Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery.

BACKGROUND: Returning to the operating theatre for management of early postoperative complications after colorectal surgery is an important key performance indicator. Laparoscopic surgery has benefits that may be useful in surgical emergencies. This study explored the evidence for the advantages of laparoscopic reoperation. METHODS: A systematic review was performed to identify publications reporting the outcomes of laparoscopy as a mode of reoperation for the management of early postoperative complications of colorectal surgery. The main outcomes examined were 30-day mortality, 30-day morbidity, length of hospital stay, second reoperation rate, ICU admission and stoma formation at reoperation. RESULTS: After screening 3657 citations, ten non-randomized cohort studies were identified (1137 reoperations). Laparoscopic reoperation was equivalent to or better than open reoperation, with lower rates of 30-day mortality (0-4·4 versus 0-13·6 per cent), 30-day morbidity (6-40 versus 30-80 per cent), length of stay (mean(s.d.) 15·8(2·8) versus 29·1(14·5) days), ICU admission and duration of stay in the ICU. Anastomotic leak was the most common indication, after which more patients received a defunctioning loop stoma instead of an end stoma at laparoscopic than open reoperation. CONCLUSION: Laparoscopic reoperation is feasible in selected patients, with the advantages of improved short-term outcomes.

Ca2+ handling and sensitivity in airway smooth muscle: emerging concepts for mechanistic understanding and therapeutic targeting.

Free calcium ions within the cytosol serve as a key secondary messenger system for a diverse range of cellular processes. Dysregulation of cytosolic Ca(2+) handling in airway smooth muscle (ASM) has been implicated in asthma, and it has been hypothesised that this leads, at least in part, to associated changes in both the architecture and function of the lung. Significant research is therefore directed towards furthering our understanding of the mechanisms which control ASM cytosolic calcium, in addition to those regulating the sensitivity of its downstream effector targets to calcium. Key aspects of the recent developments in this field were discussed at the 8th Young Investigators' Symposium on Smooth Muscle (2013, Groningen, The Netherlands), and are outlined in this review.

Regulation of GPCR-mediated smooth muscle contraction: implications for asthma and pulmonary hypertension.

Contractile G-protein-coupled receptors (GPCRs) have emerged as key regulators of smooth muscle contraction, both under healthy and diseased conditions. This brief review will discuss some key topics and novel insights regarding GPCR-mediated airway and vascular smooth muscle contraction as discussed at the 7th International Young Investigators' Symposium on Smooth Muscle (2011, Winnipeg, Manitoba, Canada) and will in particular focus on processes driving Ca(2+)-mobilization and -sensitization.

Are valence and social avoidance associated with the memory conformity effect?

Pairs of participants were shown photographs which varied in terms of valence from negative to positive, and two days later, together, they were given a memory recognition test. When the first person responded the second person saw the response. This affected how the second person responded, what is called memory conformity. The memory conformity effect was larger for previously unseen stimuli (fillers) than for previously seen stimuli (targets), and was greatest for those with low scores on a social avoidance measure. While memory for negative (and most arousing) stimuli was most accurate, the memory conformity effect did not differ significantly by the stimulus valence. Implications for theories of memory malleability and for assessing the reliability of memories in a forensic context are discussed.

Memory conformity: exploring misinformation effects when presented by another person.

Two experiments demonstrate that post-event information, when delivered by another person, can affect people's memory reports. In the first experiment participants were shown several cars, and later, in pairs, given an 'old'/'new' recognition test on these cars plus several lures. There was a small but reliable effect of memory conformity. When the person was given misinformation this lowered accuracy, while presenting accurate information increased accuracy. In the second experiment participants, in pairs, viewed an identical crime except that half saw an accomplice with the thief and half did not. Initial memories were very accurate, but after discussing the crime with the other person in the pair (who saw a slightly different sequence), most pairs conformed. Confidence ratings strongly predicted which person in the pair persuaded the other. Parallels with eyewitness testimony in the Oklahoma bombing case and implications for police interviewing more generally are discussed.

Measuring dissociation: comparison of alternative forms of the dissociative experiences scale.

The dissociative experiences scale (DES), developed by Bernstein and Putnam (1986), is commonly used to measure dissociation in clinical populations. It is often used with nonclinical populations to assess how levels of dissociation covary with other psychometric measures. When it is used with nonclinical populations, problems arise because the resulting scores can show severe floor effects and often are highly skewed. To remedy these problems, we developed alternative ways of measuring self-reported dissociative experiences. A form of the DES in which people were required to rate how often they have each of 28 experiences compared with other people was superior in avoiding problems of floor effects and skewness. We discuss situations in which this alternative, which we call DES C, is preferred.

How misinformation alters memories.

Over the past quarter of a century, hundreds of studies have demonstrated that misleading postevent information affects people's memories. Researchers have used several methods to try to understand this phenomenon and have also put forward different theories to account for the effect. Brainerd and Reyna's (1998, this issue) conjoint misinformation method and their fuzzy-trace theory are welcomed additions on both these fronts. We describe how their contribution fits with the other methods and theories which have been used to understand how misleading postevent information affects people's memory.

How memory research can benefit from CASM.

Research on cognitive aspects of survey methodology (CASM) has helped survey researchers to understand the processes involved in responding to survey questions. The survey situation, and the methods employed by CASM researchers, can also be used to benefit cognitive psychology. In particular, the size and coverage of sample surveys, and the techniques used to examine how respondents understand survey questions, could be of much value for exploring some aspects of memory research. We give some examples where this is being done and urge others to follow suit.

Flashbulb memory assumptions: using national surveys to explore cognitive phenomena.

Implicit in most flashbulb memory research are three assumptions: that major news events will be important for almost everyone in the chosen sample, that people's ratings of memory quality are reliable and that a detailed recollection of personal circumstances implies a vivid memory. Using two general population surveys of Great Britain (total N = 3160), we examine each of these assumptions for two events that have recently been used in flashbulb memory studies: Margaret Thatcher's resignation as Prime Minister and the Hillsborough football disaster. The results emphasize the importance of careful sampling of both participants and events, and question whether flashbulb memories are as vivid as originally hypothesized. This type of research is rare within the flashbulb memory literature on account of the large sample sizes and the use of samples representative of the general population. This allows us to return to Brown & Kulik's (1977) original emphasis on group differences and re-evaluate their findings.

Comments on Scott and Ponsoda's (1996) positive and negative flashbulb memories.

Most of the events studied in flashbulb memory research are negative. Scott and Ponsoda (1996) are thoroughly commended for examining differences between positive and negative flashbulbs. Here we address three points. First, we note that other applicable research on autobiographical memory exists and stress that research on flashbulb memories should be prevented from becoming an isolated topic. Second, we identify some areas wherein flashbulb research has been applied, which help explain why there has been an imbalance towards negative events. Finally, we discuss some of the methodological difficulties matching positive and negative events.

Flashbulb memories: conceptual and methodological issues.

Although flashbulb memory research is now well established, it is still not clear exactly what researchers are referring to as flashbulbs, and what is the best way to address the phenomenon. There are at least two ways in which the term "flashbulbs" is used, and at least two conceptual approaches that can be used to research them. The first usage corresponds to the bold theoretical conjectures put forward by Brown and Kulik (1977). The second results from empirical classification and intuitively lacks the essence conveyed by the first meaning. The two approaches concentrate on the cognitive and societal aspects, respectively. Although these are not incompatible, they make different assumptions and use different methodologies. We argue that research should be directed towards more unified theorising, and we describe methodologies appropriate for this approach.

Misinformation and warnings in eyewitness testimony: a new testing procedure to differentiate explanations.

Although psychologists agree that the presentation of misleading post-event information often results in errant recollections, there is disagreement about the explanation as to why this occurs. Some (cf. Loftus, Donders, Hoffman, & Schooler, 1989) believe this misinformation alters the memory trace created by the original information, whereas others (cf. McCloskey & Zaragoza, 1985) have argued that the data do not necessitate this explanation. An experiment, designed to differentiate the various explanations, was conducted. Its critical elements were: (1) a condition with a specific warning presented immediately after the misleading information; and (2) a ranking procedure used at testing. The results suggest multiple traces may exist for a limited period, but not indefinitely.

Pharmacy technicians and computer technology to support clinical pharmacy services.

Use of pharmacy technicians, computer-assisted patient-selection algorithms, and bar-code technology to increase efficiency of clinical pharmacy staff is described. Workload assessment showed that clinical pharmacists at Henry Ford Hospital (Detroit) were spending two thirds of their time with data collection, patient selection, and documentation and only one third of their time intervening to improve drug therapy. To increase pharmacist efficiency, two technicians were hired to perform the clerical functions associated with clinical pharmacy services. Also, a bar-code data-collection system was implemented to help pharmacists document their clinical activity. Computerized algorithms helped pharmacists target patients whose therapy should be most carefully reviewed. Reports generated by the system summarized workload distribution and provided information about the types of problems identified and corrected. After these changes were implemented, the fraction of time that pharmacists spent intervening to improve drug therapy increased to one half. Use of technicians to perform clerical tasks, computerized algorithms to help identify patients in need of pharmacist assistance, and bar-code technology to facilitate data collection has helped clinical pharmacists improve their time management.

Antimicrobial formulary management: a case study in a teaching hospital.

The role of the formulary system for effective cost containment is becoming increasingly important. With antimicrobial agents taking up a large proportion of most pharmaceutical budgets, this group of agents is an obvious target for cost reduction. The responsible interchange of selected antimicrobial agents offers a promising method to achieve this goal. The Pharmacy and Therapeutics Committee at Henry Ford Hospital implemented the formulary replacement of cefoxitin with cefotetan on a cost basis after the agents were evaluated and considered to be therapeutically equivalent. Drug usage guidelines were developed to implement this change. Educational materials were distributed to the medical staff, and lectures on the appropriate use of cefotetan were given to the house staff. On implementation, all orders written for cefoxitin were automatically changed to cefotetan in the appropriate dosage. After the first 12 months of cefotetan usage no unanticipated problems with treatment failures or adverse effects were noted. Based on analysis of cefotetan use for the first year, a savings of +4F229,811 was achieved with this interchange.

Developing and implementing standards of practice for clinical pharmacy services.

The authors' department has attempted to bring more order to the provision and evaluation of clinical services through the development of "Clinical Standards of Practice." A pilot project was initially conducted on one satellite. Pharmacists were asked to prepare a list of minimum standards that could be agreed upon and that everyone believed were achievable even on the busiest days. After standards were developed and implemented, a procedure was established to evaluate compliance through review of pharmacy records and patient materials. Staff received feedback concerning the results of the review. As a result of the success with the pilot, Clinical Standards of Practice have been developed by staff and are in use throughout the department. Plans for the future include continuous revision of the standards to reflect changing departmental goals and directions and a change to a "pharmacist specific" rather than a current "nursing unit specific" monthly review format to facilitate performance review and staff development. Eleven standards are shown in the appendices.

Cefsulodin.

The chemistry, microbiology, pharmacokinetics, adverse reactions, and clinical indications for cefsulodin are reviewed and compared to ceftazidime and cefoperazone. Cefsulodin is a narrow-spectrum, third-generation cephalosporin with activity virtually restricted to Pseudomonas aeruginosa. Cefsulodin is eliminated renally and has a serum half-life similar to ceftazidime and cefoperazone. Cefsulodin appears to be well tolerated and relatively free of any significant toxicity except for nausea and vomiting, which appear to be related to the infusion rate. Cefsulodin may be beneficial in those rare clinical situations where an infection is caused by a sensitive isolate of P. aeruginosa known to be resistant to the other antipseudomonal cephalosporins, and/or the avoidance of an aminoglycoside antibiotic is desired. However, its empiric use is to be discouraged.