Biliary tract visualization using near-infrared imaging with indocyanine green during laparoscopic cholecystectomy: results of a systematic review

Contains fulltext : 174508.pdf (publisher's version ) (Open Access)BACKGROUND: Near-infrared imaging with indocyanine green (ICG) has been extensively investigated during laparoscopic cholecystectomy (LC). However, methods vary between studies, especially regarding patient selection, dosage and timing. The aim of this systematic review was to evaluate the potential of the near-infrared imaging technique with ICG to identify biliary structures during LC. METHODS: A comprehensive systematic literature search was performed. Prospective trials examining the use of ICG during LC were included. Primary outcome was biliary tract visualization. Risk of bias was assessed using ROBINS-I. Secondly, a meta-analysis was performed comparing ICG to intraoperative cholangiography (IOC) for identification of biliary structures. GRADE was used to assess the quality of the evidence. RESULTS: Nineteen studies were included. Based upon the pooled data from 13 studies, cystic duct (Lusch et al. in J Endourol 28:261-266, 2014) visualization was 86.5% (95% CI 71.2-96.6%) prior to dissection of Calot's triangle with a 2.5-mg dosage of ICG and 96.5% (95% CI 93.9-98.4%) after dissection. The results were not appreciably different when the dosage was based upon bodyweight. There is moderate quality evidence that the CD is more frequently visualized using ICG than IOC (RR 1.16; 95% CI 1.00-1.35); however, this difference was not statistically significant. CONCLUSION: This systematic review provides equal results for biliary tract visualization with near-infrared imaging with ICG during LC compared to IOC. Near-infrared imaging with ICG has the potential to replace IOC for biliary mapping. However, methods of near-infrared imaging with ICG vary. Future research is necessary for optimization and standardization of the near-infrared ICG technique

Implementation of a shared care guideline for back pain: effect on unnecessary referrals

Objective: To determine the effect of the implementation of a shared care guideline for the lumbosacral radicular syndrome (LRS) on unnecessary early referrals and the duration of the total diagnostic procedure. Design: Introduction of shared care guideline in November 2005. Pre-test in 2005 (April to October), a first post-test in 2006 (April to October) and a second post-test in 2007 (April to October). Setting and Intervention: The introduction of a shared care guideline derived from national guidelines for GPs and several medical/paramedical specialists in two Dutch regions. Three hundred and sixty GPs, 550 physiotherapists and two hospitals (9 neurologists and 18 radiologists) were involved. The essential component of the guideline was a trade-off: if the GP complied with the conservative management approach in the first 6 weeks, the hospital guaranteed a priority appointment with the neurologist after 6 weeks, if still required. Main Outcome Measures: The neurologists in both hospitals registered whether a patient had been unnecessarily referred during the first 6 weeks. The duration of the total diagnostic procedure was defined as the number of days between referral by the GP and the consultation when the neurologist made the final diagnosis. Results: The percentage of patients being unnecessarily referred within 6 weeks fell significantly from 15% in 2005 to 9% in 2006 and 8% in 2007. The duration of the total diagnostic procedure also fell significantly in both the long and short terms. Conclusions: The introduction of a shared care guideline for all care providers in a region reduces the number of unnecessary early referrals for patients with LRS. © The Author 2010. Published by Oxford University Press in association with the International Society for Quality in Health Care

Labeled nitrogen fertilizer research with urea in the semi-arid tropics II. Field studies on a Vertisol

Field studies were conducted on Indian Vertisol to determine the fate of15N-labeled fertilizers applied to dryland sorghum in two successive rainy seasons. In the 1981 season, a split-band (SB) urea application of 74 kg N/ha, half amounts placed 5 cm deep and 8 cm from opposite sides of plant rows at 4 and 19 days after emergence, was superior to preemergent applications of either surface-applied (S) or incorporated (I) applications at the same rate; 907 mm of rainfall fell during the sorghum growing period. Percentages of applied N recovered in the soil-plant system after the sorghum harvest were 94%, 74%, and 72%, respectively, for the SB, I, and S application methods. Substantial quantities, 39%, 45%, and 42% of the added N for the SB, I, and S tretments, respectively, remained in the soil after the final harvest. Plant utilization of added urea-N was greater in 1980 when rainfall during the growing season was 212 mm less than in 1981. S or I applications of urea at 74 kg N/ha, with above-ground plant15N recoveries of 48.0% and 48.6%, respectively, were also equally as efficient during 1980. Residual soil N derived from fertilizer was of little value for a sorghum crop in the following rainy season and for a safflower crop in the post-rainy season in a double-cropping system

Direct Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry Improves Appropriateness of Antibiotic Treatment of Bacteremia

Matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) allows the identification of microorganisms directly from positive blood culture broths. Use of the MALDI-TOF MS for rapid identification of microorganisms from blood culture broths can reduce the turnaround time to identification and may lead to earlier appropriate treatment of bacteremia. During February and April 2010, direct MALDI-TOF MS was routinely performed on all positive blood cultures. During December 2009 and March 2010 no direct MALDI-TOF MS was used. Information on antibiotic therapy was collected from the hospital and intensive care units' information systems from all positive blood cultures during the study period. In total, 253 episodes of bacteremia were included of which 89 during the intervention period and 164 during the control period. Direct performance of MALDI-TOF MS on positive blood culture broths reduced the time till species identification by 28.8-h and was associated with an 11.3% increase in the proportion of patients receiving appropriate antibiotic treatment 24 hours after blood culture positivity (64.0% in the control period versus 75.3% in the intervention period (p0.01)). Routine implementation of this technique increased the proportion of patients on adequate antimicrobial treatment within 24 hours

Effects of slash & burn vs.slash & mulch on water, solute and sediment dynamics at the watershed level.

Editado por Reinhard Lieberei, Helmut Bianchi, Vera Boehm, Christoph Reisdorff