Bruce Y. Lee

Neuroimaging in Traumatic Brain Imaging

SummaryTraumatic brain injury (TBI) is a common and potentially devastating clinical problem. Because prompt proper management of TBI sequelae can significantly alter the clinical course especially within 48 h of the injury, neuroimaging techniques have become an important part of the diagnostic work up of such patients. In the acute setting, these imaging studies can determine the presence and extent of injury and guide surgical planning and minimally invasive interventions. Neuroimaging also can be important in the chronic therapy of TBI, identifying chronic sequelae, determining prognosis, and guiding rehabilitation.

Systematic Review and Cost Analysis Comparing Use of Chlorhexidine with Use of Iodine for Preoperative Skin Antisepsis to Prevent Surgical Site Infection

OBJECTIVEnTo compare use of chlorhexidine with use of iodine for preoperative skin antisepsis with respect to effectiveness in preventing surgical site infections (SSIs) and cost.nnnMETHODSnWe searched the Agency for Healthcare Research and Quality website, the Cochrane Library, Medline, and EMBASE up to January 2010 for eligible studies. Included studies were systematic reviews, meta-analyses, or randomized controlled trials (RCTs) comparing preoperative skin antisepsis with chlorhexidine and with iodine and assessing for the outcomes of SSI or positive skin culture result after application. One reviewer extracted data and assessed individual study quality, quality of evidence for each outcome, and publication bias. Meta-analyses were performed using a fixed-effects model. Using results from the meta-analysis and cost data from the Hospital of the University of Pennsylvania, we developed a decision analytic cost-benefit model to compare the economic value, from the hospital perspective, of antisepsis with iodine versus antisepsis with 2 preparations of chlorhexidine (ie, 4% chlorhexidine bottle and single-use applicators of a 2% chlorhexidine gluconate [CHG] and 70% isopropyl alcohol [IPA] solution), and also performed sensitivity analyses.nnnRESULTSnNine RCTs with a total of 3,614 patients were included in the meta-analysis. Meta-analysis revealed that chlorhexidine antisepsis was associated with significantly fewer SSIs (adjusted risk ratio, 0.64 [95% confidence interval, [0.51-0.80]) and positive skin culture results (adjusted risk ratio, 0.44 [95% confidence interval, 0.35-0.56]) than was iodine antisepsis. In the cost-benefit model baseline scenario, switching from iodine to chlorhexidine resulted in a net cost savings of

Systematic Review and Cost–Benefit Analysis of Radial Artery Access for Coronary Angiography and Intervention

16-

FDG-PET findings in patients with suspected encephalitis.

26 per surgical case and

Cerebral Blood Flow Effects of Pain and Acupuncture: A Preliminary Single-Photon Emission Computed Tomography Imaging Study

349,904-

Quality of life after aortic valve replacement

568,594 per year for the Hospital of the University of Pennsylvania. Sensitivity analyses showed that net cost savings persisted under most circumstances.nnnCONCLUSIONSnPreoperative skin antisepsis with chlorhexidine is more effective than preoperative skin antisepsis with iodine for preventing SSI and results in cost savings.

Increased Tc-99m MDP Accumulation in Soft Tissue Caused by Bicycle Riding

Background— Radial artery access for coronary angiography and interventions has been promoted for reducing hemostasis time and vascular complications compared with femoral access, yet it can take longer to perform and is not always successful, leading to concerns about its cost. We report a cost–benefit analysis of radial catheterization based on results from a systematic review of published randomized controlled trials. Methods and Results— The systematic review added 5 additional randomized controlled trials to a prior review, for a total of 14 studies. Meta-analyses, following Cochrane procedures, suggested that radial catheterization significantly increased catheterization failure (OR, 4.92; 95% CI, 2.69–8.98), but reduced major complications (OR, 0.32; 95% CI, 0.24–0.42), major bleeding (OR, 0.39; 95% CI, 0.27–0.57), and hematoma (OR, 0.36; 95% CI, 0.27–0.48) compared with femoral catheterization. It added approximately 1.4 minutes to procedure time (95% CI, −0.22 to 2.97) and reduced hemostasis time by approximately 13 minutes (95% CI, −2.30 to −23.90). There were no differences in procedure success rates or major adverse cardiovascular events. A stochastic simulation model of per-case costs took into account procedure and hemostasis time, costs of repeating the catheterization at the alternate site if the first catheterization failed, and the inpatient hospital costs associated with complications from the procedure. Using base-case estimates based on our meta-analysis results, we found the radial approach cost

Electronic Alerts to Prevent Venous Thromboembolism

275 (95% CI, −

Acupuncture in Theory and Practice Part 2: Clinical Indications, Efficacy, and Safety

374 to −

Health care information provided by internet search engines.

183) less per patient from the hospital perspective. Radial catheterization was favored over femoral catheterization under all conditions tested. Conclusions— Radial catheterization was favored over femoral catheterization in our cost–benefit analysis.