bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evidence‐based sample size calculations based upon updated meta‐analysis
Authors: Sutton Alexander J. , Cooper Nicola J. , Jones David R. , Lambert Paul C. , Thompson John R. , Abrams Keith R. 
Published: September 2006

AbstractMeta‐analyses of randomized controlled trials (RCTs) provide the highest level of evidence regarding the effectiveness of interventions and as such underpin much of evidence‐based medicine. Despite this, meta‐analyses are usually produced as observational by‐products of the existing literature, with no formal consideration of future meta‐analyses when individual trials are being designed.Basing the sample size of a new trial on the results of an updated meta‐analysis which will include it, may sometimes make more sense than powering the trial in isolation. A framework for sample size calculation for a future RCT based on the results of a meta‐analysis of the existing evidence is presented.Both fixed and random effect approaches are explored through an example. Bayesian Markov Chain Monte Carlo simulation modelling is used for the random effects model since it has computational advantages over the classical approach. Several criteria on which to base inference and hence power are considered. The prior expectation of the power is averaged over the prior distribution for the unknown true treatment effect. An extension to the framework allowing for consideration of the design for a series of new trials is also presented.Results suggest that power can be highly dependent on the statistical model used to meta‐analyse the data and even very large studies may have little impact on a meta‐analysis when there is considerable between study heterogeneity. This raises issues regarding the appropriateness of the use of random effect models when designing and drawing inferences across a series of studies. Copyright © 2006 John Wiley & Sons, Ltd.
Ordered Assembly of α‐Quinquethiophene on a Copper Oxide Nanotemplate
Authors: Cicoira Fabio , Miwa Jill A. , Melucci Manuela , Barbarella Giovanna , Rosei Federico 
Published: September 2006

AbstractThe organic semiconductor α‐quinquethiophene (T5) is used as the active layer in organic field‐effect transistors. We have investigated the adsorption of T5 on the (110) surface of copper and on the CuO nanotemplate formed by the high‐temperature exposure of Cu(110) to molecular oxygen. The results were obtained with high‐resolution scanning tunneling microscopy (STM) under ultra‐high‐vacuum (UHV) conditions. The adsorption of T5 on copper is an important model system because it mimics the active‐layer–electrode interface in organic devices. The molecules were observed to adsorb onto both the pristine Cu(110) surface and the CuO nanotemplate, showing a greater affinity for the pristine copper surface. Surprisingly, however, the T5 molecules assembled with a much higher degree of long‐range order on the oxygen‐passivated portion of the surface.
Observational Assessment of Surgical Teamwork: A Feasibility Study
Authors: Undre Shabnam , Healey Andrew N. , Darzi Ara , Vincent Charles A. 
Published: September 2006

AbstractBackgroundTeamwork is fundamental to effective surgery, yet there are currently no measures of teamwork to guide training, evaluate team interventions or assess the impact of teamwork on outcomes. We report the first steps in the development of an observational assessment of teamwork and preliminary findings.MethodWe observed 50 operations in general surgery from a single operating theater using a measure of teamwork specifically developed for use in the operating theater. The OTAS (Observational Teamwork Assessment for Surgery) comprises a procedural task checklist centered on the patient, equipment and communications tasks and ratings on team behavior constructs, namely: communication, co‐operation, co‐ordination, shared‐leadership and monitoring.ResultsRatings of overall team performance were reasonably high, though variable, but there was evidence that clinically significant steps were being missed which at the very least eroded safety margins. There was, for instance, a frequent failure to check both surgical and anesthetic equipment and a failure to confirm the procedure verbally, patient notes were missing in about one‐eighth of the cases and delays or changes occurred in over two‐thirds of the cases.ConclusionsThis study takes an initial step towards developing measures of team performance in surgery that are defined in relation to tasks and behaviors of the team. The observational method of assessment is feasible and can provide a wealth of potentially valuable research data. However, for these measures to be used for formal assessment, more research is needed to make them robust and standardized.
Distinct Recurrence Pattern and Outcome of Adenocarcinoma of the Gastric Cardia in Comparison with Carcinoma of Other Regions of the Stomach
Authors: Saito Hiroaki , Fukumoto Youji , Osaki Tomohiro , Fukuda Kenji , Tatebe Shigeru , Tsujitani Shunichi , Ikeguchi Masahide 
Published: September 2006

AbstractBackgroundCarcinoma arising in the cardioesophageal junction is a distinct clinical entity compared with tumors located in other regions of the stomach. The prognosis for adenocarcinoma of the upper stomach is considered to be relatively poorer than carcinomas of the more distal stomach. We have therefore investigated patients with carcinoma of the gastric cardia in order to evaluate the underlying cause of this poor prognosis.Materials and MethodsClinicopathologic features and postoperative prognosis of 101 patients with carcinoma of the cardia were evaluated and compared with findings on 1884 patients with tumors in other regions of the stomach.ResultsTumors of the cardia had a mean size of 6.8 cm, which was significantly larger than the mean size of 5.9 cm for tumors found in the middle‐ and lower third of the stomach. The incidence of serosal invasion, lymph node metastasis, and lymphatic and blood vessel invasion was higher in association with adenocarcinoma of the cardia than with adenocarcinoma in remaining parts of the stomach. In the analysis of patients who had undergone curative resection, the 5‐year survival rates were 61.6, 79.1, and 82.6% in patients with carcinoma of the cardia, upper one‐third, and remaining middle‐ and lower one‐third of the stomach, respectively, and the differences were statistically significant. Multivariate analysis indicated that adenocarcinoma of the gastric cardia is an independent prognostic factor. With regard to the site of recurrence, both lymph node and hematogenous recurrence were observed more frequently in the cardia than in the remaining parts of the stomach.ConclusionsOur data indicate that the prognosis of patients with adenocarcinoma of the gastric cardia is extremely poor. To improve their prognosis, new treatments in addition to gastrectomy with extensive lymph node dissection are needed.
Assessment of Nutritional Status and Prediction of Postoperative Liver Function from Serum Apolioprotein A‐1 Levels with Hepatectomy
Authors: Katsuramaki Tadashi , Mizuguchi Toru , Kawamoto Masaki , Yamaguchi Kouji , Meguro Makoto , Nagayama Minoru , Nobuoka Takayuki , Kimura Yasutoshi , Furuhata Tomohisa , Hirata Koichi 
Published: September 2006

AbstractBackgroundWe investigated the usefulness of apolipoprotein A‐1 (apoA) as an indicator of nutritional status, and the correlation of the preoperative apoA level with changes in postoperative liver function following hepatectomy.MethodsOne hundred patients underwent hepatectomy. Serum levels of apoA, prealbumin (prealb), retinol‐binding protein (RBP), lectin‐cholesterol acyltransferase (LCAT), hyarulonate (HA), indocyanine green dye retention at 15 minutes (ICG), and the receptor index of Tc‐GSA scintigraphy (LHL15) were measured at preoperation and on postoperative days (POD) 7 and 14. Partial resection was carried out in 62 cases, segmentectomy in nine cases, and bisegmentectomy in 29 cases. Co‐existent liver conditions were normal liver (NL) in 43 cases, chronic hepatitis (CH) in 29 cases, and liver cirrhosis (LC) in 28 cases.ResultsIn most cases the serum apoA level had decreased on POD 7, and recovered on POD 14. There were no significant differences in the changes of apoA between the individual operative procedures. Although preoperative apoA had almost the same value in the NL, CH, and LC cases, apoA in LC cases on POD 14 was the lowest of all cases. The apoA level showed significant correlations with prealb, LCAT, and HA on POD 14. All cases were divided into two groups (group N: apoA over 91 mg/dl; group L: apoA under 90 mg/dl) based on the preoperative serum apoA level. On POD 14, the ICG, LHL15, and HA of group L were significantly deteriorated compared with those of group L.ConclusionThe serum level of apoA reflects the changes in hepatic protein synthetic ability after hepatectomy; therefore, it may be possible to estimate recovery of nutritional status after hepatectomy from serum apoA. Moreover, we can predict postoperative deterioration of liver function from the preoperative apoA level.
Quality of Life Following Laparoscopic Anterior 90° Versus Nissen Fundoplication: Results from a Multicenter Randomized Trial
Authors: Woodcock Sean A. , Watson David I. , Lally Carolyn , Archer Stephen , Bessell Justin R. , Booth Michael , Cade Richard , Cullingford Graham L. , Devitt Peter G. , Fletcher David R. , Hurley James , Jamieson Glyn G. , Kiroff George , Martin Christopher J. , Martin Ian J. G. , Nathanson Leslie K. , Windsor John A. 
Published: September 2006

AbstractBackgroundThe short‐term clinical outcomes from a multicenter prospective randomized trial of laparoscopic Nissen versus anterior 90° partial fundoplication have been reported previously. These demonstrated a high level of satisfaction with the overall outcome following anterior 90° fundoplication. However, the results of postoperative objective tests and specific clinical symptoms are not always consistent with an individual patient’s functional status and general well being following surgery, and quality of life (QOL) is also an important outcome to consider following surgery for reflux. Hence, QOL information was collected in this trial to investigate the hypothesis: improvements in QOL following laparoscopic antireflux surgery are greater after anterior 90° partial fundoplication than after Nissen fundoplication.MethodsPatients undergoing a laparoscopic fundoplication for gastro‐esophageal reflux at one of nine university teaching hospitals in six major cities in Australia and New Zealand were randomized to undergo either laparoscopic Nissen or anterior 90° partial fundoplication. Quality of life before and after surgery was assessed using validated questionnaires – the Short Form 36 general health questionnaire (SF36) and an Illness Behavior Questionnaire (IBQ). Patients were asked to complete these questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively.ResultsOne hundred and twelve patients were randomized to undergo a Nissen fundoplication (52) or a 90° anterior fundoplication (60). Patients who underwent anterior fundoplication reported significant improvements in eight of the nine SF36 scales compared to four of the nine following a Nissen fundoplication. The majority of these improvements occurred early in the postoperative period. With respect to the illness behavior data, there were no significant differences between the two procedures. Both groups had a significant improvement in disease conviction scores at all time points compared to their preoperative scores.ConclusionsPatients undergoing laparoscopic anterior 90° partial fundoplication reported more QOL improvements in the early postoperative period than patients undergoing a Nissen fundoplication. However, the QOL outcome for both procedures was similar at later follow‐up.
Benefits of a Synbiotic Formula (Synbiotic 2000Forte®) in Critically Ill Trauma Patients: Early Results of a Randomized Controlled Trial
Authors: Kotzampassi Katerina , Giamarellos‐Bourboulis Evagellos J. , Voudouris Antonios , Kazamias Pantelis , Eleftheriadis Efthimios 
Published: September 2006

AbstractBackgroundSince probiotics are considered to exert beneficial health effects by enhancing the host’s immune response, we investigated the benefits of a synbiotics treatment on the rate of infections, systemic inflammatory response syndrome (SIRS), severe sepsis, and mortality in critically ill, mechanically ventilated, multiple trauma patients. Length of stay in the intensive care unit (ICU) and number of days under mechanical ventilation were also evaluated.MethodSixty‐five patients were randomized to receive once daily for 15 days a synbiotic formula (Synbiotic 2000Forte, Medipharm, Sweden) or maltodextrin as placebo. The synbiotic preparation consisted of a combination of four probiotics (1011 CFU each):Pediococcus pentosaceus 5–33:3, Leuconostocmesenteroides 32–77:1, L.paracasei ssp.paracasei 19; and L. plantarum 2,362; and inulin, oat bran, pectin, and resistant starch as prebiotics. Infections, septic complications, mortality, days under ventilatory support, and days of stay in ICU were recorded.ResultsSynbiotic‐treated patients exhibited a significantly reduced rate of infections (P = 0.01), SIRS, severe sepsis (P = 0.02), and mortality. Days of stay in the ICU (P = 0.01) and days under mechanical ventilation were also significantly reduced in relation to placebo (P = 0.001).ConclusionThe administration of this synbiotic formula in critically ill, mechanically ventilated, multiple trauma patients seems to exert beneficial effects in respect to infection and sepsis rates and to improve the patient’s response, thus reducing the duration of ventilatory support and intensive care treatment.
Prophylactic Antibiotics in Chest Trauma: A Meta‐analysis of High‐quality Studies
Authors: Sanabria Alvaro , Valdivieso Eduardo , Gomez Gabriel , Echeverry Gabriel 
Published: September 2006

AbstractBackgroundUse of antibiotics in patients with isolated chest trauma is controversial. Available studies offer contradictory results because of small sample sizes. However, information provided by recent randomized controlled trials (RCT) included in a systematic review and meta‐analysis could help solve the controversy. We performed a systematic review using high‐quality information related to the use of antibiotics in patients with a chest tube.MethodsWe developed a systematic review to evaluate the effectiveness of prophylactic antibiotics in chest‐trauma patients. Studies included were class I RCT comparing prophylactic antibiotics versus placebo in patients with isolated chest trauma. Main outcomes were posttraumatic empyema and pneumonia.ResultsFive Class I studies were selected. There were statistically significant differences regarding the frequency of posttraumatic empyema (RR 0.19) and pneumonia (RR 0.44) in favor of the use of prophylactic antibiotics when compared with placebo.ConclusionsThe use of prophylactic antibiotics in patients with chest trauma decreases the incidence of posttraumatic empyema and pneumonia.
Management of Right Colon Diverticulitis: A 10‐Year Experience
Authors: Yang Horng‐Ren , Huang Huai‐Hsu , Wang Yu‐Chun , Hsieh Chi‐Hsun , Chung Ping‐Kuei , Jeng Long‐Bin , Chen Ray‐Jade 
Published: September 2006

AbstractBackgroundControversies abound as regards the optimal treatment for patients with diverticulitis of the right colon.MethodsThis is a retrospective review of 113 patients with a diagnosis of right colonic diverticulitis who received treatment at the China Medical University Hospital from July 1994 to June 2004.ResultsMedical therapy was undertaken in 56 patients diagnosed preoperatively with uncomplicated diverticulitis. All but one patient was successfully treated with bowel rest and antibiotics. Of the 51 patients with a preoperative diagnosis of acute appendicitis, 32 received appendectomy along with postoperative antibiotic therapy, 8 received diverticulectomy in addition to appendectomy, and 11 received colectomy. In all, 17 patients required right hemicolectomy or ileocecal resection due to diverticulitis‐related complications or suspected malignancy. Of the 87 (56−1+32) patients who responded to conservative treatment, 11 developed recurrent diverticulitis. All 11 patients were successfully treated with medical therapy, and 2 subsequently received elective right hemicolectomy. Of the 9 patients who received medical treatment alone at the second attack, 2 suffered a third attack. Both were successfully managed with medical therapy.ConclusionsFor uncomplicated diverticulitis of the right colon diagnosed preoperatively, antibiotic therapy with bowel rest is an effective treatment. Once it is encountered during surgery for presumed acute appendicitis, a conservative approach involving prophylactic appendectomy and postoperative antibiotics is recommended. For patients with recurrent diseases, medical treatment is still safe and efficient. Colectomy is indicated when complications occur or when malignancy is strongly suspected.
Effect of Prevailing Local Treatment Options of Breast Cancer on Survival Outside Controlled Clinical Trials: Experience of a Specialist Breast Unit in North India
Authors: Tewari Mallika , Pradhan S. , Kumar M. , Shukla H. S. 
Published: September 2006

AbstractBackgroundThis study aimed at analyzing different treatments of breast cancer (BC) prevalent in the region, their effect on patients’ survival, and discusses the most suitable method within available resources.MethodsThe study was set up at a tertiary care hospital in north India. We retrospectively reviewed data of 473 female BC patients who attended the departments of Surgical Oncology and Radiotherapy from January 1997 to December 1999. Patients with cTNM stage IV and inoperable stage III were included; those who defaulted or were lost to follow‐up were excluded. Out of 473 patients, 372 were selected. The selected patients were divided into groups on the basis of place and type of local treatment they received: (1) local excision only, (2) standard breast conservation therapy (BCT), (3) total mastectomy (TM) + axillary lymph node dissection + radiotherapy (RT), and (4) modified radical mastectomy (MRM) + RT. Data regarding recurrence and survival were analyzed in December 2005. Minimum follow‐up was 6 years.ResultsOverall recurrence rates were significantly higher in patients operated elsewhere (P <0.0001). Of 194 operated at our Breast Unit, 25 (14.6%) of 171 MRM patients and none of 23 BCT had recurrence. Of 178 patients operated elsewhere, 44 (100%), 6 (42.9%), 41 (41%), and 8 (40%) developed recurrence in groups 1, 2, 3, and 4 respectively. Overall survival was significantly better in patients with MRM at our unit versus TM outside (93.6% vs. 80%).ConclusionsSeveral types of treatment from improper local excision alone, BCT, TM, to a carefully done MRM are prevalent here. Properly done, MRM yields significant local control with survival benefit and appears to remain the gold standard in management of our BC patients.
Who Will Care for Iraq’s Wounded Warriors? Health Policy and National Security
Authors: Bowersox Jon C. , Al‐Ainachi Shakir 
Published: September 2006

AbstractIntroductionSince 2003, Iraq has struggled to build a single national health system administered by the Iraqi Ministry of Health, but politics, lack of leadership, and a cultural bias against treating soldiers in civilian hospitals have hindered access to care for members of Iraq’s armed forces who are wounded in combat.MethodsU.S. surgeons are providing trauma care for Iraqi soldiers in American field hospitals, with more than 80% of hospital bed days occupied by Iraqis. At the same time, Iraqi hospitals have been treating the many civilian casualties of violence, and the Ministry of Health has greatly improved its emergency response and management capabilities over the past year.ResultsMinistry of Health hospitals have adequate surgical capabilities and bed capacity to care for both civilian and security forces casualties. Faltering attempts to develop a national health policy that provides comprehensive care for Iraqi Security Forces will jeopardize Iraq’s ability to assume responsibilities for the country’s national defense, and could delay the withdrawal of Coalition military forces from Iraq.ConclusionsIt is imperative that leadership of the new government of Iraq and the international surgical community strongly endorse the implementation of a single health care system for all Iraqis.
Hepatectomy for Colorectal Liver Metastases with Macroscopic Intrabiliary Tumor Growth
Authors: Sugiura Teiichi , Nagino Masato , Oda Koji , Ebata Tomoki , Nishio Hideki , Arai Toshiyuki , Nimura Yuji 
Published: September 2006

AbstractObjectivesWe set out to clarify the clinicopathologic characteristics of colorectal liver metastases with macroscopic intrabiliary tumor growth and to determine optimal surgical management.MethodsOver 15 years, 6 of 103 patients undergoing hepatectomy for colorectal liver metastases had macroscopic intrabiliary tumor growth and were analyzed retrospectively.ResultsWe performed 11 operations for the 6 patients, consisting of 10 hepatectomies (including 1 hepatopancreatoduodenectomy) and 1 pancreatoduodenectomy. Three patients survived more than 5 years: 1 died of pulmonary emphysema with no sign of recurrence 101 months after initial hepatectomy; the 2 others were alive with no sign of recurrence at 74 and 145 months after initial hepatectomy. Median survival time of all 6 patients was 87.5 months. Histologically, intrabiliary tumor growth had two components: intraluminal and intraepithelial extension. In the proximal direction, distance between these two components ranged from 4–10 mm.ConclusionAggressive surgical treatment can improve chances of long‐term survival for patients with macroscopic intrabiliary growth of colorectal liver metastasis. Although nonanatomic limited resection is a common procedure for colorectal liver metastasis, anatomic hepatobiliary resection is recommended.
Cultivating Systemic Capacity: The Rhode Island Tobacco Control Enhancement Project
Authors: Florin Paul , Celebucki Carolyn , Stevenson John , Mena Jasmine , Salago Dawn , White Andrew , Harvey Betty , Dougal Marianela 
Published: September 2006

AbstractThis paper describes the Rhode Island Tobacco Control Enhancement Project (TCEP), a state‐university‐community technical assistance system. TCEP was developed under the auspices of the Rhode Island Department of Health's Tobacco Control program and was designed to build capacity among nine community‐based organizations to mount comprehensive tobacco control interventions in five diverse communities within the state. This paper: (1) provides a description of community mobilization; (2) presents a logic model for planning and decision making used by state‐university‐community partners; (3) describes training, technical assistance services and implementation; and, (4) describes the evaluation and program improvement activities used to support on‐going project development.