An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes.

BACKGROUND: For thirty years, the Harmonic scalpel has been used for precise dissection, sealing and transection. There are numerous meta-analyses on individual surgical procedures with Harmonic, but no overarching review covering all the areas. This umbrella review seeks to summarize the clinical results from the use of Harmonic across surgical fields and broadly quantify its effects on patient outcomes. METHODS: MEDLINE, EMBASE, and Cochrane Databases were searched for meta-analyses (MAs) of randomized controlled trials (RCTs) comparing Harmonic devices to conventional techniques or advanced bipolar (ABP) devices. For each procedure type, the most comprehensive MAs were evaluated. RCTs not already analysed in a MA were also included. Operating time, length of stay, intraoperative blood loss, drainage volume, pain, and overall complications were evaluated, and the methodological quality and certainty of evidence were assessed. RESULTS: Twenty-four systematic literature reviews were identified on colectomy, hemorrhoidectomy, gastrectomy, mastectomy, flap harvesting, cholecystectomy, thyroidectomy, tonsillectomy, and neck dissection. There were also 83 RCTs included. In every MA evaluated, Harmonic devices were associated with either statistically significant or numerical improvements in every outcome compared with conventional techniques; most MAs reported a reduction in operating time of ≥ 25 min. Harmonic versus ABP device MAs in colectomy and thyroidectomy showed no significant differences in outcomes. CONCLUSION: Across surgical procedures, Harmonic devices demonstrated improved patient outcomes for operating time, length of stay, intraoperative bleeding, drainage volume, pain, and overall complications compared to conventional techniques. Additional studies are required to assess differences between Harmonic and ABP devices.

Adult Development and Associated Health Risks.

Much has been learned about adult development in recent decades. Adults go through stages of development (emerging adulthood, young adulthood, middle adulthood, post-retirement, and very old age) with certain challenges at each stage. Viewing patients through a developmental lens is part of providing patient-centered care. Knowing the prominent issues, stressors, and risks at each stage of development is important in understanding patients. This knowledge can help customize medical advice to patients regarding obesity, disability, sleep, substance use, relationships, and age-related declines. This paper summarizes an updated view of adult development and discusses its relevance to health risks and patient-centered care practices at different stages.

Strengthening biostatistics resources in sub-Saharan Africa: research collaborations through U.S. partnerships.

On September 30, 2009, the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH) conducted a workshop on strengthening biostatistics resources in sub-Saharan Africa (SSA). An increase in global spending on health research over the last decade has boosted funds available to conduct biomedical research in low- to mid-income countries. The HIV/AIDS pandemic, the re-emergence of malaria and tuberculosis, and other emerging infectious agents are major driving forces behind the increase in biomedical research and clinical care programs (clinical trials, observational studies and, other public health programs) in SSA (Exp. Biol. Med. 2008; 233:277-285). In addition, the increased engagement of the United States (U.S.) government through the Global Health Initiative, which expands the traditional focus beyond infectious diseases to other causes of poor health and to the recognition of need the to strengthen health systems for a sustainable response, only increases the need for in-depth in-country expertise in all aspects of biomedical research (White House Press Release, 2009). In this workshop, researchers both from the U.S. and SSA were invited to discuss their collaborative work, to discuss ways in which biostatistical activities are carried out within their research projects, and to identify both general and specific needs for capacity building in biostatistics. Capacity building discussions highlighted the critical need to increase the number of well-trained in-country biostatisticians, both to participate in ongoing studies and to contribute to an infrastructure that can produce the next generation of biostatistical researchers.

Quantitative Point-of-Care Colorimetric Assay Modeling Using a Handheld Colorimeter.

Colorimetric assays typically offer a rapid and convenient method to assess analytes that span healthcare monitoring to water quality testing. However, such tests can only provide qualitative results when employed in resource-limited settings or require bulky and expensive equipment such as lab spectrophotometers to allow quantitative measurements. In this paper, we report on the use of a handheld colorimeter to quantitatively determine the concentration of analytes in a manner that is independent of ambient lighting or initial sample color. The method combines the response of the sensor with first-principles modeling that better describes the nature of the assay compared to linear-in-parameters regression modeling that is typically performed in other studies. This method was successfully demonstrated using a number of colorimetric assays: (1) determination of solution pH using a universal indicator, (2) quantification of the DNase presence using a DNA-gold nanoparticle assay, and (3) quantification of the concentration of the antibiotic tetracycline using a cell-based assay.

Target/error overlap in jargonaphasia: The case for a one-source model, lexical and non-lexical summation, and the special status of correct responses.

We present three jargonaphasic patients who made phonological errors in naming, repetition and reading. We analyse target/response overlap using statistical models to answer three questions: 1) Is there a single phonological source for errors or two sources, one for target-related errors and a separate source for abstruse errors? 2) Can correct responses be predicted by the same distribution used to predict errors or do they show a completion boost (CB)? 3) Is non-lexical and lexical information summed during reading and repetition? The answers were clear. 1) Abstruse errors did not require a separate distribution created by failure to access word forms. Abstruse and target-related errors were the endpoints of a single overlap distribution. 2) Correct responses required a special factor, e.g., a CB or lexical/phonological feedback, to preserve their integrity. 3) Reading and repetition required separate lexical and non-lexical contributions that were combined at output.

Characterization of leukocyte subtypes in chicken inner ear sensory epithelia.

Human hearing and balance require intact inner ear sensory hair cells, which transduce mechanical stimuli into electrical signals that are transmitted to the brain. Loss of hair cells after birth in mammals is irreversible, whereas birds are able to regenerate hair cells after insult and demonstrate ongoing hair cell production in the vestibular epithelia. Leukocytes reside in undamaged sensory epithelia of the avian inner ear and increase in number after trauma, prior to the proliferation of hair cell progenitors. It has been hypothesized that leukocyte-produced growth factors or cytokines may be involved in triggering hair cell regeneration. Little is known about the specific leukocyte subtypes present in avian ear. Immunohistochemistry with a panel of monoclonal antibodies to chicken leukocytes was used to identify leukocyte subtypes in normal posthatch chicken ear sensory epithelia. The responsiveness of the leukocytes to aminoglycoside-induced damage was also observed. Based on immunocytochemical and morphological criteria, we quantified leukocyte subtypes in normal and drug-damaged auditory and vestibular sensory epithelia. Data indicate that lymphocytes (B and T cells) do not reside in normal or drug-damaged ear sensory epithelia at 1-3 days post insult but are present in adjacent nonsensory tissues. The most common leukocytes in inner ear sensory epithelia are ramified cells of the myeloid lineage. Many of these are MHC class II positive, and a small percentage are mature tissue macrophages. An absence of leukocytes in lesioned areas of the auditory sensory epithelium suggests they may not play a critical role in triggering hair cell regeneration.

A comparative analysis of positron emission tomography and mediastinoscopy in staging non-small cell lung cancer.

OBJECTIVES: Positron emission tomography has been demonstrated to improve the detection of distant metastases in patients with lung cancer. This study compares the efficacy of PET to mediastinoscopy in mediastinal staging of patients with non-small cell lung cancer. METHODS: Between May 1995 and May 2000, positron emission tomography was performed on 1988 patients with known or suspected non-small cell lung cancer at Duke University Medical Center. Cervical mediastinoscopy was subsequently performed in patients without demonstrable evidence of distant metastases. The efficacy of mediastinal staging was analyzed by comparing the prospective results of positron emission tomography with the histopathologic results of mediastinoscopy by nodal station. RESULTS: In this study 202 patients with non-small cell lung cancer (116 of whom were male) underwent mediastinoscopy after positron emission tomography. Of the 65 patients with positive results of positron emission tomography, only 29 patients had positive results of mediastinoscopy in the corresponding nodal station. Of the 137 patients with negative results of positron emission tomography, 16 patients were demonstrated to have N2 or N3 disease. The sensitivity, specificity, positive and negative predictive values, and accuracy for positron emission tomography were 64.4%, 77.1%, 44.6%, 88.3%, and 74.3%, respectively. Histologic findings in patients with non-small cell lung cancer and false-positive results of mediastinal positron emission tomography included granulomatous inflammation, sinus histiocytosis, and silicosis. CONCLUSIONS: Positron emission tomography neither confirms nor excludes involvement of the mediastinum in patients with non-small cell lung cancer. Cervical mediastinoscopy with lymph node biopsy remains the criterion standard for mediastinal staging.

Laparoscopic Nissen fundoplication for treating reflux in lung transplant recipients.

Gastroesophageal reflux disease may contribute to pulmonary injury and the development of bronchiolitis obliterans syndrome in lung transplant patients. As a result, such individuals are increasingly likely to undergo corrective gastrointestinal surgery. The present study collected outcome data for 28 lung transplant patients with documented reflux who underwent an uncomplicated laparoscopic Nissen fundoplication at our institution. The results were compared to data from 63 nontransplant reflux patients who had undergone the procedure over the same time period. All Nissen fundoplications were conducted by the same surgeon. There were no intraoperative or perioperative deaths in either patient group. Operative parameters did not differ but the postoperative hospital stay was significantly greater for the lung transplant patients (P<0.05). Seven transplant patients (25%) were readmitted within 30 days compared to two readmissions (3.2%) in the reflux group. Five transplant patients (17.9%) have died, all from pulmonary complications; on average, death occurred 15.5 months after the Nissen surgery. There have been no deaths in the reflux group. These data indicate that laparoscopic Nissen fundoplication can be performed on lung transplant recipients to treat reflux. The average hospital stay is longer and there are more frequent readmissions in this population, but this does not appear to be due to any Nissen-related morbidity.

The relationship of adolescent personality and family environment to psychiatric diagnosis.

This study examines the relationship of adolescent personality and family environment to psychiatric diagnosis in 170 adolescents admitted to a psychiatric inpatient unit. Patients were administered the Child Assessment Schedule (CAS), the family Environment Scale (FES), and the Millon Adolescent Personality Inventory (MAPI). Adolescent personality and/or family environment were related to 1) major depression, conduct disorder, and attention deficit/hyperactivity disorder in both boys and girls, 2) oppositional defiant disorder, post traumatic stress disorder and overanxious disorder in girls, and 3) dysthymic disorder and alcohol use in boys. The study empirically shows the relationship of both personality and family environment in psychiatric diagnoses.