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Reasons for Data-Prompted Site Visits: Field Staff Findings and Review Committee Decisions. J Grad Med Educ 2021; 13:447-454. [PMID: 34178287 PMCID: PMC8207924 DOI: 10.4300/jgme-d-21-00435.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A major component of the ACGME's Next Accreditation System (NAS) is the annual review of key performance indicators by each review committee (RC) for all programs under its oversight. The RC may request a site visit that is data-prompted for either a full review of all common and specialty-specific program requirements or a focused review of specific concerns for programs identified as underperforming. OBJECTIVE The aims of this study were to: (1) identify the reasons that RCs requested data-prompted site visits; (2) describe the findings by accreditation field representatives as reflected in their site visit reports; and (3) summarize the accreditation decisions of RCs that followed the data-prompted site visits (DPSVs). METHODS RC letters to programs informing them of a DPSV, site visit reports, and RC letters with accreditation decisions were reviewed for all programs having DPSVs from 2015 to 2020. RESULTS DPSVs were performed in 312 programs, including 59 hospital-based, 122 medical-based, and 131 surgery-based programs; 214 programs had a single DPSV, and 98 programs had repeat DPSV. The most frequent reason that RCs requested a DPSV was noncompliance on the annual ACGME Resident/Fellow Survey. Notification of a DPSV prompted a change in program director in 7% of programs in the single DPSVs group and 57% of programs in the repeat DPSVs group. Surgery-based programs in the single and repeat DPSVs groups were more likely to receive an unfavorable accreditation status. The majority of programs in the single DPSVs group (78%) and repeat DPSVs group (70%) had a status of continued accreditation as of March 2020. CONCLUSIONS Noncompliance on the Resident/Fellow survey was the most frequent reason that RCs requested a DPSV. The majority of programs in the single and repeat DPSV groups achieved a favorable accreditation status.
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Smoking Behaviors of General Educational Development (GED) Recipients. Subst Use Misuse 2021; 56:1707-1714. [PMID: 34253161 DOI: 10.1080/10826084.2021.1949614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cigarette smoking is inversely associated with education, and despite this gradient effect, individuals with a General Educational Development (GED) diploma, obtained through a high school equivalency test, have the highest smoking prevalence. Considered the high school equivalency credential, it is unclear why individuals with a GED have a substantially higher smoking prevalence compared to high school graduates and dropouts. We conducted a qualitative study to understand life experiences, tobacco use patterns, and perceptions of tobacco among GED smokers and attitudes and behaviors around smoking cessation. METHODS We recruited 40 GED smokers aged 18 to 35 years and conducted surveys and semi-structured individual interviews. Transcripts were independently coded, then coding differences were resolved and reviewed by a third team member. We independently determined themes within and between codes and met to determine final themes. RESULTS GED recipients had many early life experiences and characteristics that made them highly vulnerable to tobacco dependence. With perceived high cognitive abilities, GED smokers were knowledgeable of many evidence-based smoking cessation strategies and were aware of health risks. Health risks and the financial burden of smoking were motivation to quit. The majority were uninterested or lacked confidence that nicotine replacement therapy, medications, counseling, or the quitline could help them quit. Nearly all were enthusiastic and confident that financial incentives had the potential to help them quit. CONCLUSIONS Research is needed to determine whether financial incentives could improve smoking cessation outcomes in this unique population with an unequal burden of smoking.
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The safety and effectiveness of a long-acting transdermal fentanyl solution compared with oxymorphone for the control of postoperative pain in dogs: a randomized, multicentered clinical study. J Vet Pharmacol Ther 2013; 37:394-405. [PMID: 24344787 PMCID: PMC4265281 DOI: 10.1111/jvp.12096] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
Abstract
A prospective, double-blinded, positive-controlled, multicenter, noninferiority study was conducted to evaluate the safety and effectiveness of transdermal fentanyl solution (TFS) compared with oxymorphone for the control of postoperative pain in dogs. Five hundred and two (502) client-owned dogs were assigned to a single dose of TFS (2.7 mg/kg) applied 2–4 h prior to surgery or oxymorphone hydrochloride (0.22 mg/kg) administered subcutaneously 2–4 h prior to surgery and q6h through 90 h. Pain was evaluated over 4 days by blinded observers using a modified Glasgow composite pain scale, and the a priori criteria for treatment failure was a pain score ≥8 or adverse event necessitating withdrawal. Four TFS- and eight oxymorphone-treated dogs were withdrawn due to lack of pain control. Eighteen oxymorphone-treated, but no TFS-treated dogs were withdrawn due to severe adverse events. The one-sided upper 95% confidence interval of the difference between TFS and oxymorphone treatment failure rates was −5.3%. Adverse events associated with oxymorphone were greater in number and severity compared with TFS. It was concluded that a single administration of TFS was safe and noninferior to repeated injections of oxymorphone for the control of postoperative pain over 4 days at the dose rates of both formulations used in this study.
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Cross-sensitization between cocaine and acute restraint stress is associated with sensitized dopamine but not glutamate release in the nucleus accumbens. Eur J Neurosci 2013; 37:982-95. [PMID: 23360446 DOI: 10.1111/ejn.12121] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 12/05/2012] [Accepted: 12/07/2012] [Indexed: 12/20/2022]
Abstract
Repeated administration of psychostimulant drugs or stress can elicit a sensitized response to the stimulating and reinforcing properties of the drug. Here we explore the mechanisms in the nucleus accumbens (NAc) whereby an acute restraint stress augments the acute locomotor response to cocaine. This was accomplished by a combination of behavioral pharmacology, microdialysis measures of extracellular dopamine and glutamate, and Western blotting for GluR1 subunit of the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor (AMPAR). A single exposure to restraint stress 3 weeks before testing revealed that enduring locomotor sensitization to cocaine was paralleled by an increase in extracellular dopamine in the core, but not the shell subcompartment, of the NAc. Wistar rats pre-exposed to acute stress showed increased basal levels of glutamate in the core, but the increase in glutamate by acute cocaine was blunted. The alterations in extracellular glutamate seem to be relevant, as blocking AMPAR by 6-cyano-7-nitroquinoxaline-2,3-dione microinjection into the core prevented both the behavioral cross-sensitization and the augmented increase in cocaine-induced extracellular dopamine. Further implicating glutamate, the locomotor response to AMPAR stimulation in the core was potentiated, but not in the shell of pre-stressed animals, and this was accompanied by an increase in NAc GluR1 surface expression. This study provides evidence that the long-term expression of restraint stress-induced behavioral cross-sensitization to cocaine recapitulates some mechanisms thought to underpin the sensitization induced by daily cocaine administration, and shows that long-term neurobiological changes induced in the NAc by acute stress are consequential in the expression of cross-sensitization to cocaine.
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08:44: Use of a Novel Robotic System for Stapes Surgery. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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08:44: Hearing Loss in the U.S. Adult Population: NHANES 1999–2004. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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09:10: Tissue-Engineered Mastoid Air Cell Regeneration. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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09:10: Phase II Results: Esteem Totally Implantable Hearing System. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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08:10: Management of Acoustic Neuromas by Observation. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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09:02: Validity of the Hum Test in Predicting Hearing Loss. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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08:02: Extending Indications of Middle Ear Implantable Devices. Otolaryngol Head Neck Surg 2007. [DOI: 10.1016/j.otohns.2007.06.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE Advancements in the fields of head and neck surgery and immunology have paved the way for new quality of life-improving procedures such as larynx transplantation. To quantitatively assess the risks versus benefits in larynx transplantation, we used a questionnaire-based survey (Louisville Instrument For Transplantation [LIFT]) to measure the degree of risk individuals are willing to accept to receive different types of transplantation procedures. METHODS The LIFT contains 237 standardized questions incorporating standard gamble and time tradeoff outcome measures as well as questions assessing body image perception, depression, self-esteem, optimism, socially desirable responding, and demographics. Respondents were questioned on the extent to which they would trade off specific numbers of life-years, or sustain other costs, in exchange for receiving seven different types of transplant procedures. For this study, we questioned 243 individuals in three study populations with differing life experiences: healthy individuals, organ transplant recipients, and laryngectomees. RESULTS All populations questioned perceived risks differently based on their varied life experiences and would accept differing degrees of risk for the different transplant procedures. Organ transplant recipients were the most risk-tolerant group, whereas laryngectomees were the least risk-tolerant. CONCLUSIONS By questioning individuals with life experiences directly relevant to the risks and benefits associated with larynx transplantation, this study provides an empiric basis for assessing risk versus benefit in this new quality of life-improving procedure.
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R096: Medical Decision Analysis: Indications of Tympanostomy Tubes. Otolaryngol Head Neck Surg 2006. [DOI: 10.1016/j.otohns.2006.06.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Program directors in surgery agree that residents should be formally trained in business and practice management. Am J Surg 2005; 189:11-3. [PMID: 15701483 DOI: 10.1016/j.amjsurg.2004.05.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2004] [Revised: 05/10/2004] [Accepted: 05/10/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical residents typically receive limited exposure to business and practice management during their training. As a result, residents are ill-prepared for issues related to starting a practice, coding, collecting, and taking a meaningful role within the medical community in promoting quality and safety and in containing health care costs. With the introduction of the core competencies and the current overhaul of surgical education, we believe there is an opportunity to include business and practice management into resident training. METHODS Program directors in general surgery (189 of 242) responded to a 9-question mailed survey inquiring about their opinions regarding training surgical residents in business and practice management. RESULTS Most program directors agreed or strongly agreed (87%) that residents should be trained in business and practice management. Seventy percent believed that their current trainees were inadequately trained in this area. Over half (63%) believed that this training should begin during postgraduate years 2 to 5. CONCLUSIONS Development of simple curricula aimed at preparing surgical residents for business and practice management could promote the contemporary education of surgeons.
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Medical Devices and Drugs Committee: Powered Instrumentation and ESS Complications. Otolaryngol Head Neck Surg 2004. [DOI: 10.1016/j.otohns.2004.06.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10:08 am Chronic Panrhinosinusitis without Nasal Polyps: A Long-Term Outcome after FESS. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301133-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11:30 AM: Tele-3D—Computer-Assisted Surgery: New Approach in the Surgery of the Nose and Sinuses. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301211-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9:30 AM: Mortality of Veterans with Sleep Apnea: CPAP versus Uvulopalatopharyngoplasty. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10:30 am Endoscopic CSF Rhinorrhea Closure: Our Experience in 267 Cases. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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11:16 AM: Evaluation of the Endoscopic Transmaxillary Approach to Orbital Blowout Fracture Repair. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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9:38 AM: A Comparison of Polysomnography (PSG) and a Portable Home Sleep Study in the Diagnosis of OSAS in Adults. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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“What's New?” Looking for a Job? Trying to Fill a Position? Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301462-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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9:46 AM: The Mannheim Protocol of Multi-Level Surgery for Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300890-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10:00 am Ultrastructural Detection of Nitric Oxide in Human Nasal Mucosa. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301131-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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11:00 AM: Economic Analysis of the Treatment of Posterior Epistaxis. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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10:46 am Cerebrospinal Fluid (CSF) Pressure Monitoring after Repair of CSF Leaks. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301207-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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10:00 AM: Midline Palatoplasty: A Modified Technique for Patients without Tonsils. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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11:08 AM: Software-Enabled CT Analysis of the Optic Nerve Position and Sphenoid Sinus Pneumatization. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301209-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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10:16 am 3D CT Analysis of Frontal Recess Anatomy in Patients without Frontal Sinusitis. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10:16 AM: Propofol-Somnoendoscopy (PSE) in Sleep-Disordered Breathing. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300893-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9:30 am Endoscopic Transnasal Hypophysectomy through the Sphenoid Ostium. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980301127-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reforming medical ethics education. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2002; 30:452-454. [PMID: 12497706 DOI: 10.1111/j.1748-720x.2002.tb00415.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Biomedical advances of the past 20 years have stimulated a renewed interest in medical ethics. Transplantation of multiple human organs, implantation of artificial devices, advances in genetics, and stem cell research are a few of the medical procedures and discoveries that have awakened in both professionals and the public an awareness that medical discoveries often raise important ethical and societal issues. Today, members of the medical profession face issues that did not seem so pressing to their predecessors, and physician conduct in response to many of these issues involves decision-making based on ethical principles. Issues of informed consent, gifts from pharmaceutical companies, and patient rights to privacy were not of great concern to most physicians a generation ago. However, these and other topics that involve a physician's ethical conduct have become increasingly pertinent to the practice of medicine.A renewed emphasis on ethics has been voiced by leaders in the field of medicine.
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Effects of a 98% solution of glycerol or sterilization with ethylene oxide on FeLV in bone allografts and effects on bone incorporation of allografts in cats. Am J Vet Res 2000; 61:665-71. [PMID: 10850843 DOI: 10.2460/ajvr.2000.61.665] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare virucidal effects and bone incorporation properties of cortical bone allografts transplanted into specific-pathogen-free (SPF) cats. Allografts consisted of untreated bone from a SPF cat (negative-control group) and bone from 5 FeLV-infected cats that was subjected to sterilization with ethylene oxide (ETO), preservation with glycerol, or no treatment (positive-control group). SAMPLE POPULATION Bones from the aforementioned groups and twenty 8-week-old SPF cats (5 cats/group) implanted with an allograft from 1 of the aforementioned groups. PROCEDURE After implantation, blood samples were collected weekly to monitor FeLV p27 antigen and antibody titers. Quantification of FeLV provirus was performed on blood samples at weeks 0, 4, and 8 and donor bone samples at time of implantation. Cats were euthanatized 8 weeks after transplantation, and graft sites were evaluated. RESULTS All results for negative-control cats were negative. All ETO group cats had negative results for antigen and provirus in blood, whereas 1 cat had a low antibody titer. Although 3 ETO-treated allografts were positive for provirus, the DNA appeared denatured. One cat in the glycerol group had positive results for all tests in blood samples. All glycerol-preserved allografts were positive when tested for provirus. All results for positive-control group cats were positive. Differences in incorporation of bone grafts were not observed. CONCLUSIONS AND CLINICAL RELEVANCE Glycerol preservation of FeLV-infected bone allografts did not eliminate transmission of retrovirus to recipients. In contrast, ETO sterilization appeared to denature DNA and prevent infection. Treatments did not affect incorporation of bone grafts in young cats.
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Pelvic actinomycosis presenting as malignant large bowel obstruction: a case report and a review of the literature. Am Surg 2000; 66:85-90. [PMID: 10651355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Actinomycosis is an infrequent chronic infectious disease. In most cases the diagnosis is made postoperatively because of its unusual clinical presentation. Moreover, abdominal actinomycosis may mimic cancer, inflammatory bowel disease, or diverticulitis. Delay in diagnosis leading to inadequate management and unnecessary procedures has been reported. We report the case of a 49-year-old woman with large bowel obstruction secondary to extensive pelvic actinomycosis involving the rectosigmoid and cecum. She required emergency surgery, which involved both resection and colostomy. A review of the literature on abdominal actinomycosis during the last 50 years is also reported. Rarely has emergency surgery been described in this condition. Although the incidence of actinomycosis has decreased, the abdominal-pelvic form has been increasing over the past 10 years secondary to increased prolonged use of the intrauterine device. As the clinical spectrum of actinomycosis has dramatically changed, so have the therapeutic considerations. Aggressive surgical management in advanced cases with multiorganic involvement seems to have reemerged in recent years. Consideration of actinomycosis in a woman with prolonged use of an intrauterine device and symptoms of bowel obstruction could help to improve the preoperative diagnosis and management of this rare disease.
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Abstract
Bone grafting provides a method of enhancing bone healing in veterinary orthopedic patients. Specifically, autogenous cancellous bone graft provides the cellular components and matrix proteins that can accelerate bone healing, dramatically. Allografts provide immediate mechanical support for fracture repair and patient function, but these grafts do not create the osteogenic environment seen with the use of autogenous cancellous bone graft. Xenograft bone implants may also hold a place for use in fracture management. With the advent of recombinant bone-derived tissue growth factor technology, bone grafting may some day become a practiced technique of the past. For now, however, bone grafting still holds a strong place in orthopedic surgery when dealing with bone defects in animals.
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Abstract
Intestinal stoma creation has been performed using both open and laparoscopic surgery. However, each technique still has disadvantages. We created the intestinal stoma through one incision, with the use of the laparoscope in a gasless fashion. This method has not been reported previously. Fourteen adult patients underwent this technique between February 1996 and December 1998. Indications for stoma creation were for various anorectal disease processes, most commonly for purposes of hygiene in patients with spinal cord injury. The average operative time to perform the stoma was 58 (range, 15-78) minutes, with minimal blood loss (<35 ml). Follow-up ranged from 1 to 22 months. Two cases (14 percent) were converted secondary to severe adhesions. All nonconverted patients were able to tolerate a regular diet within two days of surgery. There was only one stoma-related complication. Two patients (14 percent) died of comorbidities during follow-up. In conclusion, the initial experience with gasless laparoscopic-assisted intestinal stoma creation through a single incision is encouraging. Patients requiring ostomy creation as a single intervention may benefit from this approach.
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Bilateral acute coalescent mastoiditis in an immunocompromised infant with a rare leukocyte adhesion deficiency. Otolaryngol Head Neck Surg 1999; 120:926-8. [PMID: 10352452 DOI: 10.1016/s0194-5998(99)70339-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Staged laparoscopic resection for complicated sigmoid diverticulitis. Surg Laparosc Endosc Percutan Tech 1999; 9:99-105. [PMID: 11757552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Previous studies have utilized different regimens of laparoscopic surgery for treatment of both acute and chronic diverticular diseases. Our aims were to assert that laparoscopic-assisted sigmoid resection and anastomosis for sigmoid diverticulitis after acute attacks is safe and feasible, provided the inflammatory process has subsided. A chart review was undertaken of patients who underwent laparoscopic sigmoid resection after resolution of the acute attack of diverticulitis at hospitals affiliated with the University of Miami. Thirty-eight patients, median age 52 years, were identified. Laceration of the spleen was the only intraoperative complication (one patient). Seven patients (18%) were converted due to severe adhesions. Regular diet was tolerated on the third postoperative day, and the length of hospital stay was 4 days. No major complications or deaths occurred. In conclusion, laparoscopic surgery for sigmoid diverticulitis after resolution of the acute process seems safe and feasible and provides excellent immediate postoperative recovery.
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Prospective comparison of four sampling methods (cystocentesis, bladder mucosal swab, bladder mucosal biopsy, and urolith culture) to identify urinary tract infections in dogs with urolithiasis. J Am Anim Hosp Assoc 1998; 34:423-30. [PMID: 9728474 DOI: 10.5326/15473317-34-5-423] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A prospective study was conducted on 27 dogs with recurrent urinary tract infections (UTIs) and urolithiasis. Four sampling methods (i.e., urine obtained by cystocentesis, bladder mucosal swab, bladder mucosal biopsy, and urolith) were compared to identify UTI. Identical culture results were obtained from urine collected by cystocentesis and from the swab of bladder mucosa. In the presence of a positive urine culture, the same organism also was cultured from the bladder mucosal biopsy and urolith. However, in the presence of a negative urine culture, an organism was cultured from the bladder mucosal biopsy or the urolith in 18.5% of the cases. Therefore, when the culture from urine obtained by cystocentesis is negative, it is recommended that aerobic cultures of a bladder mucosal biopsy and a urolith be performed in cases of urolithiasis.
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Intraoperative endoscopy during colorectal surgery. Surg Laparosc Endosc Percutan Tech 1998; 8:123-6. [PMID: 9566566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In cases where preoperative studies may have been inadequate or could not be performed, intraoperative endoscopy (IOE) becomes an essential investigative tool for identification of synchronous lesions, of nonpalpable lesions, of sources of bleeding, and localization of lesions during laparoscopic colonic surgery. We report our experience with IOE, and describe our techniques of transabdominal colonoscopy. A review of the IOE performed in hospitals affiliated with the University of Miami was done. Fifty-eight patients received IOE from July 1994 to August 1996. There were 47 colonoscopies (38 transanal and 9 transabdominal), and 11 flexible sigmoidoscopies. Colorectal cancer, diverticulitis, inflammatory bowel disease, and lower gastrointestinal bleeding represented 83% of cases. In 10% of cases IOE changed the extent of the surgical procedure. There were no complications related to IOE. We conclude that in selected patients undergoing colorectal procedures, IOE is an essential tool. It can be performed safely, effectively, and rapidly.
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Abstract
Several congenital arthropathies exist in the canine that can lead to the development of degenerative joint disease. Nevertheless, early diagnosis and treatment generally will afford the patient a favorable prognosis for limb function. There is still a great need to develop controlled studies to evaluate the long-term efficacy of many of the surgical and medical treatment modalities that are currently available and will be made available in the future to treat the patient with a congenital arthropathy.
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Abstract
OBJECTIVE To determine the amount of heat conducted by transfixation intramedullary pins (IP) and Kirschner wires (KW) during polymerization of acrylics used for external skeletal fixator (ESF) connecting bars. STUDY DESIGN Thermal conduction was measured using thermistors applied to IP and KW surfaces during the polymerization phase of acrylics. METHODS Type II ESF were created from IP or KW placed into wooden dowels and plastic tubing used to create connecting bars filled with one of two types of acrylic (Acrylic Pin External Fixation System or Technovit, Jorgensen Laboratories, Loveland, CO). Thermistors were positioned on the acrylic column surface and on IP or KW surfaces 5 or 10 mm from the acrylic column. Five ESF test groups were created. The maximum temperature (Tmax) of the acrylic column (Tmax-A), IP (Tmax-IP), KW (Tmax-KW), and duration that Tmax-IP or Tmax-KW remained greater than or equal to 55 degrees C were calculated. RESULTS All IP and KW thermistors placed 5 mm from acrylic columns reached mean temperatures greater than 50 degrees C and had peak temperature ranges greater than 55 degrees C compared with all IP and KW thermistors placed 10 mm from the acrylic columns in all groups. Thermistors placed 5 mm from the acrylic column in two groups maintained temperatures greater than 55 degrees C for greater than or equal to 0.5 minute. CONCLUSIONS Acrylic columns positioned 5 mm from a thermistor on a IP or KW had the potential to reach or exceed temperatures that have been reported to cause thermal necrosis of tissues. CLINICAL RELEVANCE Acrylic Pin External Fixation System or Technovit acrylic connecting bars used in ESF designs have the potential to cause thermal injury to soft and bony tissue by thermal conduction along transfixation pins or wires.
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Abstract
There are many acquired arthopathies that will result in some degree of osteoarthritis, even after proper management. Once the articular cartilage is damaged, it is unlikely that the architecture of the original cartilage surface will return to the normal conditions that existed prior to injury. The purpose of timely and meticulous management of traumatic joint events is to stop the progression of osteoarthritic development. When dealing with articular fractures or other forms of trauma to articular cartilage, three important principles to remember are anatomic reduction of the articular surfaces, stable fixation, and limited weight bearing on the affected limb as soon as possible after surgery. Even after strict adherence to these principles, the pet owner should always be warned that the animal will develop some degree of osteoarthritis in the affected joint at some future time; at that time, chronic medical management may be indicated.
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Effect of volume variations on osteogenic capabilities of autogenous cancellous bone graft in dogs. Am J Vet Res 1996; 57:1501-5. [PMID: 8896692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the osteogenic effect of differing volumes of autogenous cancellous bone graft (ACBG) placed into partial cortical defects of the ulna. ANIMALS 15 healthy, mature Beagles. PROCEDURE Weekly radiographic views of defects were obtained over 8 weeks and were analyzed for bone density by use of radiographic optical densitometry. Histologic sections were obtained 8 weeks after surgery and were planimetrically evaluated for area of total, lamellar, and woven bone. RESULTS Defects receiving 0.3 and 0.75 g of ACBG had rapid initial bone production, and dogs receiving 0.3 g of ACBG had faster bone ingrowth than did those receiving 0.1 g of ACBG or controls. Defects receiving 0.75 g of ACBG had a rate of bony ingrowth equal to 0.3 g of ACBG. There was no difference in the histomorphometric area fractions of total, lamellar, or woven bone between defects treated with 0.1 or 0.75 g of ACBG, and between grafted or control defects, 8 weeks after surgery. CONCLUSIONS Overfilling a cortical defect with ACBG does not enhance early osteogenesis within the defect, and underfilling will delay the onset of osteogenesis within the defect. CLINICAL RELEVANCE A volume of ACBG sufficient only to fill a cortical defect is required to obtain a clinical osteogenic effect from the graft.
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Mightier than the Sword. EAR, NOSE & THROAT JOURNAL 1996. [DOI: 10.1177/014556139607500108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mightier than the sword. EAR, NOSE & THROAT JOURNAL 1996; 75:25, 29-31. [PMID: 8608744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Benign Lymphoepithelial Lesion (Mikulicz's Syndrome) of the Submandibular Glands in a Four-Year-Old Boy. Otolaryngol Head Neck Surg 1994. [DOI: 10.1177/01945998941113p119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND A murine model of oral cavity carcinogenesis is needed to study the molecular aspects of malignant transformation. 4-Nitroquinoline-1-oxide (4NQO), a water-soluble carcinogen, produces squamous cell carcinoma in rodents. Protocols were designed to investigate the temporal aspects of neoplastic transformation. METHODS 4NQO was applied topically to mouse palates for up to 16 weeks. Mice were observed and killed from 24 to 49 weeks. RESULTS A spectrum of lesions ranging from atypia to moderately differentiated invasive squamous cell carcinoma (SCC) was produced. The severity of the lesions corresponded to the duration of treatment and the length of observation. There was no gross or microscopic evidence of an inflammatory reaction to 4NQO. The lesions were focal and normal mucosa predominated in the treated mice. CONCLUSION 4NQO reliably produced preneoplastic and malignant oral cavity lesions, which morphologically and histologically mimic human head and neck cancer. Lesions develop long after 4NQO exposure and without an inflammatory response. Thus, the model should be useful for molecular analysis of neoplastic transformation.
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Pantarsal arthrodesis in dogs and a cat: 11 cases (1983-1991). J Am Vet Med Assoc 1993; 203:1705-7. [PMID: 8307822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Bone plates applied to the cranial surfaces of the tibia, the tarsus, and the metatarsus were used in 10 dogs and 1 cat that underwent pantarsal arthrodesis. Lengthening plates were used in 7 dogs, and 2.7- and 3.5-mm dynamic compression plates were used in the remaining dogs and the cat. Radiography was used to determine whether bone plates became loose or broke, and whether the joint fused completely. Bone plates became loose in 5 dogs; mean time between surgery and development of radiographic evidence of plate loosening was 19.4 months. The bone plate used in the cat broke 4 months after surgery. Overall, 9 of 11 animals had evidence of complete bony fusion of the tarsus at the time of the last radiographic evaluation. One dog had incomplete healing of the talocalcaneocentral joint and another dog had incomplete healing of the tarsometatarsal joint.
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