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1.  Reinforced Circular Stapler in Bariatric Surgery 
In this study, the application of reinforced circular staplers reduced the incidence of gastrojejunal anastomotic complications in patients undergoing Roux-en-Y gastric bypass.
Roux-en-Y gastric bypass (RYGBP) is the most common procedure for weight loss surgery but has multiple complications. This study evaluates the use of reinforced circular staplers (RCS) and their effects on reducing gastrojejunal anastomotic complications.
We conducted a retrospective chart review from January 2007 to November 2008. Laparoscopic RYGBP were performed in 287 patients. A comparison was made of the complications with and without the use of reinforced circular staplers. The comparison was between a nonreinforced circular stapler (NRCS) group comprising 182 patients and an RCS group comprising 105 patients.
Complications at gastrojejunal anastomosis were experienced by 15.3% of the patients; 9.5% were in the RCS group and 18.7% were in the NRCS group (P=0.026). Neither group had anastomotic leaks. Bleeding rate was 4.8% in the RCS group vs. 6.6% in the NRCS group. Ulcers occurred in 2.9% of the RCS group vs. 6.0% of the NRCS group. Stricture rate was 1.9% in the RCS group vs. 6.6% in the NRCS group.
The application of RCS reduced the incidence of gastrojejunal anastomotic complications. Patients are twice as likely to develop complications when no RCS device is used (95% CI 1.03, 4.623). Therefore, it is beneficial to utilize RCS for the gastrojejunal anastomosis in RYGBP procedures.
PMCID: PMC3041031  PMID: 21333188
Bovine pericardium; Gastrojejunostomy; Complications
2.  Cost-Sharing Reform: Searching For Equity 
Biotechnology healthcare  2009;6(5):29-32.
Healthcare reform efforts include a push to limit copayments. The potential consequen ces suggest there may be better ways to remove access barriers and improve care delivery.
The healthcare reform debate has included discussion of some cost relief for patients by subsidizing their out-of-pocket costs. But employers and payers are looking at other options, such as linking the value of a healthcare intervention to its copayment, to try to improve health-care delivery and make its cost more equitable for all.
PMCID: PMC2816156  PMID: 22478797
Biotechnology healthcare  2008;5(4):16-26.
First it was pensions, now retiree benefits — and in some cases, health benefits for existing employees and their dependents. The common thread: Employers transfering these liabilities to someone else. What is the effect on access to, and cost of, biologics?
Faced with staggering healthcare costs, some large companies have transferred those liabilities to a voluntary employee beneficiary association. Eager to control employee and retiree benefits, unions gladly have taken on the challenge of running a VEBA. But success in this field is hard won, and to earn it, some unions may be forced to take a harder line with health care professionals and manufacturers than employers did.
PMCID: PMC2702188  PMID: 22478737
4.  5 Things Employers Want To Know About Biologics 
Biotechnology healthcare  2007;4(5):23-28.
Purchasers struggle to keep track of the changing biotech landscape. Observers offer 5 key considerations about the value of biologics in terms employers can understand.
Can a determination of the value of biologics really be boiled down to a handful of issues? According to our sample of purchasers, the number of issues that really counts in the realm of biologics is just 5.
PMCID: PMC2651714  PMID: 22478673
5.  The Impact of CED On Private Payers 
Biotechnology healthcare  2007;4(2):24-30.
A middle ground between unlimited coverage and no coverage at all, CED wasn’t developed with bio logic therapies in mind. But healthcare players and payers are watching CED’s application carefully, as well as its effect on coverage and drug development.
Is ‘coverage with evidence development’ a happy medium between ‘no evidence, no coverage,’ and the sky-high promise of some new biologic therapies, diagnostics, and devices? Medicare plans to find out. The application of CED raises a number of questions, the answers to which may determine whether it is a suitable model for private payers trying to answer the value equation.
PMCID: PMC3555183  PMID: 23372508
6.  Decline of Measles-Specific Immunoglobulin M Antibodies after Primary Measles, Mumps, and Rubella Vaccination 
Detection of measles-specific immunoglobulin M (IgM) has become the standard diagnostic method for laboratory confirmation of measles. In outbreaks, the interpretation of an IgM-positive result can be complicated when persons with suspected measles receive a dose of measles vaccine as part of outbreak control measures. This investigation evaluated the decay of measles-specific IgM antibodies 1 to 4 months after primary vaccination with measles, mumps, and rubella vaccine (MMRII). Serum samples were obtained from 536 infants vaccinated when they were 15 months old as part of a study to assess primary and secondary measles vaccine failure. Sixty serum specimens per week were selected from specimens collected between 4 and 9 weeks after MMRII vaccination; all 176 available serum specimens collected between 10 and ≥16 weeks were included. Specimens were tested for the presence of measles-specific IgM by an antibody-capture enzyme immunoassay. The proportion of IgM-positive specimens dropped from 73% at 4 weeks after vaccination to 52% at 5 weeks after vaccination and then declined to 7% by 8 weeks after vaccination. Less than 10% of children remained IgM positive between 9 and 11 weeks. An IgM-negative result helps rule out the diagnosis of measles in a person with suspected infection and a history of recent vaccination. The interpretation of a positive IgM result from a person with a clinically suspected case of measles and a recent history of measles vaccination (especially within 8 weeks) is problematic, and the diagnosis of measles should be based on epidemiologic linkage to a confirmed case or on detection of wild-type measles virus.
PMCID: PMC121349  PMID: 9521134

Results 1-6 (6)