The informational and decisional preferences of patients undergoing surgery for Crohn's anal fistula: a qualitative study

AIM

One in three patients with Crohn's disease will develop a perianal fistula, but only a few achieve long-term healing. Treatment is both medical and surgical. Since there is no 'best' surgical procedure, patient preference is important in selecting the appropriate treatment for this condition. The aim of this study was to investigate the informational and decisional preferences of patients when surgical treatment is being considered.

METHOD

Patients who had undergone surgery for Crohn's anal fistula underwent face-to-face semi-structured interviews. These explored the experience of treatments for fistula, of receiving information and of participation in decision-making. Transcripts were analysed by two investigators through inductive thematic analysis. Saturation was assessed for at 12 interviews and then after each subsequent interview.

RESULTS

Seventeen patients completed interviews, and saturation was achieved. Five themes were identified, of which two (desired information and decision-making) were relevant to this study. Other themes included experience of Crohn's disease, experience of receiving information and procedure-specific comments. Participants wanted to have information on any risks, high-level outcomes (e.g. success), impact on day-to-day life and aftercare. Participants felt they did not always receive the information they needed to select the best treatment option. Participants felt uninvolved in treatment decisions and would have liked to trade off operations to reach their treatment goal.

CONCLUSION

Information provided to patients about surgical treatment of Crohn's perianal fistula does not meet their needs. Clinicians should address aftercare, impact on quality of life and the risks and benefits of the any proposed procedure.

The assessment of online health videos for surgery in Crohn's disease

AIM

YouTube™ is an open-access, nonpeer-reviewed video-hosting site and is used as a source of publicly available healthcare information. This study aimed to assess the thematic content of the most viewed videos relating to surgery and Crohn's disease and to explore the viewer interactions with these videos.

METHOD

A search of YouTube™ was carried out using one search string. The 50 most viewed videos were identified and categorized by source and content themes and assessed for viewer interactions. Video comments were used to describe the usefulness of the video content to viewers.

RESULTS

The majority of videos were uploaded by patients (n = 21).The remainder were uploaded by individual healthcare professionals (n = 9), hospital/speciality associations (n = 18) and industry (n = 2). The median number of likes for patient videos was significantly higher than for hospital/speciality association videos (P < 0.001). Patient videos received more comments praising the video content (n = 27) and more comments asking for further information (n = 14). The median number of likes for 'experience of surgery' (P < 0.001) and 'experience of disease' (P = 0.0015) themed videos were significantly higher than for 'disease management' themed videos.

CONCLUSION

Crohn's disease patients use YouTube™ as a surgical information source. The content of patient-sourced videos focused on surgical and disease experience, suggesting that these themes are important to patients. Current patient developed videos provide limited information, as reflected by viewers requesting further information. Storytelling patient-centred videos combined with clinical evidence may be a good model for future videos.

Assessing internet-based information used to aid patient decision-making about surgery for perianal Crohn's fistula

BACKGROUND

Decision-making in perianal Crohn's fistula (pCD) is preference sensitive. Patients use the internet to access healthcare information. The aim of this study was to assess the online information and patient decision aids relating to surgery for pCD.

METHODS

A search of Google™ and the Decision Aids Library Inventory (DALI) was performed using a predefined search strategy. Patient-focussed sources providing information about pCD surgery were included in the analysis. Written health information was assessed using the International Patient Decision Aids Standards (IPDAS) and DISCERN criteria. The readability of the source content was assessed using the Flesch-Kincaid score.

RESULTS

Of the 201 sources found, 187 were excluded, leaving 14 sources for analysis. Three sources were dedicated to pCD, and six sources mentioned pCD-specific outcomes. The most common surgical intervention reported was seton insertion (n = 13). The least common surgical intervention reported was proctectomy (n = 1). The mean IPDAS and DISCERN scores were 4.43 ± 1.65 out of 12 (range = 2-8) and 2.93 ± 0.73 out of 5 (range = 1-5), respectively. The mean reading ease was US college standard.

CONCLUSIONS

We found no patient decision aids relating to surgery for pCD. The online sources relating to surgery for pCD are few, and their quality is poor, as seen in the low IPDAS and DISCERN scores. Less than half of the sources mentioned pCD-specific outcomes, and three sources were solely dedicated to providing information on pCD. Healthcare professionals should look to create a patient tool to assist decision-making in pCD.

Deposition and Properties of Epitaxial Ferrite Thin Films

We have grown thin films and multilayers of several ferrite materials with the spinel structure by pulsed laser deposition of stoichiometric targets. Epitaxial films can be grown on a variety of substrates including MgO, Al2O3, MgAl2O4, Y-stabilized ZrO2 (YSZ) and SrTiO3. Films on Mg- and Al-containing substrates have a low saturation Magnetization, Ms, while films on YSZ and SrTiO3 exhibit bulk values of Ms. The anisotropy can be lowered by a post growth anneal, resulting in a film with a permeability of 28.

Cervical and prostate primary epithelial cells are not productively infected but sequester human immunodeficiency virus type 1

Primary prostate and cervical epithelial cells and epithelial cell lines were examined for human immunodeficiency virus type 1 (HIV-1) infection or transmission to peripheral blood mononuclear cells (PBMC). Neither cell-free nor cell-associated HIV-1 infected primary epithelial cells or cell lines. Pretreatment of HIV-1 to enhance CD4-independent entry did not augment infection. Cell surface expression was detected for galactosyl ceramide but not for CC-chemokine receptor 5, CXC-chemokine receptor 4, or CD4. The ability to transfer HIV-1 to resting or activated PBMC was tested by culturing with rinsed or trypsinized and replated HIV-1-exposed epithelial cells. Virus was not recovered from the rinsed or replated cocultures with resting PBMC; however, activated PBMC recovered HIV-1 from rinsed epithelial cells and rarely from replated epithelial cells. Although urogenital epithelial cells are not infected, these data suggest that they can transfer virus to activated immune cells and have implications for sexual transmission of HIV-1.

Single-Crystal Epitaxial Thin Films of the Isotropic Metallic Oxides Sr1-xCaxRuO3 (0 le x le 1)

Single-crystal epitaxial thin films of the isotropic metallic oxides Sr1-xCaxRuO(3) (0 </= x </= 1) were grown on miscut SrTiO(3)(100) substrates in situ by 90 degrees off-axis sputtering. These thin films exhibit low isotropic resistivities, excellent chemical and thermal stability, good surface smoothness, and high crystalline quality. Furthermore, the lattice parameters and magnetic properties can be varied by simply changing the strontium/calcium ratio. These epitaxial thin films, and their multilayer structures with other oxide materials, can be used for the fabrication of superconducting, ferroelectric, magneto-optic, and electro-optic devices.

Nodular renal blastema in the multicystic kidney

Of 60 surgically removed multicystic, dysplastic kidneys examined for the presence of nodular renal blastema only 1 (2 per cent) had blastematous elements. Of the 60 patients 35 were from the authors' personal series and they were examined in clinical detail. The results of this study and those in the literature are discussed in relation to the over-all management of the asymptomatic multicystic, dysplastic kidney.

Purification and properties of glycerol:NADP+ 2-oxidoreductase from Schizosaccharomyces pombe

Glycerol:NADP+ 2-oxidoreductase (EC 1.1.1.156) was isolated from Schizosaccharomyces pombe, purified and characterized. It had an Mr of 57,000, and SDS-PAGE revealed two polypeptides, of Mr 25,000 and 30,000. Its coenzyme requirement was satisfied exclusively by NADP. The pH optimum for glycerol oxidation was 9.5, for dihydroxyacetone reduction 6.0. Rates of oxidation with some structurally related diols were three- to six-fold lower than for glycerol, while glyceraldehyde and other carbonyl compounds showed negligible rates of reduction. Neither monovalent nor divalent cations activated the enzyme. Apparent Km and Vmax values were determined. The enzyme is similar to glycerol dehydrogenases isolated from Mucor javanicus and from Dunaliella parva but differs considerably from the glycerol:NAD+ 2-oxidoreductase of S. pombe.

Digital angiography and osteoblastoma of the triquetrum

A patient had persistent pain in left wrist of 2 years' duration. Only intravenous digital subtraction angiography was specific in establishing a tumor in the left triquetrum as the cause. The tumor was an osteoblastoma.

A comparison of paralysing agents in double-contrast barium meal examinations

One hundred and fourteen patients attending for barium meal examination were randomly allocated to receive Buscopan (hyoscine N-butylbromide, Boehringer Ingelheim; 20 mg) or glucagon (0.5 mg) as paralysing agents, or sterile water as control. The radiographs were analysed with regard to (a) gastric and duodenal distension and coating and (b) early or delayed filling of the duodenum with barium, in order to assess claims that paralysing agents influence radiographic quality. It was found that both duodenal distension and coating were better with Buscopan and glucagon than with water but there was no difference between Buscopan and glucagon in producing these effects. Relaxants produced no significant effect on distension or coating of the stomach. Glucagon prolonged the time of some examinations but gave better visualisation of the stomach, which was less frequently obscured by contrast in the duodenum.

Source and avoidance of the "nothing dehydrogenase" effect, a spurious band produced during polyacrylamide gel electrophoresis of dehydrogenase enzymes from yeasts

During a study of the distribution of several NAD-linked dehydrogenase enzymes in various yeasts, in which polyacrylamide gel electrophoresis, followed by activity staining with phenazine methosulfate and a tetrazolium was used, a band was frequently detected, the production of which appeared to be independent of any added substrate (the "nothing dehydrogenase" effect). It has been shown that this effect is caused by alcohol dehydrogenase acting on traces of ethanol inadvertently introduced into the system. Two sources of ethanol were identified. They were (i) the enzyme extracts, which could be freed from ethanol by gel filtration, and (ii) the acrylamide used to prepare the gel, which could be freed from ethanol by recrystallization from ethanol-free chloroform. It is suggested that the use of commercial chloroform (stabilized with ethanol) as a recrystallizing solvent is the source of ethanol contamination in commercial preparations of acrylamide.

Plasmid-mediated antibiotic resistance in methicillin-resistant Staphylococcus aureus

Strains of methicillin-resistant Staphylococcus aureus (MRSA), isolated from clinical sources in Victoria, were screened for the presence of plasmid DNA. Resistance to gentamicin, kanamycin, and tobramycin was found to reside on an 18-megadalton plasmid, and resistance to chloramphenicol was mediated by a 3-megadalton plasmid. No extra-chromosomal locus was found for resistance to several other antibiotics, including methicillin. Local strains of MRSA differ from their international counterparts by the possession of extensive chromosomal resistance determinants. Together with those encoded on plasmids, these determinants are capable of neutralising almost all available antistaphylococcal antibiotics.

Outpatient termination of pregnancy: experience in a family practice residency

At the University of Washington Family Medicine Clinic, termination of pregnancy procedures were performed on 260 patients. Their records were reviewed, and an analysis was completed on demographic data, technical procedure parameters, and complication rates during and following the procedure. The majority of patients were not primigravida. Fifteen percent were between six and eight weeks of gestation. Following the procedure, 3.8 percent had excessive bleeding, and 2.7 percent developed endometritis at rates comparable to those found in the obstetrics and gynecology literature. No known perforations occurred. Outpatient termination of pregnancy performed on selected patients in a family practice setting can be a procedure of low morbidity.

Proposed pathway of triterpenoid carotenoid biosynthesis in Staphylococcus aureus: evidence from a study of mutants

Mutants of Staphylococcus aureus were isolated which showed changes in pigment composition compared with the parent strain. On the basis of differences in their triterpenoid carotenoid composition they were classified into seven types. In five of these types, there appeared to be a blockage in the biosynthetic pathway which resulted in the absence of some products and accumulation of others. The changes in the other two types appeared to be a consequence of some change in regulation. A scheme for the biosynthesis of triterpenoid carotenoids is presented in which the first C30 intermediate, 4,4'-diapophytoene, is converted via 4,4'-diapophytofluene, 4,4'-diapo-zeta-carotene, 4,4'-diaponeurosporene, 4,4'-diaponeurosporenal, 4,4'-diaponeurosporenoic acid, and glucosyl-diaponeurosporenoate to the major pigment staphyloxanthin.

Pigments of Staphylococcus aureus, a series of triterpenoid carotenoids

The pigments of Staphylococcus aureus were isolated and purified, and their chemical structures were determined. All of the 17 compounds identified were triterpenoid carotenoids possessing a C30 chain instead of the C40 carotenoid structure found in most other organisms. The main pigment, staphyloxanthin, was shown to be alpha-D-glucopyranosyl 1-O-(4,4'-diaponeurosporen-4-oate) 6-O-(12-methyltetradecanoate), in which glucose is esterified with both a triterpenoid carotenoid carboxylic acid and a C15 fatty acid. It is accompanied by isomers containing other hexoses and homologs containing C17 fatty acids. The carotenes 4,4'-diapophytoene, 4,4'-diapophytofluene, 4-4'-diapophytofluene, 4-4'-diapo-zeta-carotene, 4,4'-diapo-7,8,11,12-tetrahydrolycopene, and 4,4'-diaponeurosporene and the xanthophylls 4,4'-diaponeurosporenal, 4,4'-diaponeurosporenoic acid, and glucosyl diaponeurosporenoate were also identified, together with some of their isomers or breakdown products. The symmetrical 4,4'-diapo- structure was adopted for these triterpenoid carotenoids, but an alternative unsymmetrical 8'-apo-structure could not be excluded.

An air sampling technique for hepatitis B surface antigen

A filter-rinse technique capable of detecting low levels of airborne hepatitis B surface antigen (HBsAg) was devised and evaluated. Laboratory tests showed the procedure to have an efficiency of 22% with a coefficient of variation of 11% and a capability of detecting as little as 5 x 10(-5) ml of aerosolized antigen positive serum in a single air sample. The technique was field-tested in a hemodialysis center serving a patient population with a high prevalence of HBsAg seropositivity. The antigen was not detected in any of 60 air samples collected under conditions favoring the occurrence of aerosols.

Microbial contamination of mist therapy units on six pediatric wards

A study was conducted in six pediatric wards to investigated factors that influence microbial contamination of mist therapy units. Most samples from nebulizer reservoirs were positive for gram-negative bacilli which multiplied rapidly in distilled water and reached levels as high as 3.0 X 10(8) viable microorganisms per ml. High prevalence rates of Pseudomonas aeruginosa and coliform bacteria as well as high levels of gram-negative bacilli were found to be associated with infrequent and inadequate cleaning and disinfection of the nebulizing equipment. In one of the wards exhibiting high rates, a move to new quarters permitted the implementation of improved cleaning and maintenance procedures for mist therapy units. The result was a significant reduction of microbial contamination. This study reemphasizes the role of microbiological surveillance in assuring proper care of nebulizing equipment in the hospital.

Split beam spectrophotometer

A single light source-single detector spectrophotometer has been constructed to record continuously transmissivity or reflectivity as a function of wavelength. This instrument is especially useful for thin film samples of small areas glued to substrates, when it is difficult to produce a similar glue layer for the reference beam. Measurements on samples 1 mm(2) and smaller have been performed. Except for the simple custom-made chopper blade, commercially available components were used throughout. Through the use of reflecting optics no wavelength limitations are encountered.