Biomedical subjects

Volker R Jacobs

Publications and source records attributed to Volker R Jacobs.

21 records · Page 2Linked to original sources

PubMedDate not supplied

An economic model to reduce the cost of chemotherapy for gynecologic cancer.

OBJECTIVE: Chemotherapy with innovative state-of-the-art medicine at university level can be very costly. Reimbursement until 2002 was at a flat rate, often not even covering the costs of the pharmaceutical substances. To avoid debt a more cost-effective chemotherapy management system had to be found. MATERIALS AND METHODS: From this background, an economic model with four steps was developed: 1. Analysis of current financial situation; 2. Precalculation of chemotherapy costs; 3. Assignment to an individual cost-covering reimbursement pathway; and 4. Postcalculation for cost efficiency and elimination of potential mistakes. RESULTS: After successful implementation of this model we were able to reach cost effectiveness for our chemo unit within 12 months and pay back previous debts and were even able to employ new medical staff. CONCLUSION: With this model we are now able to perform chemotherapy cost effectively at a university level without reducing standard of care.

Antineoplastic Agents↗

PubMedDate not supplied

Carbon dioxide gas heating inside laparoscopic insufflators has no effect.

BACKGROUND AND OBJECTIVES: Within recent years, the insufflation technique for laparoscopy has become more important with high flow insufflators (> or = 30 L/min) and high gas turn over (> or = 800 L/procedure). Increased amounts of carbon dioxide (CO2) gas used can lead to laparoscopic hypothermia. We studied the insufflator with versus insufflators without internal gas heating (inside insufflator) as a sufficient method of hypothermia prevention at different flow rates. METHODS: With a computer-based data acquisition model, different standard insufflators with internal gas heating (Snowden Pencer) vs. without (Storz Endoflator, Storz Laparoflator, Richard Wolf, and BEI Medical) were compared regarding CO2 gas temperature at different points in the insufflation system (insufflator exit, insufflation hose end). RESULTS: Gas temperature of the Snowden Pencer insufflator, which is flow-rate dependent, increases at the exit (max. 35.4 degrees C). However, gas temperature is back to room temperature (-0.22 to +1.10 degrees C) at the end of the insufflation hose (10 ft or 3 m) for all 5 insufflators studied. Even at high gas flow rates (< or = 20 L/min), CO2 gas is at room temperature when it reaches the patient. DISCUSSION: No difference was noted regarding gas temperature between the insufflators compared. Insufflator internal gas heating, such as the Snowden Pencer insufflator, can not have a clinically significant effect because it is too far away from the patient to raise the gas temperature in the abdomen. Purchasers are misled because the gas-heating device has no measurable benefit for the patient.

Carbon Dioxide↗

PubMedDate not supplied

Classic intrafascial supracervical hysterectomy (CISH): 10-year experience.

OBJECTIVE: We report and review herein our 10-year experience with classic intrafascial supracervical hysterectomy focusing on our long-term experience, evolution of the operative technique, and increased use of this technique. METHOD: We performed a parallel, observational study with retrospective data to evaluate classic intrafascial supracervical hysterectomy, a laparoscopic hysterectomy technique, at Fayette Medical Center, a community hospital in Northwestern Alabama, USA. Patients comprised a consecutive series of 579 over a 10-year period from November 1992 through November 2002. RESULTS: The classic intrafascial supracervical hysterectomy technique, similar to standard supracervical hysterectomy, leaves the cardinal ligament, uterosacral ligament, vascular supply, and innervation to the upper vagina and cervix intact, but unlike supracervical hysterectomy removes the transition zone and endocervical canal. For 579 patients, the average age was 45.4 years (range, 22 to 92), follow-up was 75.3 months (range, 17 to 137), operating room time was 69 minutes (range, 44 to 370), blood loss was 72 mL (range, 10 to 765), length of hospital stay was 23.2 hours (range, 14 hours to 5 days), time to return to work was 13.2 days (range, 3 to 28). Complications include 11 cervical bleedings, 1 uterine artery bleeding, 1 pelvic hematoma, 1 postoperative ileus, and 16 mucoceles of the cervical stump. Three patients were converted from a laparoscopic to an open procedure (0.52%). Long-term follow-up of up to 137 months shows no adverse events thus far. CONCLUSIONS: Classic intrafascial supracervical hysterectomy is a safe procedure with a low short- and long-term complication rate. It has a short recuperation period and high patient satisfaction. It is the procedure of choice when hysterectomy is indicated for benign disease.

Adult↗