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Common Procedure (common + procedure)
Selected AbstractsSplit sample comparison of ThinPrep and conventional smears in endoscopic retrograde cholangiopancreatography-guided pancreatic fine-needle aspirations,DIAGNOSTIC CYTOPATHOLOGY, Issue 2 2005Momin T. Siddiqui M.D. Abstract Fine-needle aspiration (FNA) of pancreatic lesions is a common procedure to establish a tissue diagnosis before chemotherapy or surgery. In this study, the authors attempt to compare the diagnostic value of the ThinPrep (TP) method with conventional smears (CSs) in samples obtained by endoscopic retrograde cholangiopancreatography (ERCP)-guided pancreatic FNAs. Material obtained, prospectively, from ERCP-guided pancreatic FNAs was split to prepare CSs (2,5 slides) first, the remainder being rinsed in PreservCyte, and in the laboratory, 1 TP slide was prepared. The diagnostic categories of unsatisfactory, benign, reactive, suspicious for malignancy, and malignant were compared. Fifty-one pancreatic FNAs prepared by split sample method yielded the following results: TP yielded unsatisfactory, 6 cases; benign, 3 cases; reactive, 5 cases; suspicious for malignancy, 11 cases; and malignant, 26 cases; in contrast, CS yielded unsatisfactory, 13 cases; benign, 4 cases; reactive, 3 cases; suspicious for malignancy, 13 cases; and malignant, 18 cases. Histological follow-up was available in 21 cases (reactive, 8 cases; suspicious for malignancy, 1 case, and malignant, 12 cases). The foregoing data indicate a higher sensitivity in detection of pancreatic adenocarcinoma by the TP method (TP, 91% vs. 58% CS) with equivalent specificity (100%). In addition, TP provides better preservation and cytological detail. Diagn. Cytopathol. 2005;32:70,75. © 2005 Wiley-Liss, Inc. [source] Controlled overturning of unanchored rigid bodiesEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 6 2006Rubén Boroschek Abstract Typical small hospital and laboratory equipment and general supplies cannot be anchored to resist earthquake motions. In order to protect these non-structural components, a common procedure is to provide barriers to restrain overturning of objects on shelves and other furniture. In many cases this option is not available, especially for hospital equipment, because of other functional requirements. This work presents an alternative approach. The method proposed here does not avoid overturning, but controls the direction of overturning by providing an inclination to the support base so that the overturning occurs in a preferential direction towards a safe area. For example, objects on shelves, could overturn towards the inside or a wall, and equipment on tables could overturn away from the edge. In both cases this would not only reduce the damage to the particular items, but reduce the amount of debris on the floor. In order to determine the proper inclination of the base, specific rigid bodies are analytically evaluated for bi-directional excitation obtained from 314 earthquake records, in approximately 7500 cases. For each case, several inclination angles are evaluated. Finally, a parametric curve is adjusted to the data, given a relation between angle of inclination and percentage of controlled overturning cases. In all cases a 7° angle gives more than 98% confidence of controlled overturning. The design expressions were later compared with experimental results obtained on a six-degree-of-freedom shake table; confirming the analytical expressions. Copyright © 2006 John Wiley & Sons, Ltd. [source] End-to-end jejuno-ileal anastomosis following resection of strangulated small intestine in horses: a comparative studyEQUINE VETERINARY JOURNAL, Issue 4 2005D. I. RENDLE Summary Reasons for performing study: Small intestinal resection and anastomosis is a relatively common procedure in equine surgical practice. This study was designed to test objectively the subjective opinions of surgeons at the Liphook Equine Hospital that an end-to-end jejuno-ileal anastomosis (JIA) is an effective and clinically justifiable procedure, contrary to conventional recommendations. Hypothesis: An end-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end jejunojejunal anastomosis (JJA). Methods: A retrospective observational study was performed on a population of 100 horses that had undergone small intestinal resection and end-to-end anastomosis. Two groups were identified; Group 1 (n = 30) had undergone an end-to-end JIA and Group 2 (n = 70) an end-to-end JJA. The 2 populations were tested for pre- and intraoperative comparability and for their equivalence of outcomes. Results: The 2 populations were comparable in terms of their distributions of preoperative parameters and type of lesion present. The observations used as outcome parameters (incidence risk of post operative colic, incidence risk of post operative ileus, duration of post operative ileus, rates of functioning original anastomoses at the time of discharge and at 12 months, survival rates at 6 months and 12 months) were equivalent between the 2 groups. Conclusion: End-to-end JIA carries no greater risk of morbidity and mortality than an end-to-end JJA. Potential relevance: Surgeons faced with strangulating obstructions involving the jejuno-ileal junction in which there remains an accessible length of viable terminal ileum may reasonably perform an end-to-end JIA. This has the potentially significant advantage over a jejunocaecal anastomosis of preserving more anatomical and physiological normality to the intestinal tract. The study was, however, relatively small for an equivalence study and greater confidence would be gained with higher numbers. [source] Recent role of splenectomy in chronic hepatic disordersHEPATOLOGY RESEARCH, Issue 12 2008Toru Ikegami For years splenectomy in hepatic disorders has been indicated only for the treatment of gastro-esophageal varices. However, with recent advances in medical and surgical treatments for chronic hepatic disorders, the use of splenectomy has been greatly expanded, such that splenectomy is used for reversing hypersplenism, for applying interferon treatment for hepatitis C, for treating hyperdynamic portal circulation associated with intractable ascites, and for controlling portal pressure during small grafts in living donor liver transplantation. Such experiences have shown the importance of portal hemodynamics, even in cirrhotic livers. Recent advances in surgical techniques have enabled surgeons to perform splenectomy more safely and less invasively, but the procedure still has considerable clinical outcomes. Splenectomy in hepatic disorders may become a more common procedure with expanded indications. However, it should also be noted that the long-term effects of splenectomy, in terms of improved hematological or hepatic function, is still not guaranteed. Moreover, the impact of splenectomy on immunologic status remains unclear and needs to be elucidated in both experimental and clinical settings. [source] The efficacy and safety of laparoscopic nephrectomy in patients with three or more comorbiditiesINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2007Yukio Naya Objectives: Laparoscopic surgery for kidney treatment is a common procedure. However, the efficacy of this procedure in patients with several comorbidities has not been well investigated. We conducted a retrospective comparison of results of laparoscopic surgery between patients with several comorbidities and patients with no comorbidity to access the efficacy and safety of this procedure. Methods: The subjects were 20 patients with three or more comorbidities (group A) and 46 patients with less than three comorbidities (group B). These 66 patients were 48 men and 18 women with a mean age of 62.3 years (age range, 24,83 years). The data from these two groups were compared for American Society of Anesthesiology (ASA) physical status score, previous surgical history, duration of surgery, estimated blood loss, tumor size, complications during and after surgery, conversion rates, time to oral intake, and length of hospital stay. Results: The initial ASA score and age were significantly higher for the patients with comorbidities (P < 0.0001, P = 0.0008, respectively). All other variables before, during, and after surgery were similar for both laparoscopic groups. However, the incidence of atelectasis of laparoscopy was higher than that of open surgery. Conclusions: Laparoscopic nephrectomy for patients with comorbidities is safe and minimally invasive. Further investigation to prevent atelectasis is necessary. [source] Vitiligo koebnerized by eyebrow plucking by threadingJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2002S B Verma Summary, Koebnerization is a well-known phenomenon in diseases like vitiligo and psoriasis. Eyebrow plucking is a common procedure, which induces some trauma. This is a report of a woman with vitiligo whose vitiligo spread to the eyebrow area after eyebrow plucking by threading in a beauty parlour. This is an example of an unusual koebnerization of vitiligo by a very common cosmetic procedure. [source] The superolateral approach for aspiration of total hip arthroplastiesJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2000Wendy E McCurdy SUMMARY Hip aspiration for exclusion of infection is a common procedure prior to revision arthroplasty. Some patients with total hip arthroplasties develop superomedial migration of the prosthesis, while others can have extensive heterotopic bone formation. The traditional approaches may be contraindicated due to overlying bowel or bone anterior/lateral to the prosthesis. These patients are candidates for the superolateral approach. With the patient supine marks are made on the skin at (i) the greater trochanter and (ii) a superior site that aligns with the neck of the prosthesis and soft-tissue window. The needle enters the lateral skin parallel to the table top. Usually only one pass is necessary. [source] Influence of occlusal vertical dimension on the masticatory performance during chewing with maxillary splintsJOURNAL OF ORAL REHABILITATION, Issue 8 2007L. W. OLTHOFF summary, Changing the occlusal vertical dimension is a common procedure in restorative dentistry, during treatment of patients with cranio-mandibular disorders, and during orthodontic and orthognathic treatment. The treatment may alter the length of the main jaw elevator muscles and the position of the mandibular head in the fossa temporalis. These changes may influence the bite forces that are generated during chewing and thus may affect the masticatory function. We measured the objective masticatory function, defined as masticatory performance, by determining an individual's capacity to pulverize a test food. The immediate influence of the increase in the occlusal vertical dimension on the masticatory performance was determined using three anatomical maxillary splints in a group of seven dentate subjects. The splints gave an increase in the occlusal vertical dimension of 2, 4 and 6 mm, respectively. Before we started the experiments the subjects practiced chewing with the splints during about 5 min. No significant differences were observed in masticatory performance among the conditions without and with the three splints. Thus, an increase in the occlusal vertical dimension up to 6 mm did not have a significant effect on the masticatory performance. Maxillary splints may be used to study the effect of occlusal factors on the chewing process by manipulating tooth shape and occlusal area of the splint. [source] In vitro evaluation of the effect of core diameter for removing radicular post with ultrasoundJOURNAL OF ORAL REHABILITATION, Issue 6 2004E. Alfredo summary, The removal of radicular posts for endodontic reasons as well as their replacement is a common procedure in dental practice. The use of ultrasound is becoming a standard practice since it reduces the stress to displace the core from the canal minimizing the risks of root fractures, perforations and further wearing of dental structure. Thus, the objective of this study was to evaluate the effect of a reduction in the core diameter when removing radicular posts with ultrasound. Twenty-four teeth were divided in two groups. Group I received posts with the dowel and core of the same diameter (1·7 mm) and group II received posts with the dowel diameter 2 mm larger (3·7 mm) than the core diameter. Zinc phosphate cement was used to cement the posts in all groups. Half of the samples of each group received ultrasonic energy for 8, 2 min for each face. All samples were submitted to traction on an Instron machine (model 4444). Data were analysed statistically with anova and the Tukey test, revealing significant differences (P < 0·05) between groups. The authors concluded that the mean tension necessary to displace the posts from the roots was reduced by 26% when ultrasound was applied. The reduction of the post-diameter reduced the necessary tension to remove them by 24% compared with larger posts. [source] Comparative analysis of dental enamel polyvinylsiloxane impression and polyurethane casting methods for SEM researchMICROSCOPY RESEARCH AND TECHNIQUE, Issue 4 2006Jordi Galbany Abstract Dental casting is a very common procedure for making high-quality replicas of paleo-anthropological remains. Replicas are frequently used, instead of original remains, to study both fossil and extant Primate teeth in morphological and metrical analyses. Several commercial products can be used in molds. This study analyzed SEM image resolution and enamel surface feature definition of tooth molds at various magnification levels and obtained, with both Coltène® and 3MTM low-viscosity body polyvinylsiloxane impression, materials and polyurethane casts. Results, through comparison with the original teeth, show that both the negative molds and the positive casts are highly reliable in replicating enamel surfaces. However, positive cast quality is optimal for SEM observation only till the fourth consecutive replica from the original mold, especially at high SEM magnification levels. Microsc. Res. Tech 69:246,252, 2006. © 2006 Wiley-Liss, Inc. [source] Life threatening medullary injury following adenoidectomy and local anesthetic infiltration of the operative bedPEDIATRIC ANESTHESIA, Issue 2 2009ELI HERSHMAN MD Summary Objective:, To draw attention to a rare, life threatening complication of a rather common procedure, namely medullary injury following adenoidectomy and local anesthetic infiltration of the operative bed. Design:, Case report. Setting:, A tertiary pediatric critical care unit. Patient:, A healthy 7-year-old girl underwent adenoidectomy and local anesthetic infiltration of the adenoid bed with lidocaine and adrenaline. In the recovery room, nystagmus, dysarthria, dyspnea, inability to cough and right hemiparesis were noticed. Because of her inability to remove secretions tracheal intubation was performed, followed by severe, life threatening respiratory failure. Interventions:, Tracheal intubation, hemodynamic support, prolonged mechanical ventilation, nitric oxide, and tracheostomy. Conclusion:, In children, local anesthetic infiltration of the adenoid bed may cause life-threatening medullary injury and its routine use should be re-considered. [source] Seasonal variations on energy yield of a-Si, hybrid, and crystalline Si PV modulesPROGRESS IN PHOTOVOLTAICS: RESEARCH & APPLICATIONS, Issue 5 2010Miglena Nikolaeva-Dimitrova Abstract This paper presents a study of long-term outdoor performance of a-Si and hybrid modules mounted in the same location over several years. The modules were also characterized indoors using standard measurement methods employing pulsed solar simulators at the European Solar Test Installation (ESTI). The present study is intended to contribute to future standards on energy rating by presenting a common procedure for correcting the outdoor performance measurements to standard test conditions and comparing the resulting module performance at real and laboratory conditions. A seasonal variation in output, higher in the summer and lower in the winter, suggests that the module performance improves due to annealing when the module temperature is higher. The total output energy per month for these two technologies and a reference c-Si technology is also presented. Copyright © 2010 John Wiley & Sons, Ltd. [source] An Empirical Bayes Method for Estimating Epistatic Effects of Quantitative Trait LociBIOMETRICS, Issue 2 2007Shizhong Xu Summary The genetic variance of a quantitative trait is often controlled by the segregation of multiple interacting loci. Linear model regression analysis is usually applied to estimating and testing effects of these quantitative trait loci (QTL). Including all the main effects and the effects of interaction (epistatic effects), the dimension of the linear model can be extremely high. Variable selection via stepwise regression or stochastic search variable selection (SSVS) is the common procedure for epistatic effect QTL analysis. These methods are computationally intensive, yet they may not be optimal. The LASSO (least absolute shrinkage and selection operator) method is computationally more efficient than the above methods. As a result, it has been widely used in regression analysis for large models. However, LASSO has never been applied to genetic mapping for epistatic QTL, where the number of model effects is typically many times larger than the sample size. In this study, we developed an empirical Bayes method (E-BAYES) to map epistatic QTL under the mixed model framework. We also tested the feasibility of using LASSO to estimate epistatic effects, examined the fully Bayesian SSVS, and reevaluated the penalized likelihood (PENAL) methods in mapping epistatic QTL. Simulation studies showed that all the above methods performed satisfactorily well. However, E-BAYES appears to outperform all other methods in terms of minimizing the mean-squared error (MSE) with relatively short computing time. Application of the new method to real data was demonstrated using a barley dataset. [source] Dental trauma in Turkish children, ,stanbulDENTAL TRAUMATOLOGY, Issue 2 2003Betul Kargul Abstract,,, Numerous studies focus on visits to dental clinics for emergent dental problems. Many are all-inclusive, studying traumatic injuries as well as visits for infection and other causes. Epidemiologic studies have focused on the investigation of the prevalence or incidence of dental injury. The patients were evaluated at Pediatric Dentistry, Marmara University Dental School, ,stanbul over a 2-year period. For these 300 patients (446 teeth), specific diagnoses were evaluated. Dental injuries that presented most frequently in permanent dentition were crown fractures of enamel only and crown fractures of enamel and dentin. The most frequently presented dental injury in primary dentition were avulsions and crown fractures of enamel. The more frequent treatments for primary teeth were examination only. Bandage restoration, space maintainer were common procedures for permanent teeth. [source] Procedural skills quality assurance among Australasian College for Emergency Medicine fellows and traineesEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2006David McD Taylor Abstract Objective: Presently, no objective quality control mechanism exists for monitoring procedural skills among Australasian College for Emergency Medicine trainees. The present study examined trainee and fellow procedural experience and perceived competency, participation in accredited training courses and support for a procedural logbook. Methods: A cross-sectional mail survey of Australasian College for Emergency Medicine advanced trainees and fellows was performed. Experience and perceived competency in 23 common and important ED procedures were examined. Results: In total, 202 fellows and 264 trainees responded (overall response rate 39.0%). Overall, fellow procedural experience and perceived competency were reasonable. However, some fellows had never performed a number of procedures including some common procedures (e.g. nasal packing, fracture reduction) and there were reports of ,very poor' competency for 17 (73.9%) procedures. Trainee experience and perceived competency were less than the fellows but showed similar patterns. Perceived numbers of each procedure required to achieve competency varied considerably between the procedures and among the respondents. However, there were no significant differences in the perceived numbers reported by the trainees and the fellows (P > 0.05). Variable proportions of trainees and fellows had undertaken courses that incorporated procedural skills training. More fellows (75.7%, 95% confidence interval 69.1,81.4) than trainees (59.9%, 95% confidence interval 53.6,65.8) supported the use of a procedural logbook (P = 0.003). Conclusions: Lack of experience in some procedures among some fellows, especially commonly performed procedures, might represent a deficiency in existing quality assurance mechanisms for procedural skills training. Greater participation in skills courses, to improve experience in difficult and uncommonly encountered procedures, is recommended. Improved quality assurance mechanisms, including a procedural logbook, should be considered. [source] Development of a test to evaluate residents' knowledge of medical procedures,,JOURNAL OF HOSPITAL MEDICINE, Issue 7 2009Shilpa Grover MD Abstract BACKGROUND AND AIM: Knowledge of core medical procedures is required by the American Board of Internal Medicine (ABIM) for certification. Efforts to improve the training of residents in these procedures have been limited by the absence of a validated tool for the assessment of knowledge. In this study we aimed to develop a standardized test of procedural knowledge in 3 medical procedures associated with potentially serious complications. METHODS: Placement of an arterial line, central venous catheter, and thoracentesis were selected for test development. Learning objectives and multiple-choice questions were constructed for each topic. Content evidence was evaluated by critical care subspecialists. Item test characteristics were evaluated by administering the test to students, residents and specialty clinicians. Reliability of the 32-item instrument was established through its administration to 192 medical residents in 4 hospitals. RESULTS: Reliability of the instrument as measured by Cronbach's , was 0.79 and its test-retest reliability was 0.82. Median score was 53% on a test comprising elements deemed important by critical care subspecialists. Increasing number of procedures attempted, higher self-reported confidence, and increasing seniority were predictors of overall test scores. Procedural confidence correlated significantly with increasing seniority and experience. Residents performed few procedures. CONCLUSIONS: We have successfully developed a standardized instrument to assess residents' cognitive competency for 3 common procedures. Residents' overall knowledge about procedures is poor. Experiential learning is the dominant source for knowledge improvement, but these experiences are increasingly rare. Journal of Hospital Medicine 2009;4:430,432. © 2009 Society of Hospital Medicine. [source] Attitudes and Intentions of Future Health Care Providers Toward Abortion ProvisionPERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, Issue 2 2004Solmaz Shotorbani CONTEXT: Induced abortion is one of the most common procedures performed among women in the United States. However, 87% of all counties had no abortion provider in 2000, and little is known about the attitudes and intentions of future health care providers, including advanced clinical practitioners, regarding abortion provision. METHODS: During March 2002, first- and second-year students in health sciences programs (i.e., medicine, physician assistant and nursing) at the University of Washington were anonymously surveyed. Univariate, bivariate and multi-variate analyses were used to determine students' attitudes and intentions regarding provision of abortion services. RESULTS: Of the 312 students who completed the survey, 70% supported the availability of legal abortion under any circumstances. Thirty-one percent intended to provide medical abortion in their practice, and 18% planned to offer surgical abortion. Fifty-two percent of all respondents agreed that advanced clinical practitioners should be able to provide medical abortion, and 37% agreed that they should be able to provide surgical abortion services; however, greater proportions of advanced clinical practitioners (45,83%) than of medical students (21,43%) expressed such support. Sixty-four percent of all respondents were willing to attend a program whose curriculum requires abortion training. CONCLUSIONS: Although it may not be possible to require abortion training for every future health care provider, making abortion a standard part of clinical training would provide opportunities for future physicians and advanced clinical practitioners, and would likely ameliorate the abortion provider shortage. [source] Gaps in Procedural Experience and Competency in Medical School GraduatesACADEMIC EMERGENCY MEDICINE, Issue 2009Susan B. Promes MD Abstract Objectives:, The goal of undergraduate medical education is to prepare medical students for residency training. Active learning approaches remain important elements of the curriculum. Active learning of technical procedures in medical schools is particularly important, because residency training time is increasingly at a premium because of changes in the Accreditation Council for Graduate Medical Education duty hour rules. Better preparation in medical school could result in higher levels of confidence in conducting procedures earlier in graduate medical education training. The hypothesis of this study was that more procedural training opportunities in medical school are associated with higher first-year resident self-reported competency with common medical procedures at the beginning of residency training. Methods:, A survey was developed to assess self-reported experience and competency with common medical procedures. The survey was administered to incoming first-year residents at three U.S. training sites. Data regarding experience, competency, and methods of medical school procedure training were collected. Overall satisfaction and confidence with procedural education were also assessed. Results:, There were 256 respondents to the procedures survey. Forty-four percent self-reported that they were marginally or not adequately prepared to perform common procedures. Incoming first-year residents reported the most procedural experience with suturing, Foley catheter placement, venipuncture, and vaginal delivery. The least experience was reported with thoracentesis, central venous access, and splinting. Most first-year residents had not provided basic life support, and more than one-third had not performed cardiopulmonary resuscitation (CPR). Participation in a targeted procedures course during medical school and increasing the number of procedures performed as a medical student were significantly associated with self-assessed competency at the beginning of residency training. Conclusions:, Recent medical school graduates report lack of self-confidence in their ability to perform common procedures upon entering residency training. Implementation of a medical school procedure course to increase exposure to procedures may address this challenge. [source] Program Directors' Opinions about Surgical Competency in Otolaryngology ResidentsTHE LARYNGOSCOPE, Issue 7 2005FRCSC, M M. Carr DDS Abstract Objectives: The purpose of this study was to determine whether certain surgical procedures could be used as benchmark skills to monitor resident progress in developing surgical competency. Study Design: Survey. Methods: A two-stage survey was sent to otolaryngology residency program directors in the United States. Respondents were given a list of otolaryngology surgical procedures monitored by the American Board of Otolaryngology (ABO) and were asked to indicate whether they felt residents should be able to do each as a primary surgeon. The appropriate level of training for competency in each procedure and estimated number of procedures to competency was indicated by respondents. Results: Respondents selected 16 common procedures they felt residents at different levels of training should be able to perform independently. There were discrepancies between estimated number of procedures needed for competence and the numbers reported by ABO graduates. Conclusions: Surgical skill is one aspect of clinical competency, and this indicates agreement among program directors with regard to a set of benchmark skills we can use for concentrated evaluation efforts. [source] Informed Consent in Functional Endoscopic Sinus Surgery,THE LARYNGOSCOPE, Issue 5 2002Jeffrey S. Wolf MD Abstract Objectives Functional endoscopic sinus surgery (FESS) is one of the more common procedures performed by otolaryngologists. Before performing FESS, surgeons are obligated to discuss the procedure and its risks through the process of informed patient consent. The study identifies current practices in informed consent for FESS and formulates guidelines for informed consent for FESS. Study Design Survey. Methods Surveys were sent to 1000 American Academy of Otolaryngology,Head and Neck Surgery members in the United States. Surveys inquired about current informed consent practices related to FESS. Results Three hundred forty-six surveys were returned. Nearly 60% of respondents thought that 1% incidence of a complication warrants a discussion with patients. The percentage of respondents who discuss specific risks were as follows: bleeding, 96.7%; infection, 84.8%; cerebrospinal fluid leak, 99.1%; orbital injury, 96.7%; smell changes, 40.2%; cerebrovascular accident, 17.9%; myocardial infarction, 8%; and death, 28.0%. Conclusions The study suggests that there is variability in specific informed consent practices for FESS among otolaryngologists. It also suggests that the incidence or severity of a complication does not necessarily correlate with whether or not it is mentioned during the informed consent process. The authors think that practicing otolaryngologists may be able to use this information to improve their consent practices. [source] LAPAROSCOPIC HEPATECTOMY, A SYSTEMATIC REVIEWANZ JOURNAL OF SURGERY, Issue 11 2007Jerome M. Laurence This systematic review was undertaken to assess the published evidence for the safety, feasibility and reproducibility of laparoscopic liver resection. A computerized search of the Medline and Embase databases identified 28 non-duplicated studies including 703 patients in whom laparoscopic hepatectomy was attempted. Pooled data were examined for information on the patients, lesions, complications and outcome. The most common procedures were wedge resection (35.1%), segmentectomy (21.7%) and left lateral segmentectomy (20.9%). Formal right hepatectomy constituted less than 4% of the reported resections. The conversion and complication rates were 8.1% and 17.6%, respectively. The mortality rate over all these studies was 0.8% and the median (range) hospital stay 7.8 days (2,15.3 days). Eight case,control studies were analysed and although some identified significant reductions in-hospital stay, time to first ambulation after surgery and blood loss, none showed a reduction in complication or mortality rate for laparoscopically carried out resections. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by appropriately skilled surgeons. Further work is needed to determine whether these conclusions can be generalized to include formal right hepatectomy. [source] Purification of colored photosynthetic proteins for understanding protein isolation principlesBIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION, Issue 2 2003M. Teresa Bes Abstract The purification of a protein is the essential initial step in the study of its physical and biological properties and is one of the most common procedures in biochemistry. This article describes a method for teaching purification skills through the partial isolation of ferredoxin-NADP+ reductase and ferredoxin from a single cell batch. The method has been used for several years in an introductory biochemistry course using spinach leaves as cellular source. The protocol gives a complete picture of the preparation of a crude extract and the subsequent isolation of both electron transport proteins on a laboratory scale. It introduces students to the use of different techniques for the purification and detection of proteins and allows them to develop a number of valuable experimental and analytical skills without necessarily resorting to complicated or expensive equipment. [source] Generalized Additive Modeling with Implicit Variable Selection by Likelihood-Based BoostingBIOMETRICS, Issue 4 2006Gerhard Tutz Summary The use of generalized additive models in statistical data analysis suffers from the restriction to few explanatory variables and the problems of selection of smoothing parameters. Generalized additive model boosting circumvents these problems by means of stagewise fitting of weak learners. A fitting procedure is derived which works for all simple exponential family distributions, including binomial, Poisson, and normal response variables. The procedure combines the selection of variables and the determination of the appropriate amount of smoothing. Penalized regression splines and the newly introduced penalized stumps are considered as weak learners. Estimates of standard deviations and stopping criteria, which are notorious problems in iterative procedures, are based on an approximate hat matrix. The method is shown to be a strong competitor to common procedures for the fitting of generalized additive models. In particular, in high-dimensional settings with many nuisance predictor variables it performs very well. [source] A prospective evaluation of the durability of palliative interventions for patients with metastatic breast cancerCANCER, Issue 14 2010Mary Morrogh MD Abstract BACKGROUND: Although systemic therapy for metastatic breast cancer (MBC) continues to evolve, there are scant data to guide physicians and patients when symptoms develop. In this article, the authors report the frequency and durability of palliative procedures performed in the setting of MBC. METHODS: From July 2002 to June 2003, 91 patients with MBC underwent 109 palliative procedures (operative, n = 76; IR n = 39, endoscopic n = 3). At study entry, patients had received a mean of 6 prior systemic therapies for metastatic disease. System-specific symptoms included neurologic (33%), thoracic (23%), musculoskeletal (22%) and GI (14%). The most common procedures were thoracostomy with or without pleurodesis (27%), craniotomy with resection (19%) and orthopedic open reduction/internal fixation (19%). RESULTS: Symptom improvement at 30 days and 100 days was reported by 91% and 81% of patients, respectively, and 70% reported continued benefit for duration of life. At a median interval of 75 days from intervention (range, 8-918 days), 23 patients (25%) underwent 61 additional procedures for recurrent symptoms. The durability of palliation varied with system-specific symptoms. Patients with neurologic or musculoskeletal symptoms were least likely to require additional maintenance procedures (P < .0002). The 30-day complication rate was 18% and there were no procedure-related deaths. At a median survival of 37.4 mos from MBC diagnosis (range, 1.6-164 months) and 8.4 months after intervention (range, 0.2-73 months), 7 of 91 patients remained alive. CONCLUSIONS: Palliative interventions for symptoms of MBC are safe and provide symptom control for the duration of life in 70% of patients. Definitive surgical treatment of neurologic or musculoskeletal symptoms provided the most durable palliation; interventions for other symptoms frequently require subsequent procedures. The longer median survival for patients with MBC highlights the need to optimize symptom control to maintain quality of life. Cancer 2010. © 2010 American Cancer Society. [source] The Need for Emergency Medicine Resident Training in Informed Consent for ProceduresACADEMIC EMERGENCY MEDICINE, Issue 9 2007Theodore Gaeta DO Objectives: To determine emergency medicine (EM) residents' perceptions and reported practices of obtaining informed consent for emergency department procedures. Methods: The authors performed a cross-sectional observational study of EM residents. A brief, short-answer survey was distributed that covered the following topics related to informed consent: training, confidence and comfort levels, and current practices. Data were analyzed using basic frequency displays, and descriptive statistics are reported. Results: Of the 20 programs contacted, 16 responded and agreed to distribute the invitation to their residents. A total of 402 of 490 eligible residents (82%) in the participating programs responded. The majority of EM residents (56%) had never received formal training on obtaining informed consent, and those who had reported that their primary exposure to formal training occurred during their medical school years (79%). More than half of the residents (56%) have felt uncomfortable obtaining consent for a procedure. Few residents (32%) felt very confident that they provide comprehensive information to patients, while 9% were not very confident that they disclose all pertinent risks, benefits, and alternatives to their patients. Sixty-three percent of all EM residents believed formal training is necessary, and half (52%) reported interest in receiving training (i.e., listings of risks, benefits, and alternatives as well as standards for determining which procedures need consent). The residents' current perceptions of consent requirements for commonly performed emergency department procedures (emergent and nonemergent) are also reported. Conclusions: Few residents have had formal training in informed consent, and there is wide variability in the perception of which procedures require informed consent. Residents are not confident in their knowledge of all risks and benefits of common procedures, and comfort levels in obtaining informed consent are low. Residents can benefit from additional resources that provide standardized information and formal training on the issue. [source] Comparing methods of determining addition in presbyopesCLINICAL AND EXPERIMENTAL OPTOMETRY, Issue 3 2008Beatriz Antona BSc Background:, The use of plus lenses to compensate for the reduction in the range of accommodation associated with presbyopia, brings the near point of accommodation to a comfortable distance for near visual tasks. Our aim was to compare the tentative near addition determined using the most common procedures with the final addition prescribed in presbyopic patients. Methods:, Sixty-nine healthy subjects with a mean age of 51.0 years (range 40 to 60 years) were studied. Tentative near additions were determined using seven different techniques: dynamic retinoscopy, amplitude of accommodation (AA), age-expected addition, binocular fused cross-cylinder with and without myopisation, near duochrome, and balance of negative and positive relative accommodation. The power of the addition was then refined to arrive at the final addition. Results:, The mean tentative near additions were higher than the final addition for every procedure except for the fused cross-cylinder without initial myopisation and age-expected addition methods. These biases were small in clinical terms (less than 0.25 D) with the exception of the AA procedure (0.34 D). The intervals between the 95% limits of agreement differed substantially and were always higher than ±0.50 D. Conclusions:, All the techniques used displayed similar behaviour and provided a tentative addition close to the final addition. Due to the wide agreement intervals observed, the likelihood of error is high and supports the idea that any tentative addition has to be adjusted according to the particular needs of each patient. Among the methods examined here, we would recommend the age-expected procedure, as this technique produced results that correlated best with the final addition. [source] | |||||||||||||