bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Gender Bias Exist in the Use of Specialist Health Care?
Authors: Raine Rosalind
Published: January 2017

Objectives:

To investigate the evidence for the existence of gender bias (defined as care provided independently of clinical need) in the use of specialist services by critically appraising the literature.

Methods:

A computer-assisted search of the bibliographic databases PubMed, Medline, EMBASE, Healthstar and Social Science Citation Index for English language papers published from 1966 until May 1999. In addition, four journals were handsearched and the reference lists of identified papers were explored. Retrospective studies were only used when there were insufficient prospective studies.

Results:

One hundred and thirty-eight studies were identified covering five major topics: coronary artery disease; renal transplantation; human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS); mental illness; and other (mainly invasive) procedures. The majority (94) examined coronary artery disease. It appears that men are more likely to undergo non-invasive investigations than women, but that subsequent investigation and treatment shows no clear evidence of gender differences. Men are more likely to undergo renal transplantation and, for those with HIV and AIDS, to receive azidothymidine (zidovudine, AZT) than women. There are some indications that disparities in favour of men also occur for those suffering from cardiac arrhythmias and cerebrovascular disease, and for those undergoing vascular surgery, hip replacement and heart transplantation. In contrast, women are more likely to undergo liver transplantation and cataract surgery. Mental health services may be provided differently for men and women. All these findings are limited by a lack of accurate denominator information and insufficient ability to adjust for prognostic factors.

Conclusions:

Differences in health care use can be due to demand factors (e.g. differences in the prevalence and severity of disease or in patient preferences), supply factors (particularly clinical judgement), or both. There is a need to examine these explanations thoroughly for gender inequalities in order to ensure that equity (lack of bias) is achieved. There is also a need for higher quality studies if differences are to be attributed conclusively to bias or not.
Introduction to the Practice of Telemedicine
Authors: Craig John , Petterson Victor
Published: January 2017

Telemedicine is the delivery of health care and the exchange of health-care information across distances. It is not a technology or a separate or new branch of medicine. Telemedicine episodes may be classified on the basis of: (1) the interaction between the client and the expert (i.e. realtime or prerecorded), and (2) the type of information being transmitted (e.g. text, audio, video). Much of the telemedicine which is now practised is performed in industrialized countries, such as the USA, but there is increasing interest in the use of telemedicine in developing countries. There are basically two conditions under which telemedicine should be considered: (1) when there is no alternative (e.g. in emergencies in remote environments), and (2) when it is better than existing conventional services (e.g. teleradiology for rural hospitals). For example, telemedicine can be expected to improve equity of access to health care, the quality of that care, and the efficiency by which it is delivered. Research in telemedicine increased steadily in the late 1990s, although the quality of the research could be improved – there have been few randomized controlled trials to date.
A Cost-Consequences Analysis of Minor Injuries Telemedicine
Authors: Noble Sian M , Coast Joanna , Benqer Jonathan R
Published: January 2017

A cost-consequences analysis of minor injuries telemedicine was performed alongside a randomized controlled trial in a UK peripheral emergency department. The main outcome measures were safety and clinical effectiveness at seven days after presentation. Costs to the National Health Service (NHS) and patients and their families, for 253 patients, were estimated for seven days following randomization. The mean cost to the NHS for the telemedicine patients was £78.61 and for those assessed routinely was £39.15. For costs incurred by patients and their families the respective figures were £58.24 and £43.95. Sensitivity analysis showed the initial results to be robust. Telemedicine was a more expensive option for providing minor injuries care in a general-practitioner-supported peripheral emergency department, while consequences did not vary greatly between the different options.
An Assessment of the Telehealth Needs and Health-Care Priorities of Tanna Island: A Remote, Under-Served and Vulnerable Population
Authors: Khazei Afshin , Jarvis-Selinger Sandra , Ho Kendall , Lee Anna
Published: January 2017

We surveyed eight Canadian physicians who had each provided medical care for six months on the remote and under-served island of Tanna in Vanuatu. The most frequently encountered medical problems on Tanna were infectious diseases (tuberculosis, hepatitis, abscesses, malaria, pneumonia, typhoid fever, meningitis and skin infections). When physicians were asked about the top three health-care priorities, they ranked tuberculosis control, clean water and improved health-care delivery/communication between hospital and outposts as most important. The key issues were: (1) basic public health needs and infrastructure development are higher in priority than telehealth; (2) telehealth consultants must have knowledge pertinent to local conditions and resources available to the population; (3) electronic equipment suited to tropical environments is needed; (4) projects must be developed locally rather than internationally. Understanding how telehealth can provide support to health professionals under challenging conditions may assist with the health priorities in developing countries and potentially provide access to resources both locally and internationally.
A Teleradiology Case Conference System
Authors: Teslow T N , Gilbert R A , Grant W H , Woo S Y , Butler E B , Liem J H
Published: January 2017

To investigate the use of teleradiology in the quality assurance programme of a multicentre radiotherapy practice, we installed image acquisition and display workstations at each of two affiliated radiation oncology clinics. A commercial diagnostic teleradiology system was successfully modified to suit the requirements of the radiotherapy subspecialty. The system allowed intersite transmission of images, access to high-resolution images from each site and, by use of laser film scanners, made accessible all types of radiation therapy image. Transmission speed and storage capacity were better than expected. Using the system, radiation oncology residents and staff reviewed 83 complex cases over eight months. Case presentation and discussion were enhanced. In the same period, 276 cases were reviewed by conference in person. Case conferences for quality assurance conducted with the teleradiology system influenced changes in treatment planning as effectively as those conducted in person. Equivalent treatment outcomes were produced. The teleradiology system facilitated quality assurance through review of patients' radiation treatments by allowing natural interactive consultation.
User Adoption Issues in Renal Telemedicine
Authors: Mitchell B R , Mitchell J G , Disney A P S
Published: January 2017

We carried out a longitudinal survey to evaluate the users' attitudes to the introduction of telemedicine into the dialysis units of a renal ward in South Australia. The first questionnaire was distributed to all members of staff involved with the introduction of the system. There were 44 responses (80%). Staff were fairly positive about the telemedicine system, and felt that it was easy to use and reliable. They also clearly felt that the confidentiality and privacy offered by the system in an open ward were unsatisfactory. A second questionnaire was distributed to all staff about six months later and there were 40 responses (66%). Of these, 22 could be matched with the responses from the first survey (a response rate of 50% from the first sample). There were no significant differences in the staff members' feelings between the two surveys, except in two cases: there were significant changes in staff opinion about the degree of confidentiality ( P<0.05) and privacy ( P<0.01) offered by the system, with attitudes becoming more positive in each case. The results indicate the need for dialogue with users, in order to address their concerns regarding the system and practical difficulties. This study highlights the importance of planning, effort, cooperation and an appropriate culture within a renal unit in order for telemedicine to be accepted.
Outcome after Transthoracic Resection of Carcinoma of the Oesophagus and Oesophago-Gastric Junction
Authors: Jensen L. S. , Pilegaard H. K. , Puho E. , Pahle E. , Melsen N. C.
Published: January 2017

Aims:

To assess the postoperative morbidity and mortality, length of stay and long-term survival after resection of carcinoma of the oesophagus and gastro-oesophageal junction, after establishment of a new surgical team unit between thoracic and gastroenterologic surgeons.

Methods:

We analysed the prospective collected data of 166 consecutive patients who underwent a transthoracic oesophageal resection between June 1997 and December 2003.

Results:

There were 119 men and 47 women. The median age was 63 years (range 36–81). Fifty-five patients (33 %) had squamous cell carcinoma and 111 (67 %) had adenocarcinoma. Postoperative complications occurred in a total of 60 patients (36 %). Ten patients (6 %) died postoperatively, eight (4.8 %) due to medical and two (1.2 %) due to surgical complications. The median postoperative length of stay was 11 days (range 6–75). The overall 3- and 5- years survival was 35.6 % and 30.6 % respectively. Survival was adversely affected by patient age and tumor stage.

Conclusions:

Concentrating resection for carcinoma of the oesophagus and oesophagogastric junction to a dedicated team of specialists, including both gastrointestinal and thoracic surgeons as well as thoracic-anaesthesiological know-how, results in acceptable complication rates as well as low mortality rates especially due to surgical complications.
Intraoperative Cholangiography Can Be Safely Omitted during Laparoscopic Cholecystectomy: A Prospective Study of 413 Consecutive Patients
Authors: Lepner U. , Grünthal V.
Published: January 2017

Background and Aims:

The aim of the study was to show that laparoscopic cholecystectomy (LC) can be performed safely without intraoperative cholangiography (IOC).

Material and Methods:

We conducted a prospective study of 413 consecutive patients with symptomatic gallstone disease, who underwent LC. According to the preoperative clinical, laboratory and ultrasound criteria, 38 patients (9.2 %) were selected for preoperative endoscopic retrograde cholangiography (ERC). All patients were followed postoperatively for symptoms and signs of common bile duct (CBD) stones.

Results:

Preoperative ERC allowed to make a diagnosis of choledocholithiasis in 22 (58 %) of the 38 selected patients. Stone clearance was achieved with endoscopic sphincterotomy (ES) in all cases. Three patients (7.9 %) had an episode of mild self-limited pancreatitis after the procedure. Eight patients (1.9 %) of 413 required conversion from LC to open cholecystectomy. There were no CBD injuries and no death cases. Of the postoperative complications, 1.5 % were recorded during hospital stay. During the follow-up period, for at least 2 years after surgery, retained CBD stones were verified in 6 patients (1.5 %); however, the supposed rate of residual stones was 2.4 %.

Conclusions:

This study demonstrates that performance of selective preoperative ERC with ES when necessary, followed by LC, is an appropriate and safe approach to the treatment of patients with cholecystolithiasis and unsuspected choledocholithiasis. This approach allows to omit IOC and to perform LC safely without biliary duct injuries, ensuring low rate of retained CBD stones in the late follow-up period.
Risk Assessment for Severe Postoperative Hypocalcaemia after Neck Exploration for Primary Hyperparathyroidism
Authors: Kald B. A. , Heath D. I. , Lausen I. , Mollerup C. L.
Published: January 2017

Background and Aims:

A further development of the risk profile for severe postoperative hypocalcaemia after surgery for primary hyperparathyroidism (pHPT) was made with the aim of expanding the group of patients who can be discharged safely after 23 hours.

Methods:

Prospective study with 156 consecutive pHPT patients (158 operations) during 2001 and 2002. Risk factors for postoperative severe hypocalcaemia (ionised calcium <1 mmol/L), were (1) preoperative concentration of parathyroid hormone (PTH) > 35 pmol/L (five times the upper reference value, reference range 1.1 to 6.9), (2) history of previous neck surgery, (3) biopsy/excision of > 2 parathyroid glands or (4) concomitant thyroid surgery.

Results:

The risk factors showed a sensitivity of 100 % (9/9). In 110 of the operations (70%) no risk factors were identified. Postoperative calcium levels were significantly lower after 48 operations with risk factor(s) identified, as compared to the group without risk factors (p < 0.01). Seven of 17 patients (41%) with PTH > 35 pmol/L developed severe postoperative hypocalcaemia. Two of 31 patients (6%) with PTH < 35 pmol/L in the presence of other risk factor(s) developed severe postoperative hypocalcaemia.

Conclusion:

Patients with no risk factor can safely been discharged from hospital on the first postoperative day. Patients with preoperative concentration of PTH > 35 pmol/L (five times the upper reference value) should stay in hospital until nadir level of calcium is reached. Patients with concentration of parathyroid hormone less than 35 pmol/L in the presence of other risk factor(s) may have an early discharge from hospital (second postoperative day) combined with outpatient measurements of calcium levels.
Evidence-Based Medicine in Rapidiy Changing Technologies
Authors: Schroeder T. V.
Published: January 2017

Evidence-based medicine (EBM) is not a randomised controlled trial (RCT), but EBM seeks to apply evidence gained from scientific methods — Which could be RCT — To daily medical practice. Any surgical treatment reflects a certain development technically as well as skills based. The procedure may be modified and refined and the device may be developed and inherent technical weaknesses may need to be corrected. Therefore the best time to conduct a trial may be discussed. The appropriate time to initiate a RCT is when all the participating surgeons or therapists have gone through their learning curve. Special considerations should be given in rapidly developing fields. If started too early the resulting comparison will likely turn out to be irrelevant because the new technology is not fully developed, not mastered or the device may have undergone major modifications rendering the results obsolete. On the other hand, if started too late there is a chance that data may be lost because the technology has already been introduced into the daily clinics and physicians may be unwilling to recruit patients. Or the opposite, that the technique may have been rejected without a proper trial. In this situation it has been suggested to perform a so called tracker trial. In such trials protocols are more flexible without prefixed sample size and will require repeated interim analyses. Often, it will be relevant to supplement the clinical trials with data from large clinical databases — In particular when long term results are needed.
The Role of Vascular Registries in Improving the Management of Abdominal Aortic Aneurysm
Authors: Lepäntalo M. , Venermo M. , Laukontaus S. , Kantonen I.
Published: January 2017

Treatment of abdominal aortic aneurysm (AAA) is one of the vascular surgical index procedures and an important part of the total workload. Whichever way treated, it typically has high mortality and morbidity. Furthermore, endovascular repair is still a relatively new treatment method and under evolution. Therefore continuous quality control with subsequent outcome analysis, benchmarking, intervention and reassessment are mandatory to achieve high level aneurysm care. Vascular registries are tools for this audit. The aim of this review is to focus on the problems and solutions related to attempts to improve the management of abdominal aortic aneurysm with emphasis on the experience gathered in Finland. This includes great variations in dynamics over time in southern Finland. To control the influence of patient selection and case-mix, total hospital mortality is emphasized as the most appropriate outcome measure of the level of treatment of ruptured abdominal aortic aneurysm (RAAA). Total aneurysm mortality (including total hospital mortality of RAAA and other AAA surgery) is introduced as an outcome measure of vascular service.
Volume versus Outcome When Treating Abdominal Aortic Aneurysm Electively — Is There Evidence to Centralise?
Authors: Troëng T.
Published: January 2017

Aim:

To identify evidence for the minimum annual case load of open repairs of abdominal aortic aneurysms compatible with an acceptable perioperative mortality rate.

Method:

A PubMed search resulted in 137 references, sixteen articles with original data on volume and mortality not older than ten years were identified and selected for review

Result:

Three studies found no volume-mortality relationship when controlled for age, sex and medical risk. Six studies verified volume thresholds of 20 procedures per year or more. In seven studies hospital volumes of 7–17 elective abdominal aortic aneurysm (AAA) repairs per year were sufficient to reach a mortality rate of a national average or similar to that of higher volume centres. No studies were published on the minimum annual case-load of EndoVascular Aneurysm Repair (EVA R), or of a combination of EVAR and open repair.

Conclusion:

Recent studies in North America and in Europe indicate that 10–15 procedures annually can be sufficient to safely perform open AAA repairs. Centres regularly performing less should consider referral. Continuous monitoring and audit of risk-adjusted perioperative mortality rates should be practiced in all centres.
Adoption of Single Incision Laparoscopic Cholecystectomy in Small-Volume Hospitals: Initial Experiences of 51 Consecutive Procedures
Authors: Lill S. , Karvonen J. , Hämäläinen M. , Falenius V. , Rantala A. , Grönroos J. M. , Ovaska J.
Published: January 2017

Background and Aims:

Laparoscopic cholecystectomy (LC) via three or four ports has been the standard operation for gallstone disease. Recently, the development of multichannel port devices has allowed LCs to be performed through a single fascial incision in the umbilicus. Here, we report our experiences of the adoption of the single incision laparoscopic cholecystectomy (SILC) in two small-volume community hospitals.

Material and Methods:

From January until July 2010, 51 consecutive patients (41 females and 10 males, the mean age 44 (21–75) years, BMI 26 (18–35)) underwent elective SILC for symptomatic gallstone disease in Salo (n = 29) and Loimaa (n = 22) hospitals.

Results:

Of the 51 operations, 42 (82%) were accomplished without additional troacars. Seven (14%) procedures were converted to multiple-port technique and two (4%) to open cholecystectomy. In 25 (49%) operations, transabdominal retraction sutures through the gallbladder were used to maintain a good view of the triangle of Calot. The mean operative time was 74 (31–155) min. No major intraoperative complications occurred. The mean hospital stay was 0.6 (0–3) days. During a mean follow up of 4 (1–7) months, five (10%) patients had wound infection, and one (2%) had hematoma and prolonged pain in the insertion site of the retraction suture. One (2%) patient was reoperated for continuous pain in umbilical wound without findings at operation but with good results. One (2%) patient had subphrenic abscess seven months postoperatively.

Conclusions:

Our initial experiences indicate that SILC can be adopted without major complications in small-volume hospitals but the rate of wound infections seems to increase with the introduction of SILC.
Risk Factors for Conversion during Laparoscopic Cholecystectomy — Experiences from a General Teaching Hospital
Authors: van der Steeg H. J. J. , Alexander S. , Houterman S. , Slooter G. D. , Roumen R. M. H.
Published: January 2017

Background and Aims:

Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic cholelithiasis. Conversion, however, is sometimes necessary. The aim of this study was to determine predictive factors of conversion in patients undergoing LC for various indications in elective and acute settings in a general teaching hospital.

Material and Methods:

A retrospective analysis was performed on 972 consecutive patients who underwent a laparoscopic cholecystectomy in Máxima Medical Centre in Veldhoven, the Netherlands, from January 2000 till January 2006. Recorded data were sex, age, indication for LC, conversion to open cholecystectomy, reason for conversion, performing surgeon, co-morbidity, type of complication, length of hospital stay and 30-day mortality.

Results:

Conversion to open cholecystectomy was performed in 121 patients (12%). The most frequent reasons for conversion were infiltration/fibrosis of Calot's triangle (30%) and adhesions (27%). In the multivariate analyses male gender (OR 1.67, 95% CI 1.07–2.59), age > 65 years (OR 2.10, 95% CI 1.32–3.34), acute cholecystitis (OR 11.8, 95% CI 6.98–20.1), recent acute cholecystitis (OR 4.71, 95% CI 2.42–9.18) and recent obstructive jaundice (OR 20.6, 95% CI 4.52–94.1) were independent predictive factors for conversion.

Conclusions:

Male gender, age > 65 years, (recent) acute cholecystitis and recent obstructive jaundice are independent predictive risk factors for conversion. By appreciating these risk factors for conversion, preoperative patient counselling can be improved.
Translation and Validation of the Norwegian Version of the Fecal Incontinence Quality-Of-Life Scale
Authors: Dehli T. , Martinussen M. , Mevik K. , Stordahl A. , Sahlin Y. , Lindsetmo R. O. , Vonen B.
Published: January 2017

Background and Aim:

Fecal incontinence quality-of-life scale (FIQLS) is a condition-specific health-related quality-of-life questionnaire composed of four scales: lifestyle, coping/behaviour, depression/self-perception and embarrassment. It has been widely translated and used as an evaluation tool for patients with fecal incontinence. Our aim was to translate the FIQLS, and to test some of the psychometric properties of the Norwegian version of the questionnaire.

Material and Methods:

The FIQLS was translated to Norwegian, and administered to a sample of 76 patients (73 women) who completed the questionnaire at baseline and again after three weeks. In addition, the severity of incontinence was assessed by phone-interviews (St. Mark's score).

Results:

Three of four domains had good internal consistency in terms of Cronbach's alpha (.83–.91), the fourth (embarrassment) somewhat lower (.64). Stability over time was acceptable for all domains with ICC ranging from .74 to .86. Correlation with severity of incontinence (St. Mark's score) was medium to large for all four domains (–.46 to –.63) supporting the construct validity of the Norwegian FIQLS.

Conclusion:

The Norwegian version of fecal incontinence quality-of-life scale has been successfully translated and tested.
Partisan journalism and the issue framing of the Euro crisis: Comparing political parallelism of German and Spanish online news
Authors: Kaiser Johannes , Kleinen-von Königslöw Katharina
Published: January 2017

Empirical studies investigating political parallelism in news coverage mostly look at the frequency and evaluation of party actors, though political parallelism is not only tied to parties but also to broader political ideologies. By contrast, this study examines country differences in political parallelism focusing on the alignment of media’s issue interpretations with political ideologies. Based on a content analysis of 7256 statements in 961 articles about the Euro crisis in German and Spanish online newspapers, issue frames were identified in a data-driven approach before examining how the argumentative structure of these frames referred to ideologies. Results show that ideology-guided framing is present in nearly half of all articles. But Spanish media more often used frames corresponding to their political alignment than their German counterparts indicating stronger political parallelism in the Mediterranean Model. Thus, the results support the revision of the Hallin/Mancini Model of media systems proposed by Brüggemann et al.
Consulting the “Experts”: A Pilot Study on Perceptions of Professional Support among Lung Transplant Recipients and Accompanying Relatives
Authors: Ullrich Gerald , Jänsch Heyka , Schmidt Sandra , Strüber Martin , Niedermeyer Jost
Published: January 2017

Background

Lung transplantation is extremely stressful for patients and accompanying support persons.

Purpose

To improve delivery of care, we designed a cross-sectional study about unmet needs and perceived helpfulness of staff.

Methods

The sample consisted of 30 adult lung transplant recipients with cystic fibrosis (and 22 relatives) and 20 age-matched recipients with other reasons for transplantation (and 17 relatives). Mean survival since transplantation was 5 years. Data were collected via questionnaires (numerical rating scales and fill-in-the-blank items).

Results

Most patients in both groups were satisfied with staff support (nurse, doctor) especially during the acute stage of illness. Relatives were less satisfied at all stages. Patients' satisfaction with doctors' support was higher after than before transplantation, but the opposite was true for relatives. Insufficient continuity of care was the most frequent critical comment from patients and support persons. Recommendations to improve delivery of care included providing access to psychosocial professionals and broadening the information provided before transplantation.

Conclusions

Regular screening of customer satisfaction should become routine. Particular attention should be paid to support persons.
Donor Care before Pancreatic Tissue Transplantation
Authors: Powner David J.
Published: January 2017

Publications are reviewed to identify factors related to donor care that may optimize the function of pancreatic tissue (whole or segmental organ or islet cells) after transplantation. Short cold ischemia time, avoidance of hypotension, and treatment of donor hyperglycemia appear to be beneficial, although additional properly designed studies are needed to verify those findings.
Cytomegalovirus after Kidney Transplantation: A Case Review
Authors: Lawson Carol A.
Published: January 2017

Cytomegalovirus is the most common infectious complication in solid-organ transplant recipients. Despite the frequency of the problem, no commonly accepted approach to cytomegalovirus prophylaxis and treatment exists. Because cytomegalovirus may lead to the modulation of the immune system sometimes causing opportunistic superinfections, allograft injury, acute rejection, chronic rejection, and development of posttransplant lymphoproliferative disease, transplant coordinators require knowledge of the disease, diagnostic methods, and treatment and prophylaxis strategies. This case study reviews a high-risk cytomegalovirus transplant recipient after living-related kidney transplantation. In addition to a review of the pathophysiology of the disease process, patient, family, and nursing staff education, and cultural and psychosocial aspects of cytomegalovirus, prophylaxis, diagnosis, treatment strategies as well as role of the transplant coordinator, will be discussed.
Indo-Canadian Beliefs regarding Organ Donation
Authors: Molzahn Anita E. , Starzomski Rosalie , McDonald Michael , O'Loughlin Chloe
Published: January 2017

Context

There is concern that a disproportionately high number of people of South Asian origin await transplantation in Canada. The donation rate is low in this population, and it is difficult to obtain good tissue matches.

Objective

To explore the values and beliefs regarding organ donation among Indo-Canadian people living in British Columbia.

Design

A naturalistic qualitative study was designed. Individual interviews and focus groups were held to collect data pertaining to beliefs regarding organ donation.

Setting

Lower Mainland of British Columbia, Canada.

Participants

A total of 40 Indo-Canadian persons participated; a wide range of ages, religions, and backgrounds were represented.

Results

The major themes that emerged from the data related to context (including family/community, religion, trust in the healthcare system, and knowledge about organ donation); and values and beliefs (including intergenerational considerations, death and dying, and the organ donation process). Participants noted that people from their community were reluctant to discuss death and related issues such as organ donation. Although there was recognition of the importance of individual decision making pertaining to organ donation, the participants believed that family and community members also should be involved.

Conclusions

Beliefs varied considerably among participants, and one should not make assumptions about the beliefs of any one individual based primarily on that individual's membership in an ethnocultural community.
Role of “Relatedness” in Donation Discussions with Next of Kin: An Empirical Study of the Common Wisdom
Authors: Dodd-McCue Diane , Tartaglia Alexander
Published: January 2017

Context

Demographic similarities between support personnel and next of kin are of increasing interest. Studies examining like-race requestors have not produced clear and consistent outcomes. No studies have examined demographic relatedness factors for family support personnel who are not requestors.

Objectives

To examine the degree of “relatedness” between family communication coordinator chaplains and next of kin in cases that resulted in consent for donation. To examine “relatedness” in terms of demographic characteristics between primary hospital family support individuals and next of kin.

Design

Retrospective nonexperimental descriptive design spanning 1997 to 2004.

Main Outcome Measures

Demographic characteristics including gender, race and ethnicity, age, religion, and contact time.

Results

The results fail to support the hypothesis that the degree of “relatedness” between the family communicator and next of kin is associated with positive consent decisions. The findings show that gender is a shared quality in 60% of these cases, and race, age, and religion are even more infrequently shared qualities. The findings also suggest an elevated role of women in the donation discussion.

Conclusions

This study fills the void of empirical research through its use of objective outcome measures. The results fail to support the common wisdom and bring to question the foundation of many programs used to promote organ donation. Additionally, the findings emphasize the need for more rigorous investigations and development of more refined, valid measures for examining factors that may influence the donation discussion.
Ethical Analysis of Living Organ Donation
Authors: Walton-Moss Benita J. , Taylor Laura , Nolan Marie T.
Published: January 2017

In 2003, the first 3-way living kidney donor-swap was performed at Johns Hopkins Hospital in Baltimore, Md. Three new donor protocols including paired donation now allow unrelated individuals to serve as donors. Some ethicists have suggested that emotionally unrelated individuals not be permitted to donate because they will not experience the same satisfaction that a family member who is a donor experiences. Others who frame living donation as an autonomous choice do not see emotionally unrelated or even nondirected donation as ethically problematic. This article uses an ethical framework of principlism to examine living donation. Principles salient to living donation include autonomy, beneficence, and nonmaleficence. The following criteria are used to evaluate autonomous decision making by living donors, including choices made (1) with understanding, (2) without influence that controls and determines their action, and (3) with intentionality. Empirical work in these areas is encouraged to inform the ethical analysis of the new living donor protocols.
Living Donation Decision Making: Recipients' Concerns and Educational Needs
Authors: Waterman Amy D. , Stanley Sara L. , Covelli Tonie , Hazel Erik , Hong Barry A. , Brennan Daniel C.
Published: January 2017

Context

Despite the advantages of living donor transplantation, evidence suggests that some potential recipients with living donors have psychological concerns that prevent them from pursuing living donation. Addressing these concerns through education may increase the rates of living donation.

Objective

To understand the psychological barriers and educational needs of potential kidney recipients regarding living donation.

Subjects and Design

Qualitative focus group study of kidney transplant recipients, donors, and family members to explore their assessment of the advantages of dialysis and deceased donor transplantation over living donation, their concerns about living donation, and what types of living donation education would be most helpful.

Results

Kidney recipients reported that they might not pursue living donation because they felt guilty and indebted to the donor, did not want to harm or inconvenience the donor, did not want to accept a kidney that a family member might need later, and did not want to disappoint the donor if the kidney failed. Recipients were generally unaware that donors could personally benefit from donating and would rather wait for donor volunteers than ask anyone directly. Both donors and recipients thought that training on how to make the donation request and education about living donors' motivations for donation and transplant experience could help more renal patients pursue living donation.
Cardiac Dysrhythmias during Donor Care
Authors: Powner David J. , Allison Teresa A.
Published: January 2017

Organ procurement coordinators must treat various cardiac dysrhythmias (arrhythmias), including rhythm disturbances that may cause or follow a cardiac arrest, in about 15% to 50% of donors. Treatment decisions should be based on the particular dysrhythmia and its effect on donor blood pressure. Medications selected should be effective but short acting. In this article, data available in publications located through a PubMed search are reviewed and specific dysrhythmias that are likely to occur during donor care are described. Treatment recommendations are based on guidelines from the American Heart Association.
Vertebral Arteriovenous Fistula Associated with Neurofibromatosis Type I Misdiagnosed as a Giant Aneurysm
Authors: Benndorf G. , Assmann U. , Bender A. , Lehmann T. N. , Lanksch W. R.
Published: January 2017

A 59-year-old man with neurofibromatosis type 1 (NF1) presented with bruits and neck pain due to a space occupying lesion in the right neck tissue. Digital subtraction angiography (DSA) showed an arteriovenous fistula (AVF) of the right extracranial vertebral artery (VA) with a giant venous pouch and an intracranial berry aneurysm of the right middle cerebral artery (MCA). First, the MCA aneurysm was surgically clipped, then the patient was treated by embolisation with coils. The coils were placed transarterially from the left VA resulting in a partial thrombosis of the venous pouch. Complete closure was achieved secondarily by retrograde transvenous catheterization. Etiology and treatment modalities are discussed.
Unruptured Aneurysm: Vasospasm after Surgery and Endovascular Treatment
Authors: Gutiérrez O. , Caldas J.G.M.P. , Rabello J.P.
Published: January 2017

Arterial cerebral vasospasm in different pathological conditions other than subarachnoid haemorrhage (SAH) caused by ruptured aneurysm is uncommon. The haemodynamics-clinical consequences of such conditions makes a quick diagnosis, vital to choose the best therapeutic strategy.

A 55-year-old woman presented chronic headache. Computed tomography scan revealed an image suggesting carotid aneurysm on the left which was confirmed by digital angiography in the ophthalmic segment. Programmed surgery of clipping aneurysm was carried out without complications. The patient remained without morbidity for the first 16 hours, then she developed progressive aphasia, right motor deficit and loss of consciousness.

The angiography showed severe vasospasm in horizontal segments of anterior cerebral artery (A1) and middle cerebral artery (M1). Vasodilatation with topic papaverine by selective microcatheterism in A1 and M1 segments achieved clinical-radiological success in time. The patient was discharged on the seventh day, with Glasgow Coma Scale (GCS) 15/15 and slight right hemiparesis.

Vasospasm pathogenesis in conditions other than SAH from ruptured aneurysm remains a scientific frontier for ongoing research.

We know about the short half-life effect of papaverine and believe that the success in this particular case was accurate and definite due to the fact that the mechanism of the spasm presented no bleeding in the subarachnoid cisterns.
Post-Traumatic Cavernous Fistula Fed by Persistent Trigeminal Artery: Treatment by GDC Embolisation
Authors: Deol P.S. , Mishra N.K. , Gupta V. , Gaikwad S.B. , Garg A. , Singh N.
Published: January 2017

A case of traumatic persistent primitive trigeminal artery (PPTA) cavernous sinus fistula treated with GDC embolisation is reported. Because of the small lumen of PPTA, posteriorly directed course and flow contribution from the posterior circulation, balloon embolisation via the carotid system was not considered appropriate. The fistula was successfully closed by GDC embolisation.
The Development for Polymer Actuator Active Catheter System
Authors: Sewa S. , Onishi K. , Oguro K. , Asaka K. , Taki W. , Toma N.
Published: January 2017

Electric stimuli polymer-metal composite actuator material has been developed for active catheter system and other widely new applications. The polymer actuator is made of ion exchange polymer and gold as electrode, and a pulse voltage of 3 volts on the actuator gave a quick bend 90 degree angle. This composite material is possible to make small size, light and soft actuator.

So now we can actually develop an active catheter for the interventional radiology surgery. The prototype polymer actuator active catheter has been developed by using polymer actuator technology and Micro Electronics Mechanical System (MEMS) technologies. The active catheter is controllable from the outside of the body by electric signal. The tip part of the catheter is made of the polymer actuator tube and bends 90 degree angles. The animal tests (dog) showed good actuator performance to control right direction and bending angle at bifurcation of blood vessel and aneurysms.
Local Thrombolysis for Acute Ischemic Stroke Based on Findings of Diffusion and Perfusion MRI
Authors: Kitagawa N. , Morikawa M. , Hayashi K. , Ishimaru H. , Yoshioka T. , Matsuo Y. , Takahata H. , Kaminogo M. , Ochi M. , Shibata S.
Published: January 2017

Cerebral perfusion and cerebral tissue integrity were studied in 13 patients with acute embolic stroke in the territory of the internal carotid artery by diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) within six hours after onset. PWI/DWI mismatch lesion was depicted in six patients. MCA was occluded in five of six patients, who underwent local thrombolytic therapy. In three cases, complete restoration of the cerebral circulation was obtained and enlargement of irreversible brain damage compared to initial DWI lesion was prevented. Seven patients without PWI/DWI mismatch did not undergo thrombolytic therapy. Spontaneous reopening of occluded MCA was verified with subsequent cerebral angiography in one of seven patients. CT depicted symptomatic intracerebral hemorrhage in this patient. It is concluded that DWI and PWI in combination are useful in selection of patients for thrombolytic therapy.
Vasculogenesis and Angiogenesis: Molecular and Cellular Controls
Authors: Kubis N. , Levy B.I.
Published: January 2017

Angiogenesis, defined as a new blood vessel formation from a pre-existing vessel, is initiated by angiogenic growth factors and their receptors that induce endothelial cell migration and proliferation. Extracellular proteolysis is essential for deassembly and reassembly of endothelial cells to their environmental matrix. The aim of this review is to update data on the role of the coagulation and fibrinolysis system, metalloproteinases and adhesion molecules during this step of angiogenesis.
Carotid Artery Stenting to Prevent Stroke in a Patient with Bilateral Extracranial Internal Carotid Dissection and Vasospasm following Rupture of an Intracranial Aneurysm
Authors: Sedat J. , Dib M. , Szapiro J. , Paquis P.
Published: January 2017

The stenting of carotid dissection has been described for the prevention of cerebral ischemia in patients who remain symptomatic despite therapeutic anticoagulation, in those who present contraindications for anticoagulation therapy, or who present a local or extensive stenosis, with an associated pseudoaneurysm. We here report a case associating a high clinical grade aneurysmal rupture with a bilateral extracranial carotid dissection. Because of the haemodynamic risk due to the acute bilateral stenosis-induced dissection and the occurrence of a vasospasm, the carotid dissections were treated with self-expendable stents.
Retinal Embolization and Cerebellar Asymptomatic Embolization after Carotid Stenting Using Distal Balloon Protection
Authors: Islam S. , Manabe H. , Hasegawa S. , Takemura A. , Nagahata M. , Ito C. , Ezura M.
Published: January 2017

We describe a rare case of having both symptomatic ipsilateral retinal embolization and asymptomatic cerebellar embolization occurring after carotid stenting with use of distal protect device. In this case, external carotid angiograms revealed accessory meningeal artery-ophthalmic artery and occipital artery-vertebral artery anastomoses. This case suggested that the protection for external carotid artery should be considered during carotid stenting to avoid retinal embolization and cerebellar or cerebral embolization in cases showing angiographical anastomoses between external carotid artery and ophthalmic artery or intracranial arteries.
Carotid Artery Stenting: Experience of a Single Institute in China
Authors: Li S. M. , Li D. , Ling F. , Miao Z. R. , Wang M. L.
Published: January 2017

Concern regarding the safety of Carotid angioplasty and stenting (CAS) exists because of the risk of cerebral embolization during the procedure. The purpose of this article is to discuss that technology modification may improve the outcomes of this procedure.

Between October 1997 and October 2004, 439 consecutive patients with 478 stenotic carotid arteries were treated. 284 vessels were stented without the use of embolic protection devices and 194 vessels with protection. Among cases not using protection device, 201 arteries were stented with predilation alone, 63 with postdilation alone, six with both pre- and post-dilation, two with neither and twelve were stented with balloon expandable stents.

The technical success of 100%. The combined stroke and death rate during the procedure and the 30-day follow-up at 30 days was 1.67% overall. Three (0.63%) deaths occurred; one was due to a major infarction secondary to stent breakage, and two died of massive reperfusion intracerebral haemorrhage. There were total six ischemic stroke, of the five ischemic strokes wich developed in nonprotection group, two were among 201 cases with predilation alone (0.99%), which developed after stent deployment and postprocedure, and three among 63 cases with postdilation alone (4.76%), which developed immediately after postdilation.

The incidence of ischemic stroke was lower among those who were stented with predilation alone than among those who were stented with postdilation alone. This likely results from reduced intimal injury and decreased risk of embolic complications
Retrospective Study of Complications Arising during Cerebral and Spinal Diagnostic Angiography from 1998 to 2003
Authors: Leonardi M. , Cenni P. , Simonetti L. , Raffi L. , Battaglia S.
Published: January 2017

This retrospective study aimed to assess the percentage of complications in the daily practice of cerebral and spinal cord diagnostic angiography at our institution and to compare this with literature reports published in the last twenty years and guidelines for angiography.

From 1st December 1998 to 1st December 2003 2154 patients underwent digital angiography for a total of 5996 vessels selected.

Three neurological complications arose during angiographic procedures in the five year period.

Focal neurological deficit resolving within 24h in two patients, Permanent neurological deficit in one patient.

There were no adverse systemic reactions to contrast medium.

Retrospective analysis of our cohort disclosed a complication rate of 0.1% for transient neurological complications and 0.05% for permanent deficits.
Cerebral Arteriovenous Malformation Embolized through Persistent Primitive Hypoglossal Artery
Authors: Gupta A. K.
Published: January 2017

Carotid-vertebral anastomoses are commonly detected as incidental findings. But sometimes these channels are important for the clinical condition of the patient. Here a case of right thalamo-capsular arteriovenous malformation is described where a persistent primitive hypoglossal artery was the only route for embolization of the arteriovenous malformation.
Multiple Intracranial Aneurysms as Delayed Complication of Atrial Myxoma: Case Report and Literature Review
Authors: Chen Z. , Wang Y. L. , Ye W. , Miao Z. R. , Song Q. B. , Ling F.
Published: January 2017

We report a case of multiple intracranial aneurysms as delayed complication of atrial myxoma. We reviewed the literature of intracranial myxomal aneurysms, and trying to find reasonable therapy methods, but got the conclusion that neurosurgery and interventional treatment were not helpful, chemotherapy and radiotherapy maybe useful in the treatment of such cases.
Transvenous Treatment of a Dural Arteriovenous Fistula of the Transverse Sinus by Embolization with Platinum Coils and Onyx HD 500+
Authors: Siekmann R. , Weber W. , Kis B. , Kühne D.
Published: January 2017

We report the endovascular treatment of a symptomatic dural arteriovenous fistula in a 61-year-old male patient. The medial portion of the fistula was occluded with detachable platinum coils during an initial intervention using a transvenous approach. Due to persistence of the symptoms in a second intervention eight months later the fistula was completely occluded by the transvenous introduction of a liquid embolic agent (Onyx 500+). The liquid embolic agent was introduced under protection by the temporary balloon occlusion of the fistula's venous drainage. After the procedure, the patient was treated for three months with 75 mg clopidogrel (Plavix®) and with 100 mg acetylsalicylic acid (ASS®). A few days after the intervention, the patient was discharged without any neurological deficit and in good clinical condition. The follow-up examination six months later neither detected a recurrence of the dural arteriovenous fistula in the angiogram nor any neurological symptoms.