Cost–benefit analysis of surveillance for surgical site infection following caesarean section

Objective To estimate the economic burden to the health service of surgical site infection following caesarean section and to identify potential savings achievable through implementation of a surveillance programme. Design Economic model to evaluate the costs and benefits of surveillance from community and hospital healthcare providers’ perspective. Setting England. Participants Women undergoing caesarean section in National Health Service hospitals. Main outcome measure Costs attributable to treatment and management of surgical site infection following caesarean section. Results The costs (2010) for a hospital carrying out 800 caesarean sections a year based on infection risk of 9.6% were estimated at £18,914 (95% CI 11,521 to 29,499) with 28% accounted for by community care (£5,370). With inflation to 2019 prices, this equates to an estimated cost of £5.0m for all caesarean sections performed annually in England 2018-19, approximately £1,866 and £93 per infection managed in hospital and community respectively. The cost of surveillance for a hospital for one calendar quarter was estimated as £3,747 (2010 costs). Modelling a decrease in risk of infection of 30, 20 or 10% between successive surveillance periods indicated that a variable intermittent surveillance strategy achieved higher or similar net savings than continuous surveillance. Breakeven was reached sooner with the variable surveillance strategy than continuous surveillance when the baseline risk of infection was 10 or 15% and smaller loses with a baseline risk of 5%. Conclusion Surveillance of surgical site infections after caesarean section with feedback of data to surgical teams offers a potentially effective means to reduce infection risk, improve patient experience and save money for the health service. Strengths and limitations • The model estimated both community (28%) and hospital costs (72%), providing a more representative estimate of overall economic burden to the health service. • Time-matching of patients with and without infection according to length of post-operative stay provided a more accurate assessment of excess bed-days attributable to surgical site infection (2.6 days) than average excess length of stay (median difference 5 days) comparison by disentangling the impact of prolonged length of stay on increased chance of detecting an infection. • Through capture and assessment of the costs and impact of surveillance, our model demonstrated the potential for savings through reductions in incidence of surgical site infections. • Costs were obtained from NHS National Schedule Reference Costs and other sources rather than observed expenditure and assumptions made about the number of extra midwife and general practitioner appointments resulting from infection. • The study was based on healthcare utilisation and did not assess direct and indirect costs borne by the patients or their carers

The Baker's Yeast Diploid Genome Is Remarkably Stable in Vegetative Growth and Meiosis

Accurate estimates of mutation rates provide critical information to analyze genome evolution and organism fitness. We used whole-genome DNA sequencing, pulse-field gel electrophoresis, and comparative genome hybridization to determine mutation rates in diploid vegetative and meiotic mutation accumulation lines of Saccharomyces cerevisiae. The vegetative lines underwent only mitotic divisions while the meiotic lines underwent a meiotic cycle every ∼20 vegetative divisions. Similar base substitution rates were estimated for both lines. Given our experimental design, these measures indicated that the meiotic mutation rate is within the range of being equal to zero to being 55-fold higher than the vegetative rate. Mutations detected in vegetative lines were all heterozygous while those in meiotic lines were homozygous. A quantitative analysis of intra-tetrad mating events in the meiotic lines showed that inter-spore mating is primarily responsible for rapidly fixing mutations to homozygosity as well as for removing mutations. We did not observe 1–2 nt insertion/deletion (in-del) mutations in any of the sequenced lines and only one structural variant in a non-telomeric location was found. However, a large number of structural variations in subtelomeric sequences were seen in both vegetative and meiotic lines that did not affect viability. Our results indicate that the diploid yeast nuclear genome is remarkably stable during the vegetative and meiotic cell cycles and support the hypothesis that peripheral regions of chromosomes are more dynamic than gene-rich central sections where structural rearrangements could be deleterious. This work also provides an improved estimate for the mutational load carried by diploid organisms

Equation of the Sorption Isotherm on Zeolite Y Including Heterogeneity of the Sorbent: A Novel Modification

The complex character of water vapour sorption on zeolite Y has been demonstrated. It has been found that the assumptions of the Dubinin theory of volume filling of micropores (TVFM) are applicable to the description of such water vapour sorption. An equation for the adsorption isotherm is given which describes the experimental data in a satisfactory manner and which includes both the heterogeneity of the zeolite surface and the size distribution of the micropores participating in the sorption process. The equation yields realistic values of the total micropore volume which are close to the experimental sorption capacities. A significant effect of the sodium counterions on the sorption of water vapour has been found

Influences on vaginal birth after caesarean section: A qualitative study of Taiwanese women

BackgroundVaginal birth is a safe mode of birth for most women who have had a prior caesarean with a transverse incision. Despite the evidence, most Taiwanese women who have had a previous caesarean are rarely offered the opportunity to consider any possibility other than a repeat caesarean.AimThis study explored factors affecting Taiwanese women’s decisionmaking regarding vaginal birth after cesarean.MethodsAjzen’s Theory of Planned Behaviour provided the theoretical framework to underpin the study, which adopted an interpretive descriptive methodology. Sequential semi-structured interviews were conducted with 29 women who had a previous caesarean and were pregnant between 34 and 38 weeks gestation, ten women who attempted vaginal birth in the third to fifth day postpartum, and 25 women in the fourth week postpartum. Boyatzis’ method of thematic analysis was used to identify themes and codes.FindingsThis paper reports the findings of the prenatal interviews with 29 participants. The major factor influencing women’s decision-making was to avoid negative outcomes for themselves and their babies. Three thematic codes describe influences on the women’s decisions: ‘past experience of childbirth’, ‘anticipating the next experience of normal birth’ and ‘contemplation on the process of childbirth’.ConclusionsWomen who have had a previous caesarean section are prepared to have a vaginal birth but are not always supported to carry out this decision. Changing the models of antenatal care is recommended as a strategy to overcome this difficulty therefore empowering women to make a meaningful choice about VBAC after a CS