Authoring and generation of individualized patient education materials

ABSTRACT Although the pre-surgical patient-surgeon encounter is the opportunity to educate the patient, it is essential that the patient be given educational materials to complement the face-to-face exchange. This is virtually impossible to do well with brochures, because many combinations of procedures are possible, different patients have different concerns, and patients have varying levels of literacy and knowledge. In the extreme, a patient would either be given a set of brochures selected from 100s of variants, or all patients would be given the same set of brochures without regard for differing needs. We have been developing an information brochure generator that customizes material for every individual patient regardless of the complexity of the surgical intervention

Systematic Review The Role of Platelet-Rich Plasma in Arthroscopic Rotator Cuff Repair: A Systematic Review With Quantitative Synthesis

Purpose: Despite the theoretic basis and interest in using platelet-rich plasma (PRP) to improve the potential for rotator cuff healing, there remains ongoing controversy regarding its clinical efficacy. The objective of this systematic review was to identify and summarize the available evidence to compare the efficacy of arthroscopic rotator cuff repair in patients with full-thickness rotator cuff tears who were concomitantly treated with PRP. Methods: We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, and PubMed for eligible studies. Two reviewers selected studies for inclusion, assessed methodologic quality, and extracted data. Pooled analyses were performed using a random effects model to arrive at summary estimates of treatment effect with associated 95% confidence intervals. Results: Five studies (2 randomized and 3 nonrandomized with comparative control groups) met the inclusion criteria, with a total of 261 patients. Methodologic quality was uniformly sound as assessed by the Detsky scale and Newcastle-Ottawa Scale. Quantitative synthesis of all 5 studies showed that there was no statistically significant difference in the overall rate of rotator cuff retear between patients treated with PRP and those treated without PRP (risk ratio, 0.77; 95% confidence interval, 0.48 to 1.23). There were also no differences in the pooled Constant score; Simple Shoulder Test score; American Shoulder and Elbow Surgeons score; University of California, Los Angeles shoulder score; or Single Assessment Numeric Evaluation score. Conclusions: PRP does not have an effect on overall retear rates or shoulder-specific outcomes after arthroscopic rotator cuff repair. Additional well-designed randomized trials are needed to corroborate these findings. Level of Evidence: Level III, systematic review of Level I, II, and III studies

10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

BACKGROUND The comparative effectiveness of treatments for prostate cancer that is detected by prostatespecific antigen (PSA) testing remains uncertain. METHODS We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths. RESULTS There were 17 prostate-cancer-specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P = 0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P = 0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years; 95% CI, 1.9 to 4.9) (P = 0.004 for the overall comparison). Higher rates of disease progression were seen in the active-monitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years; 95% CI, 6.7 to 12.0) (P<0.001 for the overall comparison). CONCLUSIONS At a median of 10 years, prostate-cancer-specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring. (Funded by the National Institute for Health Research; ProtecT Current Controlled Trials number, ISRCTN20141297; ClinicalTrials.gov number, NCT02044172.) a bs tr ac

The global abundance of tree palms

Aim: Palms are an iconic, diverse and often abundant component of tropical ecosys-tems that provide many ecosystem services. Being monocots, tree palms are evo-lutionarily, morphologically and physiologically distinct from other trees, and these differences have important consequences for ecosystem services (e.g., carbon se-questration and storage) and in terms of responses to climate change. We quanti-fied global patterns of tree palm relative abundance to help improve understanding of tropical forests and reduce uncertainty about these ecosystems under climate change.Location: Tropical and subtropical moist forests.Time period: Current.Major taxa studied: Palms (Arecaceae).Methods: We assembled a pantropical dataset of 2,548 forest plots (covering 1,191 ha) and quantified tree palm (i.e., ≥10 cm diameter at breast height) abundance relative to co-occurring non-palm trees. We compared the relative abundance of tree palms across biogeographical realms and tested for associations with palaeoclimate stability, current climate, edaphic conditions and metrics of forest structure.Results: On average, the relative abundance of tree palms was more than five times larger between Neotropical locations and other biogeographical realms. Tree palms were absent in most locations outside the Neotropics but present in >80% of Neotropical locations. The relative abundance of tree palms was more strongly asso-ciated with local conditions (e.g., higher mean annual precipitation, lower soil fertility, shallower water table and lower plot mean wood density) than metrics of long-term climate stability. Life-form diversity also influenced the patterns; palm assemblages outside the Neotropics comprise many non-tree (e.g., climbing) palms. Finally, we show that tree palms can influence estimates of above-ground biomass, but the mag-nitude and direction of the effect require additional work.Conclusions: Tree palms are not only quintessentially tropical, but they are also over-whelmingly Neotropical. Future work to understand the contributions of tree palms to biomass estimates and carbon cycling will be particularly crucial in Neotropical forests

Ultrasound assessment of gastric content and volume

Background: Aspiration of gastric contents can be a serious perioperative complication, attributing up to 9% of all anesthesia-related deaths. However, there is currently no practical, noninvasive bedside test to determine gastric content and volume in the perioperative period. Methods: The current study evaluates the feasibility of using bedside ultrasonography for assessing gastric content and volume. In the pilot phase, 18 healthy volunteers were examined to assess the gastric antrum, body, and fundus in cross-section in five prandial states: fasting and after ingestion of 250 mL of water, 500 mL of water, 500 mL of effervescent water, and a solid meal. In the phase II study, the authors concentrated on ultrasound examination of the gastric antrum in 36 volunteers for whom regression analysis was used to determine the correlation between gastric volume and antral cross-sectional area. Results: The gastric antrum provided the most reliable quantitative information for gastric volume. The antral cross-sectional area correlated with volumes of up to 300 mL in a closeto-linear fashion, particularly when subjects were in the right lateral decubitus position. Sonographic assessment of the gastric antrum and body provides qualitative information about gastric content (empty or not empty) and its nature (gas, fluid, or solid). The fundus was the gastric area least amenable to image and measure. Conclusions: Our preliminary results suggest that bedside two-dimensional ultrasonography can be a useful noninvasive tool to determine gastric content and volume

NEW RESEARCH Psychodynamic Psychotherapy for Children and Adolescents: A Meta-Analysis of Short-Term Psychodynamic Models

Objective: Psychodynamically based brief psychotherapy is frequently used in clinical practice for a range of common mental disorders in children and adolescents. To our knowledge, there have been no meta-analyses to evaluate the effectiveness of these therapies. Method: After a broad search, we meta-analyzed controlled outcome studies of short-term psychodynamic psychotherapies (STPP, 40 or fewer sessions). We also performed sensitivity analyses and evaluated the risk of bias in this body of studies. Results: We found 11 studies with a total of 655 patients covering a broad range of conditions including depression, anxiety disorders, anorexia nervosa, and borderline personality disorder. STPP did not separate from what were mostly robust treatment comparators, but there were some subgroup differences. Robust (g ¼ 1.07, 95% CI ¼ 0.80-1.34) within group effect sizes were observed suggesting the treatment may be effective. These effects increased in follow up compared to post treatment (overall, g ¼ 0.24, 95% CI ¼ 0.00-0.48), suggesting a tendency toward increased gains. Heterogeneity was high across most analyses, suggesting that these data need be interpreted with caution. Conclusion: This review suggests that STPP may be effective in children and adolescents across a range of common mental disorders. J. Am. Acad. Child Adolesc. Psychiatry, 2013;52(8):863-875

Can anesthetic technique for primary breast cancer surgery affect recurrence or metastasis? Anesthesiology. 2006; 105: 660–664

Background: Regional anesthesia is known to prevent or attenuate the surgical stress response; therefore, inhibiting surgical stress by paravertebral anesthesia might attenuate perioperative factors that enhance tumor growth and spread. The authors hypothesized that breast cancer patients undergoing surgery with paravertebral anesthesia and analgesia combined with general anesthesia have a lower incidence of cancer recurrence or metastases than patients undergoing surgery with general anesthesia and patient-controlled morphine analgesia. Methods: In this retrospective study, the authors examined the medical records of 129 consecutive patients undergoing mastectomy and axillary clearance for breast cancer between September 2001 and December 2002. Results: Fifty patients had surgery with paravertebral anesthesia and analgesia combined with general anesthesia, and 79 patients had general anesthesia combined with postoperative morphine analgesia. The follow-up time was 32 ؎ 5 months (mean ؎ SD). There were no significant differences in patients or surgical details, tumor presentation, or prognostic factors. Recurrence-and metastasis-free survival was 94% (95% confidence interval, 87-100%) and 82% (74 -91%) at 24 months and 94% (87-100%) and 77% (68 -87%) at 36 months in the paravertebral and general anesthesia patients, respectively (P ‫؍‬ 0.012). Conclusions: This retrospective analysis suggests that paravertebral anesthesia and analgesia for breast cancer surgery reduces the risk of recurrence or metastasis during the initial years of follow-up. Prospective trials evaluating the effects of regional analgesia and morphine sparing on cancer recurrence seem warranted