Efficacy and safety of using mesh or grafts in surgery for anterior and/or posterior vaginal wall prolapse: systematic review and meta-analysis.

Background The efficacy and safety of mesh/graft in surgery for anterior or posterior pelvic organ prolapse is uncertain. Objectives To systematically review the efficacy and safety of mesh/graft for anterior or posterior vaginal wall prolapse surgery. Search strategy Electronic databases and conference proceedings were searched, experts and manufacturers contacted and reference lists of retrieved papers scanned. Selection criteria Randomised controlled trials (RCTs), non-randomised comparative studies, registries, case series involving at least 50 women, and RCTs published as conference abstracts from 2005 onwards. Data collection and analysis One reviewer screened titles/abstracts, undertook data extraction, and assessed study quality. Data analysis was conducted for three subgroups: anterior, posterior, and anterior and/or posterior repair (not reported separately). Results Forty-nine studies involving 4569 women treated with mesh/graft were included. Study quality was generally high. Median follow up was 13 months (range 1 to 51). In anterior repair, there was short-term evidence that mesh/graft (any type) significantly reduced objective prolapse recurrence rates compared with no mesh/graft (relative risk 0.48, 95% CI 0.32-0.72). Non-absorbable synthetic mesh had a significantly lower objective prolapse recurrence rate (8.8%, 48/548) than absorbable synthetic mesh (23.1%, 63/273) and biological graft (17.9%, 186/1041), but a higher erosion rate (10.2%, 68/666) than synthetic mesh (0.7%, 1/147) and biological graft (6.0%, 35/581). There was insufficient information to compare any of the other outcomes regardless of prolapse type. Conclusion Evidence for most outcomes was too sparse to provide meaningful conclusions. Rigorous long-term RCTs are required to determine the comparative efficacy of using mesh/graft.The National Institute for Health and Clinical Excellence Interventional Procedures Programme

The Iowa Homemaker vol.32, no.1

See Europe on Your Own Two Wheels, Mary Odegard, page 5 Let’s Face It, Ruth Frantz, page 6 Textile Originals from a Barn, Virginia Wilcox, page 7 Rats Diet Too, Robin Coon, page 8 In Africa, Kathryn Bain, page 9 Betsy Harris of the Hot Shoppes, Marcia Holt, page 10 Your Hair’s in the Headlines, Salli Hearst, page 11 What’s New, Evelyn Toulouse and Dorothy Will, page 12 Information Please, Susan Brown and Mary Doherty, page 15 Double Dip Bargain, Patricia Stiff, page 16 Trends, Ruth Anderson, page 1

Healthcare Utilization Among Infants Discharged From the Neonatal Intensive Care Unit: A Descriptive Cost Analysis

The cost of readmissions of neonatal intensive care unit (NICU) graduates within 6 months and a year of their life is well-studied. However, the cost of readmissions within 90 days of NICU discharge is unknown. This study\u27s objective was to estimate the overall and mean cost of healthcare use for unplanned hospital visits of NICU graduates within 90 days of discharge A retrospective review of all infants discharged between 1/1/2017 and 03/31/2017 from a large hospital system NICUs was conducted. All unplanned hospital visits (readmissions or stand-alone emergency department (ED) visits) occurring within 90 days post NICU discharge were included. The total and mean cost of unplanned hospital visits were computed and adjusted to 2021 US dollars. The total cost was estimated to be $785 804 with a mean of$1898 per patient. Hospital readmissions accounted for 98% ($768 718) of the total costs and ED visits for 2$17 086). The mean cost per readmission and stand-alone ED visit were $25 624 and$475 respectively. The highest mean total cost of unplanned hospital readmission was noted in extremely low birth weight infants ($25 295). Interventions targeted to reduce hospital readmissions after NICU discharge have the potential to significantly reduce healthcare costs for this patient population

Healthcare Utilization Among Infants Discharged From the Neonatal Intensive Care Unit: A Descriptive Cost Analysis

The cost of readmissions of neonatal intensive care unit (NICU) graduates within 6 months and a year of their life is well-studied. However, the cost of readmissions within 90 days of NICU discharge is unknown. This study’s objective was to estimate the overall and mean cost of healthcare use for unplanned hospital visits of NICU graduates within 90 days of discharge A retrospective review of all infants discharged between 1/1/2017 and 03/31/2017 from a large hospital system NICUs was conducted. All unplanned hospital visits (readmissions or stand-alone emergency department (ED) visits) occurring within 90 days post NICU discharge were included. The total and mean cost of unplanned hospital visits were computed and adjusted to 2021 US dollars. The total cost was estimated to be $785 804 with a mean of$1898 per patient. Hospital readmissions accounted for 98% ($768 718) of the total costs and ED visits for 2$17 086). The mean cost per readmission and stand-alone ED visit were $25 624 and$475 respectively. The highest mean total cost of unplanned hospital readmission was noted in extremely low birth weight infants ($25 295). Interventions targeted to reduce hospital readmissions after NICU discharge have the potential to significantly reduce healthcare costs for this patient population

Glypican-1, phosphacan/receptor protein-tyrosine phosphatase-ζ/β and its ligand, tenascin-C, are expressed by neural stem cells and neural cells derived from embryonic stem cells

The heparan sulfate proteoglycan glypican-1, the chondroitin sulfate proteoglycan phosphacan/RPTP (receptor protein-tyrosine phosphatase)-ζ/β and the extracellular matrix protein tenascin-C were all found to be expressed by neural stem cells and by neural cells derived from them. Expression of proteoglycans and tenascin-C increased after retinoic acid induction of SSEA1-positive ES (embryonic stem) cells to nestin-positive neural stem cells, and after neural differentiation, proteoglycans and tenascin-C are expressed by both neurons and astrocytes, where they surround cell bodies and processes and in certain cases show distinctive expression patterns. With the exception of tenascin-C (whose expression may decrease somewhat), expression levels do not change noticeably during the following 2 weeks in culture. The significant expression, by neural stem cells and neurons and astrocytes derived from them, of two major heparan sulfate and chondroitin sulfate proteoglycans of nervous tissue and of tenascin-C, a high-affinity ligand of phosphacan/RPTP-ζ/β, indicates that an understanding of their specific functional roles in stem cell neurobiology will be important for the therapeutic application of this new technology in facilitating nervous tissue repair and regeneration

The frequency of detection of unexpected diabetes mellitus during haemoglobinopathy investigations

ABSTRACT Aims To establish the frequency of detection of previously undiagnosed diabetes mellitus as a result of detection of an increased glycated fraction of haemoglobin during high performance liquid chromatography (HPLC) for haemoglobinopathy diagnosis. Methods A prospective study was carried out over a 3-month period. During that period a total of 2094 patient samples were received for haemoglobinopathy investigation and were included in the study. Results Fifty samples were found to have an apparent increase in the glycated haemoglobin fraction and of these 38 were found to be from patients with known diabetes. Previously undiagnosed diabetes was discovered in 11 patients and it is likely that the twelfth patient also had diabetes. Conclusions The detection of evidence of undiagnosed diabetes during HPLC haemoglobinopathy investigations is not rare, there being four cases per month in this study. This incidental observation should be reported to clinical staff. A proportion of haemoglobin A undergoes posttranslational modification including glycosylation (non-enzymatic addition of glucose to the aminoterminal valine of the b chain) or glycation (less specifically, addition of carbohydrate to a protein). 1 Glycosylation occurs throughout the life-span of the red cell, at a rate determined by the ambient glucose concentration. Glycated haemoglobin is known as haemoglobin A 1 , of which 60e80% is glycosylated haemoglobin, haemoglobin A 1c . 1 In patients with diabetes mellitus, the proportion of haemoglobin that is haemoglobin A 1c has been found to be useful as an indication of the degree of hyperglycaemia during the preceding 3 months. In addition, since there are few other causes of an elevated haemoglobin A 1c , the finding of an elevated proportion can be useful in diagnosis. Glycated haemoglobin includes a labile fraction, which responds rapidly and transiently to raised blood glucose levels, and a stable fraction, to which the labile fraction is converted. 1 It is the stable fraction that is useful in judging long-term control of diabetes. Haemoglobin A 1c can be quantified by a variety of methods, of which high-performance liquid chromatography (HPLC) is increasingly used. When suspected haemoglobinopathies are investigated by cellulose acetate electrophoresis, the glycated fraction is not resolved and no specific abnormality is apparent in diabetic patients. However, when the technique used for such investigations is HPLC, the presence of a glycated fraction may be apparent. Our laboratory has previously drawn attention to the possibility that this may lead to the diagnosis of previously unsuspected diabetes mellitus. 2 Early diagnosis and good control of diabetes mellitus is important in reducing the end-organ damage that is characteristic of this disease, and it is therefore important for haematologists to alert clinical staff to the probability of this diagnosis when an increased proportion of glycated haemoglobin is observed. We therefore carried out a study to determine the frequency with which this is observed, and as a result of this study we developed a policy for notification of an increased glycated fraction to clinical staff. MATERIALS AND METHODS All tests were performed on peripheral blood samples anticoagulated with EDTA. HPLC for establishing relevant reference ranges and for haemoglobinopathy investigations was performed on a Bio-Rad Variant II instrument (Bio-Rad Laboratories, Hemel Hempstead, UK) using the b-Thalassaemia Short Program. Haemoglobin A 1c was quantified by HPLC using a Tosoh A1c 2.2 instrument. One hundred and two samples were obtained from fully informed young healthy volunteers of north European origin, in order to establish a reference range for haemoglobin A 2 . Data from the same samples were used to establish a reference range for peak 2 (P2), this being the peak with a retention time slightly longer than that of haemoglobin F, which we had previously noted to be increased in patients with an increased proportion of haemoglobin A 1c . The instruction manual of the Variant II states 'Diabetic specimens typically exhibit an elevated P2 peak'. In order to investigate the relationship between P2 on the Bio-Rad Variant II and haemoglobin A 1c on the Tosoh A1c 2.2, 93 samples from either healthy volunteers or patients with an elevated glycated fraction were studied in parallel on the two instruments. Results of all patients investigated by our haemoglobinopathy laboratory were surveyed over a 3-month period and when a sample was found to have a P2 fraction of 6% or greater, haemoglobin A 1c was measured and we investigated whether or not a diagnosis of diabetes mellitus had previously been established. If a review of request forms and laboratory records did not disclose this diagnosis, we contacted relevant clinical staff and requested review of clinical notes. If the patient had not been identified previously as suffering from diabetes mellitus, further tests were advised in order to confirm the diagnosis. Subsequently we followed-up the results of these confirmatory tests. Tests done were those usually carried out by the relevant clinical staff in order to confirm a diagnosis of diabetes

Exploring the contribution of general self-efficacy to the use of self-care symptom management strategies by people living with HIV infection

General self-efficacy (GSE), the expectation that one is able to perform a behavior successfully, may differentiate those who are able to successfully utilize self-care symptom management strategies (SCSMS). This subanalysis (n = 569) of an international 12 site longitudinal randomized controlled trial (RCT) (n = 775), investigated GSE as an important factor determining symptom burden, SCSMS, engagement with the provider, and medication adherence over time, and identified differences in those with high and low GSE ratings concerning these variables. Parametric and nonparametric repeated-measures tests were employed to assess GSE and the perceived effectiveness of SCSMS for anxiety, depression, diarrhea, fatigue, nausea, and neuropathy. Symptom burden, engagement with the provider, and antiretroviral adherence were analyzed with regard to GSE. Our data indicated that there were differences in the perceived symptom burden over time of HIV infected individuals by GSE. Those individuals with higher GSE had fewer symptoms and these symptoms were perceived to be less intense than those experienced by the low GSE group. There were few meaningful differences in the SCSMS used by those with high versus low GSE other than the use of illicit substances in the low GSE group. The low GSE group was also significantly ( p= \u3c 0.001) less engaged with their healthcare providers. Given the difference in substance use by perceived GSE, and the importance of engagement with the healthcare provider, more attention to the resolution of the concerns of those with low GSE by healthcare providers is warranted

Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis

Objective: To examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis. Summary background data Since the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment. Methods: A broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing. Results: 1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety. Conclusions: A SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings

Developmental and Molecular Characterization of Emerging β- and γδ-Selected Pre-T Cells in the Adult Mouse Thymus

The first checkpoint in T cell development, β selection, has remained incompletely characterized for lack of specific surface markers. We show that CD27 is upregulated in DN3 thymocytes initiating β selection, concomitant with intracellular TCR-β expression. Clonal analysis determined that CD27^(high) DN3 cells generate CD4^+CD8^+ progeny with more than 90% efficiency, faster and more efficiently than the CD27^(low) majority. CD27 upregulation also occurs in γδ-selected DN3 thymocytes in TCR-β−/− mice and in IL2-GFP transgenic reporter mice where GFP marks the earliest emerging TCR-γδ cells from DN3 thymocytes. With CD27 to distinguish pre- and postselection DN3 cells, a detailed gene expression analysis defined regulatory changes associated with checkpoint arrest, with β selection, and with γδ selection. γδ selection induces higher CD5, Egr, and Runx3 expression as compared to β selection, but it triggers less proliferation. Our results also reveal differences in Notch/Delta dependence at the earliest stages of divergence between developing αβ and γδ T-lineage cells