BioGlue® is not associated with polypropylene suture breakage after aortic surgery

Objective: We have encountered broken or damaged polypropylene sutures (Prolene®) at the anastomotic sites during aortic reoperations. Because a surgical sealant, bovine serum albumin-glutaraldehyde (BioGlue®), was used in previous aortic surgery in some of these cases, we undertook this in vitro study to evaluate whether the use of BioGlue® was associated with breakage of polypropylene sutures at the aortic anastomosis. Materials and methods: The broken polypropylene sutures, anastomotic sites and aortic tissue at the location of suture breakage were visually inspected and evaluated intraoperatively. Six human cadaveric aortic samples were incised circumferentially and anastomosed proximally to a valved conduit with running 4–0 polypropylene sutures (Prolene®). In the test group (n = 3), BioGlue® was applied directly to the Prolene® sutures at the anastomotic sites, while in the control group (n = 3) the anastomoses were not sealed with any surgical adhesive. The six samples were immersed in Dulbecco's phosphate buffered saline solution and mounted on a M-6 Six Position Heart Valve Durability Testing System and tested up to 120 million cycles for a 2-year period. During and upon completion of the testing, the integrity of Prolene® sutures, the anastomosis and aortic tissues was regularly assessed by visual inspection. Results: Intraoperative findings included a stretched and thin aortic wall (some with thrombus), a small cleft between the aortic tissue and the Dacron vascular graft. An excessive amount of BioGlue® was often found around the anastomosis, with cracking material, but no signs of mechanical damage were observed in these cases. Upon visual inspection during and after in vitro testing, there was no apparent damage to the polypropylene sutures on the interior or exterior of the aortic anastomoses in any of the samples. No difference was observed in the physical integrity of the polypropylene sutures at anastomotic lines, the anastomoses and aortic tissues between the test and control samples. Conclusions: The results of this study suggest that the use of BioGlue® was not associated with breakage of the polypropylene sutures at the anastomotic sites after aortic dissection repair

Improving computer interaction for older adults

Many older people are at a disadvantage with computers, having difficulties with traditional point and click interaction because of age-related changes in perception, cognition and motor control. Generational differences also mean that older people may not understand technologies as well as younger people. Despite attempts to improve access to computers, much of this has focused on perceptual changes (such as visual declines) and changes in motor control; generational differences (i.e. differences in the understanding of technologies between people of different age groups) and changes in cognition (such as cognitive slowing) have largely been ignored by system designers. The goal of this thesis is to investigate techniques that can help to improve computer interaction for older adults, and begins with a study that examines some of the difficulties encountered using common computer applications such as email, web browsing and using a wordprocessor. Losing the mouse cursor is also a common problem, so an experiment was undertaken to test a novel technique to help with finding a lost cursor. A common difficulty for many older computer users is using the file system on a computer, and so this was investigated by first considering how people manipulated paper documents and folders. The results were used in the development of an interface that mimics the way in which paper-based files and folders operate in the real world. The final study investigated whether an interface based on familiar objects can help older adults more easily learn and remember how to use a computer application, and results suggest that familiar interfaces can help to simplify tasks, encourage experimentation, increase confidence and retain more of what they have learned. Directions for future research are discussed, in light of some of the current chal- lenges in human computer interaction. In particular, applications need to be designed to be more appealing to older computer users, in addition to being both accessible and usable, and there may also be potentjal to improve the performance of target selection through visual illusions. A further direction is the development of a methodology for reliably assessing computer proficiency for older adults.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Negative pressure wound therapy: improving the patient experience Part 2 of 3

Despite the clear benefits of negative pressure wound therapy (NPWT) as a treatment for wounds, it is essential that greater focus is given to the patient experience of this treatment. In particular, it is important that any unpleasant consequences, such as pain, stress, and skin trauma are minimised, so as to promote quality of life and healing. This article presents part two of three studies which aim to explore ways in which the patient experience of NPWT can be improved. In this study, the views of wound care clinicians (n=12) were investigated in greater depth through semi-structured interviews. Findings indicate a pressing need to minimise pain, particularly through ongoing assessment and collaboration with patients, and also through the use of appropriate dressings, films and other products that promote patient comfort. Additionally, it is evident that greater education is needed for both nurses and patients about NPWT, in order to promote high-quality care and patient wellbein

International Study on Syncope of Uncertain Etiology 2: the management of patients with suspected or certain neurally mediated syncope after the initial evaluation Rationale and study design

Study design Multi-centre, prospective observational study Objectives Main objective is to verify the value of implantable loop recorder (ILR) in assessing the mechanism of syncope and the efficacy of the ILR-guided therapy after syncope recurrence. Inclusion criteria Patients who met the following criteria are included: suspected or definite neurally mediated syncope based on initial evaluation; greater than or equal to3 syncope episodes in the last 2 years; severe clinical presentation of syncope requiring treatment initiation in the judgement of the investigator and age >30 years. Exclusion criteria Patients with one or more of the following are excluded: carotid sinus syndrome; suspected or definite heart disease and high likelihood of cardiac syncope; symptomatic orthostatic hypotension diagnosed by standing blood pressure measurement; loss of consciousness different from syncope (e.g. epilepsy, psychiatric, metabolic, drop-attack, TIA, intoxication, cataplexy) and subclavian steal syndrome. End-points The primary end-points are the ECG-documented syncopal events and the syncope recurrences after application of ILR-guided therapy. Sample size and duration A minimum of 400 patients will be enrolled during an anticipated period of 3 years. (C) 2003 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserve