Arteriovenous Fistula for dialysis - Let's Google it. Readability and quality of online information.

BACKGROUND: This study evaluated the readability and quality of information regarding arteriovenous (AV) fistula for dialysis on the Internet in the English language. STUDY DESIGN: Using Google© search, the keywords "AV Fistula for dialysis" were searched. The top 75 ranking sites were analyzed. One website was excluded due to repetition. Each landing page was assessed independently by two authors (RB, LR) for readability using the Flesch Reading Ease Score (FRES) and Gunning Fog Index (GFI). Web site quality was assessed using the DISCERN instrument. The individual position of the top 15 websites in the search engine ranking order list was noted. The country of origin, organization type and issuance of Health on the Net (HoN) Certification was recorded. Statistical analyses were performed using unpaired t-tests and ANOVA variance. RESULTS: The mean GFI score was 9.2 and the mean FRES score was 50.6, indicating poor readability. The mean DISCERN score was 48.4, indicating weak quality of websites. Website quality was influenced by the academic/healthcare organization type (p = 0.012). Organization type was not found to impact GFI and FRES scores. Presence of a HoN Certification was not found to impact the quality of information. The majority of sites originated from the United States (61%). CONCLUSION: Our study demonstrates that internet information pertaining to AV fistula for dialysis is of poor quality necessitating improvements to readability and overall website quality to improve the patient experience. Further research into how to improve healthcare web information is needed.

First rib removal and decompression of the thoracic outlet as an indication to facilitate hemodialysis.

We present two cases of thoracic outlet decompression performed to facilitate hemodialysis through upper limb arteriovenous fistulas. In patients undergoing arteriovenous fistula formation for dialysis access, venous hypertension is a well-known complication. We used a supraclavicular approach in our two reported cases to remove the first rib to facilitate hemodialysis. Dialysis patients presenting with central venous stenosis should be assessed for evidence of extrinsic compression by the first rib as management options differ from those with central venous stenosis due to an intravenous catheter.

Remote ischaemic preconditioning as a method for perioperative cardioprotection: concepts, applications and future directions.

Remote ischaemic preconditioning (RIPC) is a phenomenon whereby brief episodes of non-lethal ischaemia in one organ or tissue can render a distant organ or tissue resistant to subsequent longer ischaemic insults. It represents an exciting perioperative risk reduction strategy as it allows cardioprotection (and organ protection in general) from injuries that are caused by multiple mechanisms. Several proof of concept studies show benefits in cardiovascular interventions and in a variety of other procedures. However convincing and consistent evidence of benefits in patient important outcomes is lacking but may emerge with the completion of large scale studies. This article aims to provide a concise review of the origins and concepts of RIPC. It will revisit the biological theories of RIPC and the clinical applications thus far. The article concludes by discussing the current status of multi-centre cardiovascular RIPC research and the future challenges that investigators must overcome.

Who's talking about breast cancer? Analysis of daily breast cancer posts on the internet.

OBJECTIVE: Breast cancer is the cancer most commonly searched for on the internet. Our aim was to assess daily new breast cancer related posting on the internet. METHODS: We analyzed numbers of new daily posts for common cancers for one month and subsequently analyzed content of 1426 breast cancer related posts. We also assessed use of online discussion forums for breast cancer related dialogue. RESULTS: Breast related topics had significantly more posts per day compared to others (mean 66.7, p < 0.01). Most posts were on media sites (65.8%). Accuracy levels were high (87.5%) but significantly lower where posted on blogs and discussion forums (p < 0.001). Anonymous posts were common (55%) and less likely to be accurate (p < 0.001). Use of discussion forums has exponentially increased over the last five years (p < 0.001). CONCLUSIONS: The internet has become a primary forum within which health information, particularly relating to breast cancer, is both sought and shared. Increasingly information is provided by patients themselves.

From theater to the world wide web--a new online era for surgical education.

INTRODUCTION: Traditionally, surgical education has been confined to operating and lecture theaters. Access to the World Wide Web and services, such as YouTube and iTunes has expanded enormously. Each week throughout Ireland, nonconsultant hospital doctors work hard to create presentations for surgical teaching. Once presented, these valuable presentations are often never used again. AIMS: We aimed to compile surgical presentations online and establish a new online surgical education tool. We also sought to measure the effect of this educational tool on surgical presentation quality. METHODS: Surgical presentations from Cork University Hospital and Beaumont Hospital presented between January 2010 and April 2011 were uploaded to http://www.pilgrimshospital.com/presentations. A YouTube channel and iTunes application were created. Web site hits were monitored. Quality of presentations was assessed by 4 independent senior surgical judges using a validated PowerPoint assessment form. Judges were randomly given 6 presentations; 3 presentations were pre-web site setup and 3 were post-web site setup. Once uploading commenced, presenters were informed. RESULTS: A total of 89 presentations have been uploaded to date. This includes 55 cases, 17 journal club, and 17 short bullet presentations. This has been associated with 46,037 web site page views. Establishment of the web site was associated with a significant improvement in the quality of presentations. Mean scores for pre- and post-web site group were 6.2 vs 7.7 out of 9 respectively, p = 0.037. CONCLUSIONS: This novel educational tool provides a unique method to enable surgical education become more accessible to trainees, while also improving the overall quality of surgical teaching PowerPoint presentations.

Improving surgical outpatient efficiency through mobile phone text messaging.

INTRODUCTION: Currently, 175,000 people are on outpatient waiting lists in Irish hospitals. Many clinic slots are taken by patients returning for routine review postoperatively. METHODS: A Nokia mobile phone was used to send an outpatient text (OPT) to patients 2 weeks postdischarge. Patients replying that they were well were discharged. If no reply after 2 attempts was received, they were scheduled for the next outpatient clinic. RESULTS: Overall, 55 patients were offered the service over a 4-month period. Of these, 74.5% of patients were discharged from follow-up using text message surveillance. Patients were surveyed regarding their perception of the surveillance model, with all respondents ranking OPT surveillance as their preferred method of follow-up. There was a 13.6% decrease in outpatient visits over the study period. In addition, 6 emergency department visits were also avoided. CONCLUSION: Text message surveillance decreases outpatient waiting times and increases quality of care.

A quantitative assessment of changing trends in internet usage for cancer information.

BACKGROUND: The internet is an important source of healthcare information. To date, assessment of its use as a source of oncologic information has been restricted to retrospective surveys. METHODS: The cancer-related searches of approximately 361,916,185 people in the United States and the United Kingdom were examined. Data were collected from two separate 100-day periods in 2008 and 2010. RESULTS: In 2008, there were 97,531 searches. The majority of searches related to basic cancer information (18,700, 19%), followed by treatment (8404, 9%) and diagnosis (6460, 7%). This compares with 179,025 searches in 2010 representing an increase of 183%. In 2008 breast cancer accounted for 21,102 (21%) individual searches, increasing to 85,825 searches in 2010. In 2010 a total of 0.2% (321) of searches focused on litigation, with those searching for breast cancer information most likely to research this topic (P=0.000). CONCLUSION: Use of the internet as a source of oncological information is increasing rapidly. These searches represent the most sensitive information relating to cancer, including prognosis and litigation. It is imperative now that efforts are made to ensure the reliability and comprehensiveness of this information.

Genomic and oncoproteomic advances in detection and treatment of colorectal cancer.

AIMS: We will examine the latest advances in genomic and proteomic laboratory technology. Through an extensive literature review we aim to critically appraise those studies which have utilized these latest technologies and ascertain their potential to identify clinically useful biomarkers. METHODS: An extensive review of the literature was carried out in both online medical journals and through the Royal College of Surgeons in Ireland library. RESULTS: Laboratory technology has advanced in the fields of genomics and oncoproteomics. Gene expression profiling with DNA microarray technology has allowed us to begin genetic profiling of colorectal cancer tissue. The response to chemotherapy can differ amongst individual tumors. For the first time researchers have begun to isolate and identify the genes responsible. New laboratory techniques allow us to isolate proteins preferentially expressed in colorectal cancer tissue. This could potentially lead to identification of a clinically useful protein biomarker in colorectal cancer screening and treatment. CONCLUSION: If a set of discriminating genes could be used for characterization and prediction of chemotherapeutic response, an individualized tailored therapeutic regime could become the standard of care for those undergoing systemic treatment for colorectal cancer. New laboratory techniques of protein identification may eventually allow identification of a clinically useful biomarker that could be used for screening and treatment. At present however, both expression of different gene signatures and isolation of various protein peaks has been limited by study size. Independent multi-centre correlation of results with larger sample sizes is needed to allow translation into clinical practice.

Synchronous association of rectal adenocarcinoma and three ileal carcinoids: a case report.

BACKGROUND: Synchronous midgut carcinoids with gastrointestinal adenocarcinoma are a rare but recognised association. CASE PRESENTATION: The patient, a 74 year old woman, underwent anterior resection for a low rectal adenocarcinoma. Intra-operatively 3 serosal deposits of tumour were noted in the distal ileum. Histology revealed these to be ileal carcinoids. CONCLUSION: During resection of a gastrointestinal tumour, a thorough inspection of the abdominal cavity should be undertaken to investigate the possibility of metastatic secondaries or a synchronous tumour as is reported in this case.