Prevention of Gynaecological Adhesions using Haemostatic Fleece in a Rabbit Model

This pre-clinical study was performed to investigate the ability of the haemostatic fleece TachoComb® to prevent adhesion formation following uterine surgery. Thirty rabbits were randomized to receive TachoComb® or no intervention following incision to the right uterine horn. After 14 days, the animals were killed and examined for the presence of adhesion. The lengths of any adhesions were measured and the severity was recorded as a score (0, no adhesion; 1, adhesion easy to lyse; 2, adhesion lysed with traction; 3, adhesion separated by sharp dissection). The incidence of adhesions was 100% in the control group compared with 33% in the TachoComb®-treated animals. The mean adhesion score was significantly lower (0.7 versus 2.2) and the mean adhesion length category was significantly shorter (0.4 versus 2.0) with TachoComb® than in the control group. This study indicates that TachoComb® is a well-tolerated and effective means of preventing adhesion following gynaecological surgery.

The 2005 'Last Chance Bravo' bioterrorism exercise

The 2005 'Last Chance Bravo' bioterrorism exercise provided a forum for testing advanced technologies in a simulated disaster. The four-day exercise included a 2-day simulated pneumonic plague outbreak, with 50 participants from the Montana Department of Health and Human Services, 20 participants from various hospital organizations and approximately 150 participants from over 40 telemedicine sites. Telephone communications and Web tools supported much of the critical information exchange. Videoconferencing added an element of image sharing for pathology, radiology and geospatial mapping. During the exercise three telehealth networks facilitated a telemedicine session to over 40 sites across Montana. Because of the large number of telehealth sites participating, the videoconference session became more like an informational news broadcast. The ability of telemedicine to support image and data sharing may be a significant advantage over simple telephone communications in disaster response.

OptEase Retrievable Inferior Vena Cava Filter: Initial Multicenter Experience

The purpose of this article is to describe our experience with the retrievable OptEase inferior vena cava filter (IVCF) (Cordis Corporation, Miami Lakes, FL) in the prevention of pulmonary embolus (PE). Forty patients (24 men, age range 15–85 years, mean age 38 years) who were at temporary risk of PE underwent insertion and retrieval of the OptEase IVCF at two institutions. Eleven patients were treated with filter implantation and subsequent repositioning in the inferior vena cava (IVC) to extend implantation time. All patients were followed up for 24 hours after retrieval, with additional follow-up at the physician's discretion. Forty patients had successful filter insertion. Two patients who underwent intravascular ultrasound guidance for filter deployment required filter repositioning within 24 hours owing to inadvertent placement in the right common iliac vein. All 40 patients underwent successful filter retrieval with no adverse events. In those patients who did not undergo IVCF repositioning, the time to retrieval ranged from 3 to 48 days (mean ± SD 16.38 ± 7.20 days). One patient had a successful retrieval at 48 days, but all other retrieval experiences were performed within 23 days. The second strategy involved implantation, with repositioning at least once before final retrieval. This latter strategy occurred in 11 patients, and the time to first capture ranged from 4 to 30 days (mean ± SD 13.82 ± 6.13 days). No symptomatic PE, IVC injury or stenosis, significant bleeding, filter fracture, or filter migration was observed. In this feasibility study, the OptEase IVCF prevented symptomatic PE, was safely retrieved or repositioned up to 48 days after implantation, and served as an effective bridge to anticoagulation. In patients who require extended IVCF placement, the OptEase IVCF can be successfully repositioned within the IVC, thereby extending the overall implantation time of this retrievable IVCF.

Neural correlates of emotional response inhibition in obsessive-compulsive disorder: A preliminary study

Failure to inhibit recurrent anxiety-provoking thoughts is a central symptom of obsessive-compulsive disorder (OCD). Neuroimaging studies suggest inhibitory control and disgust processing abnormalities in patients with OCD. However, the emotional modulation of response inhibition deficits in OCD and their neural correlates remain to be elucidated. For this preliminary study we administered an adapted affective response inhibition paradigm, an emotional go/no-go task, during fMRI to characterize the neural systems underlying disgust-related and fear-related inhibition in nine adults with contamination-type OCD compared to ten matched healthy controls. Participants with OCD had significantly greater anterior insula cortex activation when inhibiting responses to both disgusting (bilateral), and fearful (right-sided) images, compared to healthy controls. They also had increased activation in several frontal, temporal, and parietal regions, but there was no evidence of amygdala activation in OCD or healthy participants and no significant between-group differences in performance on the emotion go/no-go task. The anterior insula appears to play a central role in the emotional modulation of response inhibition in contamination-type OCD to both fearful and disgusting images. The insula may serve as a potential treatment target for contamination-type OCD.

Quality of life in pediatric patients affected by electrophysiologic disease

BACKGROUND

Treatment of electrophysiologic (EP) disease in pediatric patients has improved; however, the effects on quality of life (QOL) are unknown.

OBJECTIVE

The purpose of this study was to compare QOL within EP disease groups and to other congenital heart diseases, to evaluate the effects of cardiac rhythm devices on QOL, and to identify drivers of QOL in EP disease.

METHODS

Cross-sectional study of patient/parent proxy-reported Pediatric Cardiac Quality of Life Inventory scores (Total, Disease Impact, Psychosocial Impact) in subjects aged 8 to 18 years from 11 centers with congenital complete heart block (CCHB), ventricular tachycardia (VT), supraventricular tachycardia (SVT), and long QT syndrome (LQTS). QOL was compared between EP disease groups and congenital heart disease groups [bicuspid aortic valve (BAV), tetralogy of Fallot (TOF), and Fontan]. General linear modeling was used to perform group comparisons and to identify predictors of QOL variation.

RESULTS

Among 288 patient-parent pairs, mean age was 12.8 ± 3.0 years. CCHB (μ = 83) showed higher patient Total QOL than other EP disease cohorts (P ≤ .02; LQTS μ = 73; SVT μ = 74). SVT (μ = 75) and LQTS (μ = 75) had lower patient Total scores than BAV (μ = 81; P ≤ .008). Patient/parent-proxy QOL scores for all EP disease groups were not different than TOF and higher than Fontan. The presence of a cardiac rhythm device was associated with lower QOL scores in LQTS (μ = 66 vs μ = 76; P < .01). Predictors of lower patient/parent-proxy QOL included EP disease type (P ≤ .03), increased medical care utilization (P ≤ .04), and no parental college degree (P ≤ .001).

CONCLUSION

Given the significant variation in QOL in EP disease type, stratification by EP disease type and increased medical care utilization may allow for targeted interventions to improve QOL.

Human papillomavirus and overall survival after progression of oropharyngeal squamous cell carcinoma

PURPOSE

Risk of cancer progression is reduced for patients with human papillomavirus (HPV) -positive oropharynx cancer (OPC) relative to HPV-negative OPC, but it is unknown whether risk of death after progression is similarly reduced.

PATIENTS AND METHODS

Patients with stage III-IV OPC enrolled onto Radiation Therapy Oncology Group trials 0129 or RTOG 0522 who had known tumor p16 status plus local, regional, and/or distant progression after receiving platinum-based chemoradiotherapy were eligible for a retrospective analysis of the association between tumor p16 status and overall survival (OS) after disease progression. Rates were estimated by Kaplan-Meier method and compared by log-rank; hazard ratios (HRs) were estimated by Cox models. Tests and models were stratified by treatment protocol.

RESULTS

A total of 181 patients with p16-positive (n = 105) or p16-negative (n = 76) OPC were included in the analysis. Patterns of failure and median time to progression (8.2 v 7.3 months; P = .67) were similar for patients with p16-positive and p16-negative tumors. After a median follow-up period of 4.0 years after disease progression, patients with p16-positive OPC had significantly improved survival rates compared with p16-negative patients (2-year OS, 54.6% v 27.6%; median, 2.6 v 0.8 years; P < .001). p16-positive tumor status (HR, 0.48; 95% CI, 0.31 to 0.74) and receipt of salvage surgery (HR, 0.48; 95% CI; 0.27 to 0.84) reduced risk of death after disease progression whereas distant versus locoregional progression (HR, 1.99; 95% CI, 1.28 to 3.09) increased risk, after adjustment for tumor stage and cigarette pack-years at enrollment.

CONCLUSION

Tumor HPV status is a strong and independent predictor of OS after disease progression and should be a stratification factor for clinical trials for patients with recurrent or metastatic OPC.

Appointment reminder systems and patient preferences: Patient technology usage and familiarity with other service providers as predictive variables

This study had two aims: to measure patient preferences for medical appointment reminder systems and to assess the predictive value of patient usage and familiarity with other service providers contacting them on responsiveness to appointment reminder systems. We used a cross-sectional design wherein patients' at an urban, primary-care clinic ranked various reminder systems and indicated their usage of technology and familiarity with other service providers contacting them over text messages and e-mails. We assessed the impact of patient usage of text messages and e-mails and patient familiarity with other service providers contacting them over text messages and e-mails on effectiveness of and responsiveness to appointment reminder systems. We found that patient usage of text messages or e-mails and familiarity with other service providers contacting them are the best predictors of perceived effectiveness and responsiveness to text message and e-mail reminders. When these variables are accounted for, age and other demographic variables do not predict responsiveness to reminder systems.

Does continuity of care have an effect on diabetes quality measures in a teaching practice in an urban underserved community?

Teaching clinics are an important source of care for urban, minority, underserved communities and face great challenges to improve quality of care for diabetics. This study examined the impact of continuity with the same primary care provider on health care process and outcome measures for patients with diabetes treated at an urban, family medicine resident teaching practice. The Modified Modified Continuity of Care Index was used to measure care continuity. The diabetes care quality measures were based on the NCQA HEDIS and Diabetes Recognition Program. Low levels of care continuity were associated with poor HbA1c control and higher levels of care continuity were associated with good LDL control. These findings suggest that improving care continuity should be considered in a systems-based approach to address disparities in diabetes care. Additional research is needed to include the patient's perspective in measuring care continuity and patient outcomes.