Objectives: To determine the optimal medication for the treatment of renal colic using evidence based medicine (EBM) parameters (RR, ARR, NNT, NNH, ARI, RRI). Sample and Methodology: During 2010, an ITT study was conducted on 400 outpatients of the Sarajevo University Clinical Center Urology Clinic in order to investigate renal colic pain relief drugs. Each group consisting of 100 patients was administered either Metamizol amp. i.v., or Diclofenac amp. i.m., or Butylscopolamine amp. i.v., while 100 patients belonged to the placebo group that was given distilled water (aqua redestilata). All patients completed visual analogue pain scale (VAPS) from 0 to 10 prior to and after the treatment. Results: Using EBM parameters Diclofenac Na and Metamizol were shown to be the most efficient in the treatment of renal colic. In these two groups, relative risk (RR) was 21 and 8,5% respectively; Absolute Risk Reduction (ARR) was 74 and 86% respectively, and Number Needed to Treat (NNT) was 1 for both groups, while chi-squared (X2) test has shown that there is no statistically significant difference between these two drugs when it comes to their effect. In the Butylscopolamine group, RR was 81; ARR 18%, while NNT was 5. With respect to side effects, only in his group it was shown that Relative Risk Increase (RRI) was 84, ARI 83%, while Number Needed to Harm (NNH) was 2. Conclusion: The most optimal medication for the treatment of renal colic according to EBM parameters is Diclofenac Na, followed by Metamizol. Butylscopolamine is not recommended for the treatment of renal colic.

Material and method: Using the survey data obtained from doctors in Connecticut, we estimate the “true” costs of defensive medicine and medical malpractice awards via litigation in the overall aggregate picture of U.S. national annual health expenditures. Results and discusion: Progressives claim that these costs amount only to approximately 2% of total annual health expenditures, while conservatives claim that these costs are much higher, in the neighborhood of 10%. Conservatives want to reform the current medical malpractice system because the savings could be significant. Progressives claim that this issue is a “red herring” in the overall picture of health care reform and that other factors such as hospital costs, payments to physicians and pharmaceutical prices are the largest contributors to runaway health care costs, currently amounting to 18% of GDP. The health of the national economy, deficit reduction and future prosperity will depend upon the speed and quality of the cost reducing solutions. Conclusion: An in-depth look into cost and profit structure of each provider’s procedure and legislative push for price and quality transparency of the informed and educated constituents are recommended to improve this serious national, socio-economic problem.

To The Editor: We commend Chung et al for an interesting original article reporting on the safety, efficacy, and long-term outcome of percutaneous cholecystostomy (PC) as of a definitive treatment for acute acalculous cholecystitis (AAC). They concluded that PC is an effective procedure and a good alternative for patients unfit to undergo immediate surgery because of the existence of severe sepsis or an underlying comorbidity. This is an excellent article with a strong impact on clinical practice. Traditionally, acute cholecystitis is mainly treated by surgical approach 1–3 but, in patients with poor general condition surgical treatment may carry a high risk of complications associated with major morbidity and mortality. Only limited data are available on PC treatment of AAC and little is known about the safety of PC in critically ill patients. Therefore, Chung’s study, which evaluates the feasibility and clinical outcome of PC in patients with AAC is of a high importance. However, AAC comprises <10% of all cases of acute cholecystitis. In over 90% of cases, acute cholecystitis is caused by cholecystolithiasis. Therefore, it is important to answer whether PC should be limited only to AAC. We had several cases of acute cholecystitis in patients with poor general condition, caused by cholecystolithiasis, which were successfully treated by PC and so we wish to add some comments regarding this topic. Our initial intention was for PC to be used as a temporizing measure whereas, awaiting resolution of sepsis and optimization of comorbidities before performing elective surgery. But, majority of those cases required no further surgical treatment after PC. Therefore, we believe that ultrasound-guided PC should be considered a reasonable option in the therapeutic spectrum for both acalculous and calculous cholecystitis and a good alternative for patients unfit to undergo immediate surgery because of severe sepsis or an underlying comorbidity.

A lot of research has been done on author classification using various methodologies. One of them is using artificial neural networks. It is common that the number of descriptors used for author classification exceeds two. In this paper we propose a means of using artificial neural network to classify the authors of texts using only two descriptors: the number of words in a paragraph and a number of characters per word in a paragraph. The approach taken uses committee machines based on ensemble averaging. The basic idea is to solve the complex computational task by dividing it into a number of computationally simple tasks and then combining the solution of these tasks. The high performance achieved is because the committee is much better than the single best constituent in the isolation. Our results show that with the above approach we succeeded to correctly classify the works of Leo Tolstoy and George Orwell.