) reimbursements. Methods. We compared four surgical protocols presently used in our region: (A) traditional BCS with axillary lymph node dissection (ALND); (B) BCS with SLNB and concomitant ALND for positive sentinel nodes (SN); (C) BCS and SLNB under local anaesthesia with subsequent ALND under general anaesthesia according to the SN result; (D) SLNB under local anaesthesia with subsequent BCS under local anaesthesia for negative SN, or ALND under general anaesthesia for positive SN. For each protocol, patient compliance, use of consumables, resources and time spent by various dedicated professionals, were analyzed. Furthermore, a detailed breakdown of 1-/2-day hospitalization costs was calculated using specific DRGs. Results. We reported a mean costs variation that ranged from 1,634 to 2,221 Euros (protocols C and D). The number of procedures performed and the pathologists' results are the most significant variables affecting the rate of DRG reimbursements, that were the highest for protocol D and the lowest for protocol B. Conclusions. In our experience protocol C is the most suitable in terms of patient compliance, impact of surgical procedures, and work organization, and is granted by an appropriate DRG. We observed that a multidisciplinary approach enhances overall patient care and that a revaluation of DRG reimbursements is opportune

Pre-incision antibiotic prophylaxis reduces the incidence of post-caesarean surgical site infection

A two-part prospective study was conducted to assess rates of surgical site infection (SSI) following caesarean section in a large Australian regional hospital before and after a change of timing of antibiotic prophylaxis from after cord clamping to pre-incision. SSI rates dropped from 10.8% in 2010 to 2.8% in 2011 with no adverse neonatal consequences, providing further evidence that antibiotic prophylaxis should be given pre-incision for caesarean section in hospitals in Australia and New Zealand, as is now accepted practice elsewhere

Pre-incision antibiotic prophylaxis reduces the incidence of post-caesarean surgical site infection

A two-part prospective study was conducted to assess rates of surgical site infection (SSI) following caesarean section in a large Australian regional hospital before and after a change of timing of antibiotic prophylaxis from after cord clamping to pre-incision. SSI rates dropped from 10.8% in 2010 to 2.8% in 2011 with no adverse neonatal consequences, providing further evidence that antibiotic prophylaxis should be given pre-incision for caesarean section in hospitals in Australia and New Zealand, as is now accepted practice\ud elsewhere

The prognostic impact of histology in esophageal and esophago-gastric junction adenocarcinoma

Stage significantly affects survival of esophageal and esophago-gastric junction adenocarcinomas (EA/EGJAs), however, limited evidence for the prognostic role of histologic subtypes is available. The aim of the study was to describe a morphologic approach to EA/EGJAs and assess its discriminating prognostic power. Histologic slides from 299 neoadjuvant treatment-na\uefve EA/EGJAs, resected in five European Centers, were retrospectively reviewed. Morphologic features were re-assessed and correlated with survival. In glandular adenocarcinomas (240/299 cases\u201480%), WHO grade and tumors with a poorly differentiated component 656% were the most discriminant factors for survival (both p < 0.0001), distinguishing glandular well-differentiated from poorly differentiated adenocarcinomas. Two prognostically different histologic groups were identified: the lower risk group, comprising glandular well-differentiated (34.4%) and rare variants, such as mucinous muconodular carcinoma (2.7%) and diffuse desmoplastic carcinoma (1.7%), versus the higher risk group, comprising the glandular poorly differentiated subtype (45.8%), including invasive mucinous carcinoma (5.7%), diffuse anaplastic carcinoma (3%), mixed carcinoma (6.7%) (CSS p < 0.0001, DFS p = 0.001). Stage (p < 0.0001), histologic groups (p = 0.001), age >72 years (p = 0.008), and vascular invasion (p = 0.015) were prognostically significant in the multivariate analysis. The combined evaluation of stage/histologic group identified 5-year cancer-specific survival ranging from 87.6% (stage II, lower risk) to 14% (stage IVA, higher risk). Detailed characterization of histologic subtypes contributes to EA/EGJA prognostic prediction