Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review.

OBJECTIVE: To determine the contemporary prevalence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome in critically ill patients. DATA SOURCES: Medline, Embase, and Central databases. STUDY SELECTION: Studies reporting on the prevalence of IAH in consecutively admitted critically ill patients using the World Society of Abdominal Compartment Syndrome (WSACS) consensus guidelines for intra-abdominal pressure (IAP) measurement. DATA EXTRACTION: Duplicate independent review and data abstraction. DATA SYNTHESIS: The search identified 2428 titles with 6 eligible studies (n = 1965). Reported prevalence ranged from 30% to 49%. Despite abiding by the WSACS guidelines for IAP measurement, studies varied in their definition of IAH, frequency and duration of IAP measurement, and reporting of outcomes. Three of 6 studies reported that IAH, especially at higher grades, was an independent predictor of mortality. CONCLUSIONS: Intra-abdominal hypertension is a common finding in critically ill patients and may be associated with increased mortality, especially at higher grades. Further prospective research is required to examine the effect of screening and treatment of IAH on patient outcomes.

Quality of Life After Total Proctocolectomy With Ileostomy or IPAA: A Systematic Review.

BACKGROUND: The standard surgical treatment for ulcerative colitis involves either a total proctocolectomy and end ileostomy or an IPAA. Both treatments result in similar control of disease but differ in terms of patient experience and daily functioning. OBJECTIVE: The aim of this systematic review was to determine whether one surgical approach was superior with regard to health-related quality of life. DATA SOURCES: An electronic literature search of PubMed, MEDLINE, EMBASE, and the Cochrane Database of Collected Reviews was performed for dates from 1978 to 2014. The search included the following terms: "inflammatory bowel disease," "colitis," "colectomy," and "ileal pouch-anal anastomosis." STUDY SELECTION: Studies were included if they reported on a comparison of total proctocolectomy and end ileostomy with an IPAA and evaluated some aspect of quality of life. INTERVENTION(S): All of the studies were systematically reviewed. No meta-analysis was performed secondary to significant heterogeneity across studies in different health-related quality-of-life measures. MAIN OUTCOME MEASURES: End points were a mixture of global, generic, and disease-specific measures of quality of life. RESULTS: Thirteen studies reporting a total of 1604 patients who underwent total proctocolectomy with ileostomy (N = 820) or IPAA (N = 783) were included for review. Neither procedure was found to be clearly superior with regard to health-related quality of life. LIMITATIONS: The conclusions of this review were limited by small study sample size, significant between-study heterogeneity, observational designs, and limited follow-up. CONCLUSIONS: Despite being limited by poor study quality, both total proctocolectomy with ileostomy and IPAA appear equivalent in terms of overall health-related quality of life. Most patients are satisfied with their choice regardless of procedure. Most of the improvement in quality of life after surgery is related to the control of disease-related symptoms. These findings indicate that both IPAA and permanent ileostomy should be discussed in detail with patients preoperatively to help them make an informed decision.

The relative effectiveness of computer-based and traditional resources for education in anatomy.

There is increasing use of computer-based resources to teach anatomy, although no study has compared computer-based learning to traditional. In this study, we examine the effectiveness of three formats of anatomy learning: (1) a virtual reality (VR) computer-based module, (2) a static computer-based module providing Key Views (KV), (3) a plastic model. We conducted a controlled trial in which 60 undergraduate students had ten minutes to study the names of 20 different pelvic structures. The outcome measure was a 25 item short answer test consisting of 15 nominal and 10 functional questions, based on a cadaveric pelvis. All subjects also took a brief mental rotations test (MRT) as a measure of spatial ability, used as a covariate in the analysis. Data were analyzed with repeated measures ANOVA. The group learning from the model performed significantly better than the other two groups on the nominal questions (Model 67%; KV 40%; VR 41%, Effect size 1.19 and 1.29, respectively). There was no difference between the KV and VR groups. There was no difference between the groups on the functional questions (Model 28%; KV, 23%, VR 25%). Computer-based learning resources appear to have significant disadvantages compared to traditional specimens in learning nominal anatomy. Consistent with previous research, virtual reality shows no advantage over static presentation of key views.