RESUMEN

BACKGROUND: This targeted chart review study reports the first ever detailed global account of clinical approaches adopted to detect and manage anastomotic leaks identified during surgery in routine clinical practice. METHOD: 156 surgeons from eight countries retrospectively extracted data from surgical records of 458 patients who underwent colorectal surgery with an identified intraoperative leak at the circular anastomosis. Demographic details, procedures, and outcomes were analyzed descriptively, by country. RESULTS: Most surgeries were performed laparoscopically (57.6%), followed by open surgeries (35.8%). The burden of intraoperative leaks on the healthcare system is driven in large part by the additional interventions such as using a sealant, recreating the anastomosis, and diverting the anastomosis to a colostomy bag, undertaken to manage the leak. The mean duration of hospitalization was 19.9 days. Postoperative anastomotic leaks occurred in 62 patients (13.5%), most frequently 4 to 7 days after surgery. Overall, country-specific differences were observed in patient characteristics, surgical procedures, method of diagnosis of intraoperative leak, interventions, and length of hospital stay. CONCLUSION: The potential cost of time and material needed to repair intraoperative leaks during surgery is substantial and often hidden to the healthcare system, potentially leading to an underestimation of the impact of this complication.

RESUMEN

BACKGROUND: Avoiding excess energy intake and rapid weight gain during infancy may be effective in preventing childhood obesity. We developed a programme for healthy growth and nutrition in formula milk-fed babies. The aim of this study was to understand users' perspectives about the programme and planned trial. METHODS: We conducted three focus group discussions (10 mothers) and nine individual interviews (seven health visitors, one midwife and one mother) discussing the programme materials and trial protocol. All sessions were transcribed verbatim and a thematic analysis was performed using the framework approach. RESULTS: Mothers reported receiving conflicting messages about infant feeding and were keen for consistent advice. They welcomed the support that the programme would offer to mothers who gave their babies formula milk, but some were sceptical about the feasibility of limiting formula milk quantities. They suggested that recommended quantities should be presented as general guidelines rather than rigid rules. Some mothers said that it was too early to intervene to prevent obesity, that babies could not be overfed and that the risks of formula milk feeding had been exaggerated. Because of the routine advice to feed on demand, babies were fed in response to crying, and crying was equated with 'hunger'. Some mothers said that growth was genetically determined so they ignored the growth charts. Health visitors used the growth charts to assess adequate weight gain rather than to identify excess weight gain. Health visitors said that mothers would need a lot of education and support to limit formula milk quantities. CONCLUSIONS: Efforts to prevent childhood obesity by avoiding excess weight gain during infancy have to address mothers' beliefs that babies cannot be overfed, that crying always signals hunger and that growth is determined by genes rather than nutrition. Mothers and healthcare providers have different motivations and understanding these are important in the development of any intervention.

Asunto(s)

RESUMEN

The architecture of bone trabeculae is based on the direction of stresses applied to the bone. The human talar dome receives compressive forces from the tibia and, to a much lesser extent, the fibula when standing, walking, and running, and transmits the force downward to the calcaneus through the talar body and anterior to the navicular via the talar head. As a result, the body of the talus has predominately vertical trabeculae. However, here we hypothesize that cartilage degeneration at the articular surface is associated with trabecular angle within the associated bone, as a reflection of joint alignment and/or biomechanics (stability, congruence, angulation, etc). Through measurement of trabecular angle with Fast Fourier Transform Analysis, we show a positive correlation between the cartilage degeneration score of the articular surface of the talar dome and the angle of trabecular deviation from the perpendicular axis of the dome (right talus R=0.75, p<0.01; left talus R=0.79, p<0.01).

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Approximately 42 years ago, the Berg acid phosphatase (AP) test (1) was accepted in most rape treatment centers nationally as the standard to determine whether sexual intercourse or related actions in any form had occurred. More specifically, the test was designed to determine the presence of a certain enzyme. In October 1969, I published an article making the test simpler (2) and reviewing the history of various tests for the detection of AP, an enzyme found in great abundance in seminal fluid. Both AP-impregnated material and refrigerated reagents had been saved along with a quantity of seminal fluid used in the original tests. The objectives of this study were to determine whether 25-year-old seminal fluid in any form can still be identified by the AP test and whether 25-year-old chemicals have remained stable and are still usable.

Asunto(s)

Asunto(s)

RESUMEN

The medical capabilities derived from modern reproductive technology, such as in vitro fertilization and cryopreservation, have enabled physicians and scientists to intervene in the procreative process in innumerable ways. However, this intervention in the natural reproductive process raises both moral and legal concerns. In this Article, Professor Schiff explores some of the conflicts that may result when an individual or couple elects to cryopreserve gametes or embryos and subsequently, one or both of the contributors dies, or when gametes are harvested from a dead body. This Article will specifically address the moral and legal responses to circumstances where the decedent has either clearly expressed opposition to posthumous use of the reproductive material or else the decedent's intent regarding posthumous use of the material is ambiguous. By discussing philosophical and moral positions relating to personhood and the body and analyzing legal issues such as reproductive choice and organ donation, Professor Schiff creates the necessary format to examine and recommend the proper legal treatment of this controversial aspect of posthumous procreation.

Asunto(s)

RESUMEN

In any event, the decision to institute a corporate compliance program is a relatively simple one. In view of the ambiguity surrounding certain fraud and abuse provisions, and the corporate "death sentence" that may result from program exclusion, a compliance program is always sound corporate policy. To be sure, if the compliance program is administered improperly, it can actually increase the likelihood of whistleblower actions and create a body of potentially hurtful documentation. But these dangers can be minimized by structuring the program to protect the self-evaluative process through relevant privileges. The risks also pale in comparison to the exposure to criminal or exclusionary sanctions when improper conduct goes undetected by an organization.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)