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Context. The most advanced and fastest growing form of bariatric surgery is laparoscopic gastric bypass. Very little is known about population-based 180-day laparoscopic bypass costs, complication rates, readmission rates, and post-operative care.

Objective. To examine the 6-month costs and outcomes of laparoscopic vs. open bariatric bypass surgery using a national population-based sample.

Design. We use the 1998–2003 Nationwide Inpatient Sample to examine national trends in the rate of laparoscopic bypass. To examine post-operative outcomes, we examine insurance claims for 2,384 bariatric bypass surgeries, at 308 hospitals, among a population of 5.6 million non-elderly people covered by large employers across 49 states in 2001 and 2002. Multivariate logit regression analysis is performed to risk-adjust outcomes.

Main Outcome Measures. 180-day outcomes: 12 complications specific to bariatric surgery and 44 general post-operative conditions, readmission rates, ER rates, and expenditures following bariatric surgery.

Results. Between 1998 and 2003, the national percentage of bariatric bypass surgeries that were laparoscopic grew from 1.5 to 17.1%. There was no significant difference in in-hospital mortality between laparoscopy and open surgery. With the 2001–2002 claims data, we find that of the patients having bypass surgery, men had 48% lower odds of having laparoscopy and that high bariatric volume hospitals were close to four times more likely to use laparoscopy. Laparoscopic bypass, compared with open bypass, had 34% lower odds of a complication during the initial surgical stay, 27% lower odds of a 30-day complication, but no statistically significant difference in 180-day complications. Laparoscopy had 49% higher odds of having the general 44 post-operative conditions, with 45% higher odds of a readmission and 54% higher odds of an ER visit. However, overall, laparoscopy resulted in a 23% lower number of hospital days and 9% lower 180-day expenditures.

Conclusion. The laparoscopic cost-savings during the less invasive initial surgery stay outweigh the increase in post-discharge utilization. Further cost-savings will only emerge from laparoscopy only if its late post-operative complications are reduced. More cost-savings will also emerge as more physicians switch to the use of laparoscopy for bypass surgery.

The authors determine how the scheduling and sequencing of surgeries by surgeons impacts the rate of post-surgical complications and patient length-of-stay in the hospital.

Leveraging a dataset of 29,169 surgeries performed by 111 surgeons from a large hospital network in Ontario, Canada, the authors perform a matched case-control regression analysis. The empirical findings are contextualized by interviews with surgeons from the authors’ dataset.

Surgical complications and longer hospital stays are more likely to occur in technically complex surgeries that follow a similarly complex surgery. The increased complication risk and length-of-hospital-stay is not mitigated by scheduling greater slack time between surgeries nor is it isolated to a few problematic surgery types, surgeons, surgical team configurations or temporal factors such as the timing of surgery within an operating day.

There are four major limitations: (1) the inability to access data that reveals the cognition behind the behavior of the task performer and then directly links this behavior to quality outcomes; (2) the authors’ definition of task complexity may be too simplistic; (3) the authors’ analysis is predicated on the fact that surgeons in the study are independent contractors with hospital privileges and are responsible for scheduling the patients they operate on rather than outsourcing this responsibility to a scheduler (i.e. either a software system or an administrative professional); (4) although the empirical strategy attempts to control for confounding factors and selection bias in the estimate of the treatment effects, the authors cannot rule out that an unobserved confounder may be driving the results.

The study demonstrates that the scheduling and sequencing of patients can affect service quality outcomes (i.e. post-surgical complications) and investigates the effect that two operational levers have on performance. In particular, the authors find that introducing additional slack time between surgeries does not reduce the odds of back-to-back complications. This result runs counter to the traditional operations management perspective, which suggests scheduling more slack time between tasks may prevent or mitigate issues as they arise. However, the authors do find evidence suggesting that the risk of back-to-back complications may be reduced when surgical pairings are less complex and when the method involved in performing consecutive surgeries varies. Thus, interspersing procedures of different complexity levels may help to prevent poor quality outcomes.

The authors empirically connect choices made in scheduling work that varies in task complexity and to patient-centric health outcomes. The results have implications for achieving high-quality outcomes in settings where professionals deliver a variety of technically complex services.

Failure to rescue events, or events involving preventable deaths from complications, are a significant contributor to inpatient mortality. While many interventions have been designed and implemented over several decades, this patient safety issue remains at the forefront of concern for most hospitals. In the first part of this study, the development and implementation of one type of highly studied and widely adopted rescue intervention, algorithm-based patient assessment tools, is examined. The analysis summarizes how a lack of systems-oriented approaches in the design and implementation of these tools has resulted in suboptimal understanding of patient risk of mortality and complications and the early recognition of patient deterioration. The gaps identified impact several critical aspects of excellent patient care, including information-sharing across care settings, support for the development of shared mental models within care teams, and access to timely and accurate patient information.

This chapter describes the use of several system-oriented design and implementation activities to establish design objectives, model clinical processes and workflows, and create an extensible information system model to maximize the benefits of patient state and risk assessment tools in the inpatient setting. A prototype based on the product of the design activities is discussed along with system-level considerations for implementation. This study also demonstrates the effectiveness and impact of applying systems design principles and practices to real-world clinical applications.

Building information modelling (BIM) is not without risk, as the greater reliance on information technology has associated technical risks. Thus, the purpose of this paper is to assess the perceptions of the users of BIM regarding the likelihood of emergence of technical risks which might influence the successful application of BIM, to facilitate the successful implementation of BIM in the construction industry.

The primary data were collected via a questionnaire to document the BIM risks, where 105 responses were recorded from constructors, consultants, cost consultants and other professionals from the UK construction industry. Subsequently, the analysis of the results was driven by univariate and inferential statistics (ANOVA) to assess the perception of risk emergence.

The study found the most likely technical risks that might emerge from BIM application. These risks are complexity of transferring modelling data from one program to another, lack of understanding of the BIM for the different software platforms, interoperability shortcomings, failure to discover errors in the model and risks of different software platforms.

The results will certainly intensify the discussion about BIM risks, risk allocation and all other aspects that are related to BIM contractual processes. Also, the compiled list of risks will help stakeholders in assessing financial implications that may result from BIM application.

Important technical risks have been identified in the application of BIM. This renders a new understanding of the risks that might influence the successful application of BIM. The respondents generally agreed on the importance of the following risks: “complexity of transferring modelling data between programs from one program to another”, “lack of understanding of the BIM for the different software platforms”, “interoperability shortcomings”, “failure to discover errors in the model” and “risks of different software platforms”, which are in line with current literature.

To explore the politics of gender, health, medicine, and citizenship in high-income countries, medical sociologists have focused primarily on the practice of legal abortion. In middle- and low-income countries with restrictive abortion laws, however, medical sociologists must examine what happens when women have already experienced spontaneous or induced abortion. Post-abortion care (PAC), a global reproductive health intervention that treats complications of abortion and has been implemented in nearly 50 countries worldwide, offers important theoretical insights into transnational politics of abortion and reproduction in countries with restrictive abortion laws. In this chapter, I draw on my ethnography of Senegal’s PAC program to examine the professional, clinical, and technological politics and practices of obstetric care for abortions that have already occurred. I use the sociological concepts of professional boundary work and boundary objects to demonstrate how Senegalese health professionals have established the political and clinical legitimacy of PAC. I demonstrate the professional precariousness of practicing PAC for physicians, midwives, and nurses. I show how the dual capacity of PAC technologies to terminate pregnancy and treat abortion complications has limited their circulation within the health system, thereby reducing quality of care. Given the contradictory and complex global landscape of twenty-first-century abortion governance, in which pharmaceutical forms of abortion such as Misoprostol are increasingly available in developing countries, and as abortion restrictions are increasingly enforced across the developed world, PAC offers important theoretical opportunities to advance medical sociology research on abortion politics and practices in the global North and South.

The purpose of this paper is to explore the preferences of the average risk Iranian population for colorectal cancer (CRC) screening tests.

A standard stated-preferences method with discrete choice models was used to identify the preferences. Data about socio-demographic status, health status and preferences for CRC screening tests were collected by a structured questionnaire that was completed by 500 people aged 50–75 years. Mixed logit model was used to analyze the preferences.

The regression model showed that the test process, pain, place, frequency, preparation, sensitivity, complication risk, mortality rate and cost were the final attributes; that had a statistically significant correlation with the preferences of the people in choosing CRC screening tests. The socio-demographic and health status of participants had no significant correlation with the individuals’ preferences.

This study provides insight into how different characteristics of a CRC screening test might influence the preferences of individuals about that test.

This was the first study of this type in Iran to elicit the preferences of the average risk population for CRC screening tests using a discrete choice model.

Ritual female genital practices, widespread throughout Africa, are essential to gender identification and often are a pre-requisite for marriage. More severe forms of the practice, which are common in parts of Northeastern Africa, are also believed to enhance a woman’s childbearing capacity. Here, we critically review the gender- and class-based theories that explain the origins and persistence of female genital practices and the factors that precipitate social change. We also critically review evidence of the association of certain forms of the practice with various health, demographic, and social consequences. Our review exposes several methodological limitations of existing research that preclude population-based inferences about the medical and social implications of these practices and suggest that existing policies targeting such practices draw more on concerns over human rights than on scientific evidence about their sequelae. This review nevertheless exposes a potential contradiction between local justifications for and consequences of certain forms of the practice. Namely, despite an intended function of female genital practices to enhance a woman’s marital capital, certain forms may ironically lead to marital instability and dissolution through their negative effects on the health and reproductive capacity of women. We conclude with recommendations for research to examine the salience and implications of this potential paradox for women in Northeastern Africa.

The purpose of this study was to examine adverse outcomes associated with cesarean deliveries and to assess potential confounding factors.

A hospital-based cross-sectional study was conducted from September 1−30, 2019 using mixed methods of data collection. Multistage sampling was used to draw the eligible study participants. The sample size was calculated using the single population proportion formula. A systematic random sampling technique was used to draw the sample size. 180 original medical records were excluded because of having missed information, leaving 1,618 women as the study population. We used the questionnaire adapted from the Ethiopian Demographic and Health Survey to collect quantitative data and analyzed using SPSS version 22, while thematic analysis for qualitative measures was used to generate themes regarding associated perspectives of participants from a community.

More than 383 women delivered by cesarean section. 20% of the mothers with the mean age at birth of 26.1 ± 4.8 experienced adverse outcomes. Adjusted odds ratio (AOR) was used to measure the association of determinants and was 2.95 (95% CI 1.19–7.29) for nonuse of antenatal care, 3.18 (95% CI 1.43–6.94) for nonuse of prophylaxis, 4.28 (95% CI 1.58−11.61) for history of medical illness and 7.09 (95% CI 1.19−45.59) for use of substandard operation set up compared with their counterparts.

Strengths of the study include the finding of the study are reliably reported in mixed study methods examining hospital-based institutional and personal risk factors and exploring the whole community's perspectives. However, the important limitations of the study indicate that the study poses a number of challenges related to studying design, therefore there was not sufficient evidence of causality to draw conclusions from the findings. In addition, the study was conducted at a single hospital so that it is not convenient to generalize the findings of the study for setting different in social and economic status.

Based on the findings, attention has been drawn to healthcare personnel to provide training and consultation services for pregnant women and for health care administration to ensure standard set up for operation.

The nutritional status of a woman before and during pregnancy is important for a healthy pregnancy outcome. The increasing prevalence of maternal overweight and obesity worldwide has become a problem of concern among public health professionals. The purpose of this paper is to review the evidence regarding the impact of maternal weight on pregnancy outcomes to facilitate the provision of evidence-based information to pregnant women during antenatal clinics in Ghana.

A search was conducted in PubMed, PLOS ONE, Cochrane, Embase and bibliographies for all studies on maternal weight and pregnancy outcomes published from January 2000 to May 2013. The key words used for the search were: “pre-pregnancy BMI”, “gestational weight gain”, “maternal weight”, “pregnancy outcomes” and “birth outcomes”.

The search yielded 113 papers; out of these, 35 studies were included in the review after exclusion of duplicates and irrelevant papers. Excluded papers included animal studies and human studies that did not meet inclusion criteria.

The review only considered papers published from 2000 to 2013 and might have left out other important papers published before 2000 and after 2013.

The origins of the studies included in the review suggest paucity of studies on maternal weight and pregnancy outcomes in developing countries where there is a double burden of malnutrition. There is the need for more studies to be initiated in this area.

Results of this review have revealed that the extremes of maternal weight prior to and during pregnancy increase the risk of maternal and fetal complications.

This paper provides evidential information on the impact of maternal weight on pregnancy outcomes for counseling during antenatal clinics.

The SARS-CoV-2 pandemic has caused a major impact on worldwide public health and economics. The lessons learned from the successful attempts to contain the pandemic escalation revealed that the wise usage of contact tracing and information systems can widely help the containment work of any contagious disease. In this context, this paper investigates other researches on this domain, as well as the main issues related to the practical implementation of such systems and specifies a technical solution.

The proposed solution is based on the automatic identification of relevant contacts between infected or suspected people with susceptible people; inference of contamination risk based on symptoms history, user navigation records and contact information; real-time georeferenced information of population density of infected or suspect people; and automatic individual social distancing recommendation calculated through the individual contamination risk and the worsening of clinical condition risk.

The solution was specified, prototyped and evaluated by potential users and health authorities. The proposed solution has the potential of becoming a reference on how to coordinate the efforts of health authorities and the population on epidemic control.

This paper proposed an original information system for epidemic control which was applied for the SARS-CoV-2 pandemic and could be easily extended to other epidemics.