bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of a national anti-tuberculosis drug resistance survey in Tanzania
Authors: Chonde Timothy M , Doulla Basra , van Leth Frank , Mfinanga Sayoki GM , Range Nyagosya , Lwilla Fred , Mfaume Saidi M , van Deun Armand , Zignol Matteo , Cobelens Frank G , Egwaga Saidi M
Published: December 2008

Background

A drug resistance survey is an essential public health management tool for evaluating and improving the performance of National Tuberculosis control programmes. The current manuscript describes the implementation of the first national drug resistance survey in Tanzania.

Methods

Description of the implementation process of a national anti-tuberculosis drug resistance survey in Tanzania, in relation to the study protocol and Standard Operating Procedures.

Results

Factors contributing positively to the implementation of the survey were a continuous commitment of the key stakeholders, the existence of a well organized National Tuberculosis Programme, and a detailed design of cluster-specific arrangements for rapid sputum transportation. Factors contributing negatively to the implementation were a long delay between training and actual survey activities, limited monitoring of activities, and an unclear design of the data capture forms leading to difficulties in form-filling.

Conclusion

Careful preparation of the survey, timing of planned activities, a strong emphasis on data capture tools and data management, and timely supervision are essential for a proper implementation of a national drug resistance survey.
MicroRNA profile changes in human immunodeficiency virus type 1 (HIV-1) seropositive individuals
Authors: Houzet Laurent , Yeung Man Lung , de Lame Valery , Desai Dhara , Smith Stephen M , Jeang Kuan-Teh
Published: December 2008

MicroRNAs (miRNAs) play diverse roles in regulating cellular and developmental functions. We have profiled the miRNA expression in peripheral blood mononuclear cells from 36 HIV-1 seropositive individuals and 12 normal controls. The HIV-1-positive individuals were categorized operationally into four classes based on their CD4+ T-cell counts and their viral loads. We report that specific miRNA signatures can be observed for each of the four classes.
Potential for La Crosse virus segment reassortment in nature
Authors: Reese Sara M , Blitvich Bradley J , Blair Carol D , Geske Dave , Beaty Barry J , Black William C
Published: December 2008

The evolutionary success of La Crosse virus (LACV, family Bunyaviridae) is due to its ability to adapt to changing conditions through intramolecular genetic changes and segment reassortment. Vertical transmission of LACV in mosquitoes increases the potential for segment reassortment. Studies were conducted to determine if segment reassortment was occurring in naturally infected Aedes triseriatus from Wisconsin and Minnesota in 2000, 2004, 2006 and 2007. Mosquito eggs were collected from various sites in Wisconsin and Minnesota. They were reared in the laboratory and adults were tested for LACV antigen by immunofluorescence assay. RNA was isolated from the abdomen of infected mosquitoes and portions of the small (S), medium (M) and large (L) viral genome segments were amplified by RT-PCR and sequenced. Overall, the viral sequences from 40 infected mosquitoes and 5 virus isolates were analyzed. Phylogenetic and linkage disequilibrium analyses revealed that approximately 25% of infected mosquitoes and viruses contained reassorted genome segments, suggesting that LACV segment reassortment is frequent in nature.
Large naturally-produced electric currents and voltage traverse damaged mammalian spinal cord
Authors: Zuberi Mahvash , Liu-Snyder Peishan , ul Haque Aeraj , Porterfield David M , Borgens Richard B
Published: December 2008

Background

Immediately after damage to the nervous system, a cascade of physical, physiological, and anatomical events lead to the collapse of neuronal function and often death. This progression of injury processes is called "secondary injury." In the spinal cord and brain, this loss in function and anatomy is largely irreversible, except at the earliest stages. We investigated the most ignored and earliest component of secondary injury. Large bioelectric currents immediately enter damaged cells and tissues of guinea pig spinal cords. The driving force behind these currents is the potential difference of adjacent intact cell membranes. For perhaps days, it is the biophysical events caused by trauma that predominate in the early biology of neurotrauma.

Results

An enormous (≤ mA/cm2) bioelectric current transverses the site of injury to the mammalian spinal cord. This endogenous current declines with time and with distance from the local site of injury but eventually maintains a much lower but stable value (< 50 μA/cm2).

The calcium component of this net current, about 2.0 pmoles/cm2/sec entering the site of damage for a minimum of an hour, is significant. Curiously, injury currents entering the ventral portion of the spinal cord may be as high as 10 fold greater than those entering the dorsal surface, and there is little difference in the magnitude of currents associated with crush injuries compared to cord transection. Physiological measurements were performed with non-invasive sensors: one and two-dimensional extracellular vibrating electrodes in real time. The calcium measurement was performed with a self-referencing calcium selective electrode.

Conclusion

The enormous bioelectric current, carried in part by free calcium, is the major initiator of secondary injury processes and causes significant damage after breach of the membranes of vulnerable cells adjacent to the injury site. The large intra-cellular voltages, polarized along the length of axons in particular, are believed to be associated with zones of organelle death, distortion, and asymmetry observed in acutely injured nerve fibers. These data enlarge our understanding of secondary mechanisms and provide new ways to consider interfering with this catabolic and progressive loss of tissue.
Two new splice variants in porcine PPARGC1A
Authors: Erkens Tim , Bilek Karel , Van Zeveren Alex , Peelman Luc J
Published: December 2008

Background

Peroxisome proliferator-activated receptor γ coactivator 1α (PPARGC1A) is a coactivator with a vital and central role in fat and energy metabolism. It is considered to be a candidate gene for meat quality in pigs and is involved in the development of obesity and diabetes in humans. How its many functions are regulated, is however still largely unclear. Therefore a transcription profile of PPARGC1A in 32 tissues and 4 embryonic developmental stages in the pig was constructed by screening its cDNA for possible splice variants with exon-spanning primers.

Findings

This led to the discovery of 2 new splice variants in the pig, which were subsequently also detected in human tissues. In these variants, exon 8 was either completely or partly (the last 66 bp were conserved) spliced out, potentially coding for a much shorter protein of respectively 337 and 359 amino acids (aa), of which the first 291 aa would be the same compared to the complete protein (796 aa).

Conclusion

Considering the functional domains of the PPARGC1A protein, it is very likely these splice variants considerably affect the function of the protein and alternative splicing could be one of the mechanisms by which the diverse functions of PPARGC1A are regulated.
Converted-wave splitting estimation and compensation
Authors: Simmons James L.
Published: December 2008

Converted-wave (C-wave) splitting estimation and compensation (SEAC) estimates and removes the effects of shear-wave splitting from C-wave data. A locally 1D earth is assumed where a priori rotation of the field data to radial-transverse coordinates is valid. Subsurface fractures (horizontal transverse isotropy [HTI] layers are assumed) polarize C-wave reflection energy onto the transverse component, and introduce azimuth-dependent traveltime variations to the radial component. SEAC estimates the fast principal direction of the fractures, and the amount of traveltime splitting, from input radial and transverse azimuth-sectored stacks. SEAC also produces a splitting-compensated radial component, and a data misfit transverse component. Local fracture variations not accounted for in the coarse-interval inversion may be interpreted in the data misfit. Synthetic data generated by anisotropic reflectivity modeling for a model containing two HTI layers having different principal directions was used to illustrate SEAC. The field data example used was from a large3-C, 3D Vectorseis survey from onshore China. Preprocessed C-wave data (radial and transverse components) were prestack time migrated into offset planes within 10-degree azimuth sectors. These data were then corrected for residual moveout (azimuth-independent correction), and stacked over offset to produce azimuth-sectored stack gathers that were input to SEAC. SEAC estimated the azimuth of the fast principal direction [Formula: see text] and the amount of traveltime splitting [Formula: see text] that describe the overburden anisotropy. Spatially variable parameter estimates for the entire 3D data set, ([Formula: see text] and [Formula: see text]), produce significantly reduced energy on the transverse component at all record times after inversion. Azimuth-dependent traveltime variations on the input radial data were also significantly reduced at all record times, resulting in a postinversion radial full-azimuth stack having improved reflection continuity and temporal bandwidth. The data misfit (transverse component after inversion) potentially revealed local variations in shear-wave splitting not accounted for by the overburden layer-stripping correction.
Second Cancers After Squamous Cell Carcinoma and Adenocarcinoma of the Cervix
Authors: Chaturvedi Anil K. , Kleinerman Ruth A. , Hildesheim Allan , Gilbert Ethel S. , Storm Hans , Lynch Charles F. , Hall Per , Langmark Froydis , Pukkala Eero , Kaijser Magnus , Andersson Michael , Fossa Sophie D. , Joensuu Heikki , Travis Lois B. , Engels Eric A.
Published: December 2008

Purpose

Although cervical squamous cell carcinoma (SCC) and adenocarcinoma (AC) are both caused by human papillomavirus (HPV) infection, they differ in cofactors such as cigarette smoking. We assessed whether these cofactor differences translate into differences in second cancer risk.

Patients and Methods

We assessed second cancer risk among 85,109 cervical SCC and 10,280 AC survivors reported to population-based cancer registries in Denmark, Finland, Norway, Sweden, and the United States. Risks compared to the general population were assessed using standardized incidence ratios (SIR).

Results

Overall cancer risk was significantly increased among both cervical SCC survivors (n = 10,559 second cancers; SIR, 1.31; 95% CI, 1.29 to 1.34) and AC survivors (n = 920 second cancers; SIR, 1.29; 95% CI, 1.22 to 1.38). Risks of HPV-related and radiation-related cancers were increased to a similar extent among cervical SCC and AC survivors. Although significantly increased in both groups when compared with the general population, risk of smoking-related cancers was significantly higher among cervical SCC than AC survivors (P = .015; SIR for cervical SCC = 2.07 v AC = 1.78). This difference was limited to lung cancer (SIR for cervical SCC = 2.69 v AC = 2.18; P = .026). The increased lung cancer risk among cervical AC survivors was observed for both lung SCC and lung AC. SIRs for second cancers of the colon, soft tissue, melanoma, and non-Hodgkin's lymphoma were significantly higher among cervical AC than SCC survivors.

Conclusion

The second cancer profiles among cervical SCC and AC survivors mirror the similarities and differences in cofactors for these two histologies. Because smoking is not a cofactor for cervical AC, the increased lung cancer risk suggests a role for additional factors.
Medication Errors Among Adults and Children With Cancer in the Outpatient Setting
Authors: Walsh Kathleen E. , Dodd Katherine S. , Seetharaman Kala , Roblin Douglas W. , Herrinton Lisa J. , Von Worley Ann , Naheed Usmani G. , Baer David , Gurwitz Jerry H.
Published: December 2008

Purpose

Outpatients with cancer receive complicated medication regimens in the clinic and home. Medication errors in this setting are not well described. We aimed to determine rates and types of medication errors and systems factors associated with error in outpatients with cancer.

Methods

We retrospectively reviewed records from visits to three adult and one pediatric oncology clinic in the Southeast, Southwest, Northeast, and Northwest for medication errors using established methods. Two physicians independently judged whether an error occurred (κ = 0.65), identified its severity (κ = 0.76), and listed possible interventions.

Results

Of 1,262 adult patient visits involving 10,995 medications, 7.1% (n = 90; 95% CI, 5.7% to 8.6%) were associated with a medication error. Of 117 pediatric visits involving 913 medications, 18.8% (n = 22; 95% CI, 12.5% to 26.9%) were associated with a medication error. Among all visits, 64 of the 112 errors had the potential to cause harm, and 15 errors resulted in injury. There was a range in the rates of chemotherapy errors (0.3 to 5.8 per 100 visits) and home medication errors (0 to 14.5 per 100 visits in children) at different sites. Errors most commonly occurred in administration (56%). Administration errors were often due to confusion over two sets of orders, one written at diagnosis and another adjusted dose on the day of administration. Physician reviewers selected improved communication most often to prevent error.

Conclusion

Medication error rates are high among adult and pediatric outpatients with cancer. Our findings suggest some practical targets for intervention, including improved communication about medication administration in the clinic and home.
Fluorouracil, Leucovorin, and Oxaliplatin With and Without Cetuximab in the First-Line Treatment of Metastatic Colorectal Cancer
Authors: Bokemeyer Carsten , Bondarenko Igor , Makhson Anatoly , Hartmann Joerg T. , Aparicio Jorge , de Braud Filippo , Donea Serban , Ludwig Heinz , Schuch Gunter , Stroh Christopher , Loos Anja H. , Zubel Angela , Koralewski Piotr
Published: December 2008

Purpose

This randomized study assessed whether the best overall response rate (ORR) of cetuximab combined with oxaliplatin, leucovorin, and fluorouracil (FOLFOX-4) was superior to that of FOLFOX-4 alone as first-line treatment for metastatic colorectal cancer. The influence of KRAS mutation status was investigated.

Patients and Methods

Patients received cetuximab (400 mg/m2 initial dose followed by 250 mg/m2/wk thereafter) plus FOLFOX-4 (oxaliplatin 85 mg/m2 on day 1, plus leucovorin 200 mg/m2 and fluorouracil as a 400 mg/m2 bolus followed by a 600 mg/m2 infusion during 22 hours on days 1 and 2; n = 169) or FOLFOX-4 alone (n = 168). Treatment was continued until disease progression or unacceptable toxicity. KRAS mutation status was assessed in the subset of patients with assessable tumor samples (n = 233).

Results

The confirmed ORR for cetuximab plus FOLFOX-4 was higher than with FOLFOX-4 alone (46% v 36%). A statistically significant increase in the odds for a response with the addition of cetuximab to FOLFOX-4 could not be established (odds ratio = 1.52; P = .064). In patients with KRAS wild-type tumors, the addition of cetuximab to FOLFOX-4 was associated with a clinically significant increased chance of response (ORR = 61% v 37%; odds ratio = 2.54; P = .011) and a lower risk of disease progression (hazard ratio = 0.57; P = .0163) compared with FOLFOX-4 alone. Cetuximab plus FOLFOX-4 was generally well tolerated.

Conclusion

KRAS mutational status was shown to be a highly predictive selection criterion in relation to the treatment decision regarding the addition of cetuximab to FOLFOX-4 for previously untreated patients with metastatic colorectal cancer.
Lesbian Use and Abuse of Alcohol
Authors: Roberts Susan Jo , Tarmina M. Suzanne , Grindel Cecelia Gatson , Patsdaughter Carol A. , DeMarco Rosanna
Published: December 2008

The Boston Lesbian Health Project II, a national survey of 1139 self-identified lesbian women, found higher rates of drinking alcohol, heavy alcohol intake and self reported alcoholism than in national studies of women in general. Several known risk factors for alcoholism were higher in lesbians who self defined as alcoholic in this sample: family history of alcoholism and drug abuse, rape and childhood sexual abuse and report of having made a suicide attempt. These findings are consistent with other studies that found a high rate of drinking alcohol, alcohol abuse and problem drinking among lesbians. The reasons for these findings are not clear and further research is needed to continue to explore the reasons.
Physicians’ Knowledge of Alcohol, Tobacco and Folic Acid in Pregnancy
Authors: Lefebvre L. G. , Ordean A. , Midmer D. , Kahan M. , Tolomiczenko G.
Published: December 2008

Objective

To assess: (1) physicians’ knowledge and clinical confidence regarding problematic substance use in pregnancy compared to folic acid, and (2) physicians’ desire for education in this area and their preferred learning modalitiestools.

Design

Self-administered survey.

Setting

Family Medicine Forum 2004 in Toronto, Canada.

Participants

Physicians attending Family Medicine Forum2004 in Toronto who provide antenatal care.

Main Outcome Measures

Knowledge of folic acid, smoking and alcohol in pregnancy. Clinical confidence and interest in resources regarding problematic substance use in pregnancy.

Results

Sixty-six surveys completed. Physicians answered 92.3% of folic acid questions correctly, compared to 82.0% for nicotine and 57.1% for alcohol. Scores were higher on questions about effects of nicotine and alcohol use in pregnancy than on questions about treatment options. A perceived inability to influence clinical outcomes and a lack of professional resources regarding substance use in pregnancy were also identified. Physicians were interested in learning more about problematic substance use in pregnancy, particularly from continuing medical education events, websites and pocket cards.

Conclusion

Participants’ level of knowledge regarding substance use in pregnancy was significantly lower than their knowledge of folic acid, as was their clinical confidence. This lack of knowledge was not attributable to disinterest and clearly more educational resources are needed to address this topic.
Understanding Treatment Readiness in Recently Assessed, Pre-Treatment Substance Abusers
Authors: Rapp Richard C. , Xu Jiangmin , Carr Carey A. , Lane D. Timothy , Redko Cristina , Wang Jichuan , Carlson Robert G.
Published: December 2008

The goal of this study was to more fully understand readiness for treatment in a pre-treatment sample of 446 substance abusers. Structural Equation Modeling (SEM) was used to: (1) examine the relationships between readiness factors identified in the Pre-Treatment Readiness Scale; and (2) identify the effects of predisposing, illness, and inhibiting determinants on the factors. As with in-treatment samples, Problem Recognition was found to influence Treatment Readiness, although through a different intervening factor, Desire for Change rather than Desire for Help. A fourth factor, Treatment Reluctance, was also influenced by the Desire for Change factor. Fixed characteristics such as age and gender had minimal influences on readiness factors, as did inhibiting characteristics that reflected recent functioning. Illness characteristics including drug severity and perceived treatment barriers had a more robust influence on readiness factors. This study provides an increased understanding of readiness for treatment among pre-treatment substance abusers and also supported the construct validity of the Pre-Treatment Readiness Scale.
High Suicide Risk after the Development of Cognitive and Working Memory Deficits Caused by Cannabis, Cocaine and Ecstasy Use
Authors: Pompili Maurizio , Lester David , Girardi Paolo , Tatarelli Roberto
Published: December 2008

We report the case of attempted suicide by a 30-year-old man who had significant cognitive deficits that developed after at least three years of polysubstance use with cannabis, methylenedioxymethamphetamine (MDMA, “ecstasy”) and cocaine. The patient reported increasing difficulties in his professional and interpersonal life which may have been associated with his cognitive dysfunction caused by his poly-drug use. In this setting, the patient complained of increasing symptoms of depression, including feelings of hopelessness and helplessness, and multi somatic complaints (based on DSM-IV criteria). These depressive symptoms led to the development of active suicidal ideation and ultimately to a suicide attempt. We propose that the patient's cognitive deficits resulted directly from his polysubstance use and contributed to his depression, suicide attempt and current serious suicidal ideation.
Why are Recovering Substance Abuse Counselors Paid Less?
Authors: Olmstead Todd A. , Johnson J. Aaron , Roman Paul M. , Sindelar Jody L.
Published: December 2008

The goal of this study is to determine why recovering substance abuse counselors are paid less, on average and controlling for other factors, than nonrecovering substance abuse counselors. The data come from the 2002-2003 wave of the National Treatment Center Study and consist of 1,487 full-time counselors from nationally representative samples of public and private substance abuse treatment programs in the United States. We use ordinary least squares regression models to estimate the differential impacts of numerous personal and program characteristics on the self-reported annual salaries of recovering and nonrecovering counselors. We found that differential returns to a college degree explain the vast majority of the difference in pay by counselor recovery status. Compared to nonrecovering counselors, recovering counselors receive, on average and controlling for other factors, $2,580 less per year for a college degree. Several possible explanations for this result are discussed, including the possibility that recovering counselors are willing to accept lower pay as a reflection of their “calling” to this work.
Patients' Attitude Towards the Use of a Chaperone in Breast Examination
Authors: Sinha S , De A , Jones N , Jones M , Williams RJ , Vaughan-Williams E
Published: December 2008

INTRODUCTION

The aim of this study was to assess the attitude and the preferences of patients towards the use of a chaper one during breast examination.

PATIENTS AND METHODS

A two-part questionnaire was circulated among 204 consecutive new patients, attending both symptomatic breast and screened assessment clinics.

RESULTS

A total of 200 questionnaires were fully completed and returned. Although 104 (52%) patients felt that they did not need a chaperone during breast examination, 65 (33%) preferred to have one. Amongst these 65 patients, the majority (52%) wanted a chaperone in the presence of both a male and female doctor whereas 19 (29%) wanted a chaperone in the presence of a male doctor. When patients were asked which person would be the best chaperone for them, 63 patients (32%) preferred their spouse to act as a chaperone, whereas 57 (29%) preferred a clinic nurse. However, the majority of teenagers and young adults (10–30 years) preferred their parents to act as a chaperone. On asking the reason for preferring a chaperone during breast examination, 69% felt a chaperone helped them to feel more at ease, 28% felt they get more support, 23% get less embarrassed and 10% felt safer. The majority (54%) preferred the nurse to offer a chaperone instead of the doctor (22%). Patients generally said they were comfortable in asking for a chaperone (68%). Overall, 68% of patients considered the offer of a chaperone as a sign of respect and the majority felt the attitude (32%) and gender (20%) of the clinician are the two most important factors influencing the chaperone use. Most patients were of the opinion that the presence of a chaperone does not have a negative effect on the doctor-patient relationship (75%), patient confidentiality (74%) and do not cause embarrassment (68%). Following their assessment in clinic, the patients' views on the use of a chaperone were not significantly changed.

CONCLUSIONS

There is a wide variety of opinion among patients about the desirability of a chaperone during breast examination. However, the majority consider the offer of a chaperone as a sign of respect and many patients commented that the presence of a chaperone is important for medicolegal protection of both patient and clinician. In recent years, there has been an increasing call from medicolegal societies and medical insurance companies for greater use of chaperones during intimate examinations. We feel that recommendations regarding the use of a chaperone should now be incorporated into the British Association of Surgical Oncology guidelines.
Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study
Authors: Palanivelu Chinnusamy , Rangarajan Muthukumaran , Jategaonkar Priyadarshan Anand , Madankumar Madhupalayam Velusamy , Anand Natesan Vijay
Published: December 2008

INTRODUCTION

Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from ‘postcholecystectomy syndrome’. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi.

PATIENTS AND METHODS

We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant.

RESULTS

The mean duration between first and second surgery was 8.35 months (range, 6–10.7 months). The mean operating time was 103.5 min (range, 75–132 min). Duration of hospital stay was 4–12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy 13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality.

CONCLUSIONS

Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. ‘T’-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.
Long-Term Follow-Up of the Use of the Jones' Intestinal Tube in Adhesive Small Bowel Obstruction
Authors: Fazel MZ , Jamieson RW , Watson CJE
Published: December 2008

INTRODUCTION

Intestinal intubation with a Jones' tube has been suggested to reduce the incidence of recurrent adhesive bstruction. This paper describes our experience of this technique.

PATIENTS AND METHODS

A retrospective case-note review was performed on 68 patients admitted to a teaching hospital who re identified as having had the Jones' intestinal tube placed over an 11-year period from 1980 to 1991, with a follow-up to 2003. The indication for placement and outcome following placement of the tube were documented with particular reference to recurrence of adhesive small bowel obstruction.

RESULTS

Data on 63 patients were available. Of these, 7 had the Jones' tube placed prophylactically after pouch surgery and re thus excluded from the main study. Of the remaining 56 patients, all had the Jones' tube placed for recurrent adhesive small bowel obstruction with a median follow-up of 92 months, representing 353 patient-years. In 51 patients, the Jones' tube was placed during emergency surgery, while five others had it placed electively. A total of 1.7 cases of adhesive small bowel obstruction per 100 years of patient follow-up were identified following use of the Jones' tube compared to 12.9 cases per 100 patient-years prior to the use of the Jones' tube.

CONCLUSION

Intestinal intubation with a Jones' tube is a safe and effective method of preventing recurrent adhesive obstruction.
Stenting for Large Bowel Obstruction – Evolution of a Service in a District General Hospital
Authors: Olubaniyi BO , McFaul CD , Yip VSK , Abbott G , Johnson M
Published: December 2008

INTRODUCTION

Stenting for obstructing large bowel malignancy is a technique that is gradually increasing in popularity. The two main indications are for palliation and as a ‘bridge to surgery’. Some of the proposed advantages of colonic stenting are safety, reduced morbidity and mortality, avoidance of a stoma and shorter hospital stay.

PATIENTS AND METHODS

This was a retrospective study of consecutive patients who had self-expanding metal stents deployed between February 2001 and June 2006. Data were collected from the MEDITECH electronic integrated healthcare information support system and case note review. Data concerning demographics, primary diagnosis, and location of malignant stricture, indication for stenting, method of stenting, outcome, complications and mortality rates were obtained and analysed on Microsoft Excel.

RESULTS

Colonic stenting was first performed in the Countess of Chester Hospital in 2001. Thirty-two procedures have been performed since then. The median age was 80 years and the majority of cases were palliative (28 of 32), with three of the remaining cases successfully stented as a ‘bridge to surgery’. Initially, this was performed as a radiological procedure; however, the success rate was noted to be better if a surgical endoscopist was also involved. We recorded a 57% clinical success rate in the group of patients that had the colonic stent inserted radiologically; however, the group where this was inserted as a combined radiological and endoscopic procedure yielded a clinical success rate of 78%. We experienced stent-migration in four patients (13%) and rectal perforation in one patient (3%). There was no tumour re-obstruction or stent-related mortality.

CONCLUSIONS

A colonic stenting service can be introduced into a district general hospital with low morbidity and mortality. A well-motivated team is required and combined endoscopic and radiological approach in our hands appears to offer the best results.
Supporting Limb Reconstruction Patients: A Fine-Wire Circular Fixator Support Group
Authors: Ede MP Newton , Malik Mha , Prudhoe L , Miller C , Khan SA , Wilkes RA
Published: December 2008

INTRODUCTION

External fixator frames are widely used in limb reconstruction surgery. They are used for relatively long periods and the multidimensional impact on patients is documented. We examined the role of a nurse-led specialist group when supporting patients both pre-operatively and postoperatively.

PATIENTS AND METHODS

All patients with external fixators were contacted via postal questionnaire. Questions asked covered regularity of attendance at the specialist group, information received and problems with the frames.

RESULTS

Thirty-seven patients replied. Twenty-one had attended the clinic and nearly all (32) had been offered the opportunity to attend. Most reported being well prepared for surgery and felt that the information given was satisfactory. Problems were generally addressed within the group and patients attended the group with frame-related problems before attending their general practitioner or the accident and emergency department. All patients found the group environment supportive.

CONCLUSIONS

We describe a unique patient support group. To our knowledge, it is the first in the country. It is a valuable resource in equipping patients prior to surgery as well as dealing with problems that arise with the frame in situ. We recommend it to other limb reconstruction units.
The Cost of Ignoring Acute Cholecystectomy
Authors: Garner JP , Sood SK , Robinson J , Barber W , Ravi K
Published: December 2008

INTRODUCTION

Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications.

PATIENTS AND METHODS

The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place.

RESULTS

In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over £40,000. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place.

CONCLUSIONS

Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.
A One-Stop Clinic for Men with Testicular Anxiety
Authors: Moore James A , O'Neil Cathy , Fawcett Derek
Published: December 2008

INTRODUCTION

Testicular lumps and orchialgia both cause considerable anxiety, usually related to concerns about possible cancer.

PATIENTS AND METHODS

We established a rapid-access testicular clinic staffed by a urologist and a specialist ultrasonographer in order to delay the time to a definitive diagnosis.

RESULTS

Over a 30-month period, 845 men underwent clinical examination and scrotal ultrasonography. Overall, 4% of men were found to have testicular cancer. The majority of men were found to have normal testes or minor abnormalities and could be re-assured.

CONCLUSIONS

This one-stop clinic reduces the time to a definitive diagnosis which may reduce anxiety suffered by men with testicular complaints and allows rapid identification of those harbouring a testicular malignancy.
Party conferences: shaping the debate
Authors: Webster Daniel
Published: December 2008

In autumn and for the second year running, the College participated in a full programme of events at all three political party conferences. Central to this was a series of seminars organised by the College on the collection and use of outcome data, which brought together key stakeholders from across the parties and the wider health sector. These meetings provided an ideal setting in which to launch a new policy briefing on this significant topic.
The College has teeth!
Authors: Shepherd Jonathan
Published: December 2008

As part of the modernisation of dental research arrangements that it is leading in the College, the Faculty of Dental Surgery (FDS) has funded the cataloguing and display of its world-famous odontological collection. This comprises a unique range of dental and related specimens from all corners of the globe, some of them very impressive indeed, which will enhance the attractiveness and impact of the renowned College museum. A further proposal is to recruit a case PhD student to carry out original research on the primate specimens, known as the Hill collection.
Joint report warns of looming problems in working hours
Authors: Worrall Matthew
Published: December 2008

Is your hospital ready for the 48-hour week? Do you think your rota as it stands is going to cope? If every member of your clinical team lost eight hours a week from tomorrow, do you think you could continue to offer patients a proper service? At present, for many fellows and members the answer to these questions is probably no. Over half of respondents to a survey undertaken by this College, alongside the Royal College of Anaesthetists, declared they were unprepared for the European Working Time Directive (EWTD) August 2009 deadline of 48 hours per week.
Sisters and consultants
Authors: Black John
Published: December 2008

I mentioned in my last newsletter some interesting dialogue with the Royal College of Nursing (RCN), concerning the role of the ward sister. The RCN has recently produced some policy guidance entitled, The Ward Sister and Charge Nurse Role: Key to Quality Patient Care. The conclusion is that 'the role of the ward sister remains central and absolutely critical to the organisation and delivery of hospital nursing and high standards of patient care'. As you might imagine, this was music to my ears and to those of Mike Parker, Council lead for nursing issues, who attended the meetings.
U.S. Sludge Management Guidelines Explained
Authors: Fradkin L , Bruins RJF , Stara JF , Rubin AB , Lomnitz ED
Published: December 2008

The U.S. Environmental Protection Agency (EPA) is developing comprehensive technical regulations under the Clean Water Act Section 405(d) on the reuse and disposal of municipal wastewater sludge. The reuse and disposal options are land application (including distribution and marketing), landfilling, incineration, and ocean disposal. This paper identifies the key questions to be addressed by EPA and the tasks and major steps to pursue in answering these key questions.
Regional and State Needs in Sampling and Analytical Methodology
Authors: Little JA , Finger JH , Knight RW
Published: December 2008

Sampling and analytical methods for chemical and biological analyses of sediments, sludges, dredge spoils, and soils samples are available in a number of publications (which will be described). There are also draft and interim Environmental Protection Agency (EPA) documents in wide use. There are needs for new methods to deal with such areas as long-term monitoring of Superfund remedial actions sites and body-contact toxicity testing at hazardous waste sites. Greater needs exist for: (1) standardization to insure that data for a particular environmental monitoring program will be comparable throughout the country; (2) consolidation of methodology across media/EPA program lines, for example, for water quality and hazardous waste investigation; (3) guidance on sample preservation methodology; (4) validation of existing methodology for organic compounds other than those on the priority pollutant list or the hazardous substance (RCRA Appendix VIII) list; and (5) reducing lag time to update or develop new methodology to accompany changing or new environmental regulations.
A Computerized Data Management System for U.S. EPA QA/QC Methods
Authors: Panko AW , DiFruscio TO
Published: December 2008

This paper describes a user-friendly IBM-PC compatible computer program capable of managing the Quality Assurance/Quality Control (QA/QC) requirements of any size laboratory performing analysis to Environmental Protection Agency (EPA) specifications. The program design criteria addresses the QA/QC requirements of the analysis of sludges, sediments, waters, and other materials. The database is initialized using well established standard data for solids and liquids (for example, Standard Reference Materials from the National Bureau of Standards). The analyst enters the following QC data for the parameters of interest into the database: found concentrations for internal and/or external standards, values for blanks, spike recoveries, replicates, duplicates, and midpoint internal standards. This step is performed for each parameter for each discrete sample set or analytical run. The program then generates control charts for these parameters and creates a QC data sheet, which documents all aspects of the QA/QC requirements for chemical analysis as specified by the EPA. This database management system also transfers the QA/QC documentation into a universal format capable of being used in standard statistical and spreadsheet software, such as Lotus 1-2-3, Supercalc 4, Chartmaster, and others. This allows a wide range of statistical and graphical manipulations to be performed not only on the QA/QC data but on the analytical data as well.
Interpretation of bed Sediment Trace Metal Data: Methods for Dealing with the Grain Size Effect
Authors: Horowitz AJ , Elrick KA
Published: December 2008

One of the most significant factors controlling bed-sediment capacity for collecting and concentrating trace metals is grain size—as grain size decreases, metal levels increase. As a result, bed sediments can display marked chemical heterogeneity, even over relatively short distances. Consequently, the interpretation of water-quality trends through space or time based upon bed sediment-trace metal analysis requires consideration of the grain size effect. Commonly, the grain size effect is minimized by either mathematical normalization of bulk chemical data based upon an independent grain size analysis, or physical separation of a size range or fraction followed by a chemical analysis of the separated material. Normalization procedures are useful for clarifying trends but often produce over- or underestimates of metal concentrations. On the other hand, physical separation followed by chemical analysis clarifies trends and produces accurate measurements of metal levels. Based on a detailed grain size and chemical analysis of 17 samples from a wide variety of aquatic settings, and from consideration of factors such as mineralogy, ease of handling, likelihood of contamination, and cost, the most appropriate size separation for reconnaissance surveys or monitoring studies is <63 µm. When an initial survey or study indicates that a trend or potential problem exists, it is advantageous to isolate the metal-bearing fraction for further study. Although many techniques are available for separating material finer than 63 μm into individual size fractions, air elutriation appears to be a method that minimizes such problems as contamination, chemical alteration, and limited masses of separated material. Size distributions obtained by air elutriation are similar to those derived by nonchemically dispersed pipet analyses. Contaminant-free size fractions can be separated from bulk samples for the analysis of copper, zinc, lead, chromium, cobalt, arsenic, antimony, selenium, iron, manganese, aluminum, titanium, and probably cadmium.
Development, Evaluation, and Use of the Toxicity Characteristic Leaching Procedure (TCLP)
Authors: Kimmell TA
Published: December 2008

As a result of the Environmental Protection Agency's (EPA) efforts to expand the capability of the Extraction Procedure (EP) leaching test to address organic components, including volatiles, and also to address some of its operational problems, a new leaching test, known as the Toxicity Characteristic Leaching Procedure (TCLP), has been developed. This test has been proposed for use in the Land Disposal Restrictions Rule and will soon be proposed in the expansion of the Extraction Procedure (EP) Toxicity Characteristic. Both actions were mandated by the Hazardous and Solid Waste Amendments of 1984. This paper describes the new leaching test with respect to its development, evaluation, and use. Data are presented regarding precision and ruggedness, and several operational aspects of the procedure are described in detail. Emphasis is placed on a comparison of the existing EP to the TCLP in terms of additional operational and analytical requirements. Finally, several aspects of the test are discussed that are being examined for possible improvement.
Method Development for the Determination of Formaldehyde in Samples of Environmental Origin
Authors: Bicking MKL , Cooke WM , Kawahara FK , Longbottom JE
Published: December 2008

An analytical method was developed for the determination of formaldehyde in samples of environmental origin. After a review of the current literature, five candidate methods involving chemical derivatization were chosen for evaluation. The five derivatization reagents studied were 2,4-dinitrophenylhydrazine (DNPH), 3-methyl-2-benzothiazolinone hydrazone, 2,4-pentanedione, pentafluorophenylhydrazine, and pentafluorobenzyloxyamine. The instrumental techniques used included either high performance liquid chromatography or gas chromatography, based on the nature of the derivative. After determining that the DNPH derivatization could be efficiently performed under mild reaction conditions, this method was chosen as the most appropriate of the five considered and was extensively evaluated. Optimized experimental procedures included a 1-h reaction time, followed by methylene chloride extraction and concentration of the extract. Quantification was best achieved by reverse phase liquid chromatography using absorbance detection at 360 nm. The derivatization of formaldehyde proceeded in high yield with excellent reproducibility and recovery. With the procedures employed, concentrations in the low parts per billion (ppb) range could be determined. Laboratory blank levels were in the 10- to 15-ppb range. An optimized procedure was utilized in studying several matrices, including two samples originating from the pulp and paper industry: a phenol/formaldehyde sludge and a wood dust sample containing urea/formaldehyde glue. The solid samples were extracted using the toxicity characteristic leaching procedure (TCLP) extraction method. Both matrices showed formaldehyde levels that were statistically higher than laboratory blanks. Recovery and reproducibility were excellent for the solid samples. Matrix and derivative storage problems were also evaluated.
Application of Analytical Pyrolysis and Cupric Oxide Oxidation to Characterization of Nonextractable Organic Constitutents in Drilling Fluids and Sediments
Authors: Saue TC , Requejo AG , Brown JS , Ayers RC , Boehm PD
Published: December 2008

A study was conducted to develop analytical methods suitable for the characterization of the nonextractable organic mud additives (organic polymers) in drilling mud formulations and sediments. Two analytical techniques were evaluated for this purpose: analytical pyrolysis, which involves pyrolysis gas chromatography and pyrolysis gas chromatography/mass spectrometry of organic polymers, and a cupric oxide oxidation technique, which is specific for the analysis of lignin-derived organic matter (lignosulfonates). The pyrolysis technique was suitable for characterizing and distinguishing between individual drilling mud additives. However, upon formulating those additives into drilling muds (bentonite, barite, and caustic) and sediments, their relative abundance and total pyrolysis yields decreased greatly. This decrease in abundance and yields in pyrolysis products is thought to be caused by the catalytic and/or sorptive effects of the clay matrix during pyrolysis. As a result, we conclude that the pyrolysis technique has limited application to the characterization of organic polymers in drilling fluids and sediments. The cupric oxide oxidation technique was a sensitive specific indicator of lignosulfonates and, to a lesser extent, lignites in mud formulations. The major oxidation products of the technique are vanillyl phenols, with concentrations that vary, presumably according to lignosulfonate purity, but make up more than 90% of the total lignin-derived oxidation products. Vanillyl phenol content and total lignin content were identified as the most suitable tracers of drilling mud discharges.