Aseptic barriers in surgery: their present status

Aseptic barriers are employed in the form of surgical gowns, drapes, and wrappers for sterile goods. They possess many of the attributes of textiles, but must also protect sterile zones from microbial invasion. Surgeons rely on them to resist penetration by liquids and other bacterial vehicles. A large variety of both woven and nonwoven materials are being produced for this purpose. The user is faced with difficult choices. The provider of the barrier materials must assure the surgeon of their barrier quality under the usual conditions of their use in operating rooms. Identical standards of quality can be and should be applicable whether these materials are created to be used once and discarded or are reusable.     

Novel tools for localizing ion channels in living cells

The authors report two cases of colovesical fistula as a complication of diverticular disease. They underline the increasing frequency of this complication, although the less frequent one. They also stress the importance of clinical and instrumental examinations that are several and among which TC scan can be crucial for surgical treatment. The therapy, exclusively surgical, can be made in one or two steps, according to patient status.     

Alpha hydroxy acids for skin care

Entrepreneurs look to the future and see opportunity where others see barriers. They are proactive with the never-ending cycle of change, recognizing that change relocates opportunity. Nurse entrepreneurs make themselves aware of emerging health care trends, acquire the skills demanded by those trends, and arrive in the new era fully equipped to flourish.     

How adequate are state data to support health reform or monitor health system change?

This article reports on results of a 1994 telephone survey sponsored by the Robert Wood Johnson Foundation to obtain better information on state policymakers' views of the quality of state-based health data and selected information on the actual data available. The findings suggest that state policymakers cannot identify easily who and how many are without health insurance coverage, nor do they know exactly how much money is spent in the state on health care and who spends it. They also cannot ascertain quality or consumers' satisfaction with health plans. Funding, lack of comparability across data sets, and the reluctance of providers and insurers to submit required data are perceived as barriers to improving data. Adopting realistic strategies to overcome these barriers may be crucial if states are to assume greater leadership in health policy and in monitoring health system performance.     

Urinary complications of the resectable cancers of the cervix uteri (author's transl)

The authors studied the urinary complications following 721 operations performed between 1960 and 1974 for cervix uterin carcinoma. The surgical method was the one used at the Fondation Curie according to the protocol of treatment. They have noted that: --first, the surgical act as primary treatment (672 cases) was innocuous, as this series showed only 0,6% of the severe complications; in contrast, when the surgery is performed for a recurrence after a total dose irradiation, the severe complications raised to 8%; --secondly, the uretero-hydronephroses following this type of surgery are relatively frequent on the systematic urograms, but most of them are quite asymptomatic and without later sequelae only 0,3% of them required a surgical treatment. The authors analyse the factors influencing the ureteral stenoses, especially the extent of lymphadenectomy and the associated external irradiation. They studied too the ureteral stenoses due to a local recurrence.     

Adhesions: pathogenesis and prevention-panel discussion and summary

This article summarizes the discussions of the faculty and chairpersons on four major topics on postsurgical adhesions examined at the symposium, "Adhesions: Pathogenesis and Prevention". These topics are: 1) clinical significance; 2) pathogenesis; 3) research status and directions; and 4) recommendations for reduction or prevention. Abdominal postsurgical adhesions develop following trauma to the mesothelium, which is damaged often by surgical handling and instrument contact, foreign materials such as sutures and glove dusting powder, desiccation, and overheating. Postoperative adhesions occur after most surgical procedures and can result in serious complications, including intestinal obstruction, infertility, and pain. A long-term and unpredictable problem, postoperative adhesions impact the surgical workload and hospital resources, resulting in considerable health care expenditures. Although understanding of the pathogenesis of adhesions has improved recently, the molecular mechanisms involved continue to be delineated. Adhesions result from the normal peritoneal wound healing response and develop in the first five to seven days after injury. Adhesion formation and adhesion-free re-epithelialization are alternative pathways, both of which begin with coagulation which initiates a cascade of events resulting in the buildup of fibrin gel matrix. If not removed, the fibrin gel matrix serves as the progenitor to adhesions by forming a band or bridge when two peritoneal surfaces coated with it are apposed. The band or bridge becomes the basis for the organization of an adhesion. Protective fibrinolytic enzyme systems of the peritoneum, such as the plasmin system, can remove the fibrin gel matrix. However, surgery dramatically diminishes fibrinolytic activity. The pivotal events determining whether the pathway taken is adhesion formation or re-epithelialization are therefore the apposition of two damaged surfaces and the extent of fibrinolysis. Research in postsurgical adhesion formation and prevention abounds in a variety of avenues of investigation, including: 1) identification on a molecular level of the components involved in adhesiogenesis and their interactions; 2) clarification of the role of fibrin and fibrinolysis in adhesion formation; 3) standardization of design in preclinical and clinical studies of adhesion formation and prevention; 4) delineation of the relationship between adhesion formation and adhesive complications; and 5) elucidation of efficient, site-specific methods of prophylactic drug delivery. Currently, it seems logical to focus preventive research on development of barriers, fibrinolytic drugs, and selected agents such as phospholipids. The major strategies for adhesion prevention or reduction are adjusting surgical practice and applying adjuvants. Surgeons should adjust their major practices by: 1) becoming aware of the potential adhesive complications of a procedure; 2) minimizing the invasiveness of surgery; and 3) minimizing surgical trauma, ischemia, exposure to intestinal contents, introduction of foreign material into the body, and the use of talc- or starch-containing gloves. Available adjuvants include a newly developed by hyaluronic acid-phosphate-buffered saline solution applied intraoperatively to protect peritoneal surfaces from indirect surgical trauma and three mechanical barriers. One of these, a bioresorbable membrane consisting of hyaluronic acid and carboxymethylcellulose, has demonstrated efficacy and safety in both general and gynecological surgery. The other two barriers, one made of expanded polytetrafluoroethylene and one developed from oxidized regenerated cellulose, are indicated only for use in gynecological surgery.     

A survey of ventilator circuitry changing practices in the UK

The aneurysms of the celiac trunk are the rarest aneurysms of the visceral arteries. From 1958 only 69 cases have been reported in the international literature. They are frequently asymptomatic and their discovery is more often occasional. They can rupture in 15-20% of the cases with a mortality approaching 80% of the cases. This explains the need of a surgical treatment even in the asymptomatic cases. Personal experience in the surgical treatment of a case of aneurysm of the celiac trunk is reported and a survey of the literature on this matter is made.     

Overcoming the barriers: national to European to G7

An information revolution is underway which will have an impact on all sectors of society. It will fundamentally change national and international health systems. The global Internet is a key influence and will change the balance of power within and between healthcare professions, and between them and the general public. This revolution offers enormous potential benefits to global health but there is also potential for harm. There are a wide range of barriers to realising the potential benefits. They lie in areas such as the protection of personal information; ownership and legal accountability; data meanings: structures and database navigation; deficiencies in the global Internet and lack of access by many communities. This paper considers the nature of those barriers. In 1994, the Group of Seven Nations launched an initiative to stimulate a global information society. Theme 8 deals with healthcare and therein Sub-project 5 'Enabling Mechanisms', which the author leads, is seeking to identify barriers and the authoritative international sources of advise and good practice. It is conducting an international survey, the results of which should be published by the end of 1997. This paper describes the aims of this Sub-project.     

Fecal incontinence in geriatric patients]

Membranes provide the structural framework that divides cells from their environment and that, in eukaryotic cells, permits compartmentation. They are not simply passive barriers that are liable to be damaged during environmental challenge or pathological states, but are involved in cellular responses and in modulating intracellular signalling. Recent data show that the expression of several genes, particularly those that respond to changes in temperature, ageing or disease, is influenced and/or controlled by the membrane's physical state.     

Progress toward a viable interface between social and clinical-counseling psychology.

This article examines the history of the relation between social psychology and clinical-counseling psychology. The authors discuss the barriers that traditionally have impeded close collaboration between the fields and the ways in which these barriers have eroded recently to allow for the emergence of a viable interface between social and clinical-counseling psychology. They describe the current social-clinical-counseling domain, discuss the implicit assumptions underlying the interface, assess the impact of this movement on academic and professional psychology, and make suggestions for further improving the working relations among these fields. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parent motivation to enroll in parenting skills programs: A model of family context and health belief predictors.

In this study, the authors tested a heuristic model of health belief and family context factors associated with parent inclination to enroll in parenting skills programs. They collected data from 1,192 rural midwestern parents of 5th graders. Results support a basic model including health belief constructs derived from the health belief model (I. M. Rosenstock, 1966; perceived teen problem susceptibility, problem severity, program benefits, and program barriers) and an expanded model incorporating the indirect effects of several family context variables, household income, parent education, number of children, child problem behaviors, and past parenting resource use. Perceived program benefits, program barriers, and past parenting resource use showed the strongest influence on the parents' inclination to enroll. Implications for practitioners are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Traumatic rupture of the cervical trachea. Emergency diagnosis and treatment

The authors report 3 cases of traumatic rupture of the cervical trachea including one associated with total division of the oesophagus. They were impressed by the lack of precision and rapidity of the first surgical measures. They then give an account of the therapeutic gestures which are possible in a non-specialised unit.     

Guided tissue regeneration update

The ultimate goal of periodontal therapy is to restore periodontal tissues lost through disease or trauma. The most predictable way to accomplish this goal is by guided tissue regeneration (GTR). The principle of GTR is to give preference to certain cells to repopulate the wound area to form a new attachment apparatus. Clinically this is accomplished by placing a barrier over the defect thereby excluding gingival tissues from the wound during early healing. The first generation of GTR barriers were non-resorbable which implies that they have to be removed in a second surgical procedure. Resorbable barriers have recently been introduced, changing GTR into a single-step procedure. Periodontal defects that will predictably benefit from GTR therapy are intrabony, furcation class II and gingival recession defects. This paper reviews the scientific evidence of what can be achieved by GTR procedures for various periodontal defects as well as factors of importance to increase the predictability of a successful treatment outcome.     

Relationship between anelastic and nonlinear viscoplastic behavior of 316 stainless steel at low homologous temperature

At low homologous temperature the plastic strain rate seems to be controlled largely by dislocation glide friction. However, since a sizeable fraction of the applied stress σ is dissipated in overcoming the strong barriers due to dislocation tangles generated by strain hardening, only a portion of the applied stress is actually expended against the frictional resistance. A recent model for this process, proposed by Hart, includes the role of dislocation pile-ups at the strong barriers. The pile-ups provide a mechanism for producing the internal back stress that reflects the barrier penetration stress. They also appear in the deformation as a stored anelastic strain component. The resultant behavior at low temperature and high stress is similar to that proposed by Gupta and Li. The same model also predicts an anelastic behavior at low stress. Measurements at both high and low stress levels on 316 Stainless Steel have now shown that the predictions of the model are quantitatively consistent at both stress levels.     

Video-assisted thoracoscopic repair of an intercostal pulmonary hernia

Pulmonary hernias are extremely rare. They are usually treated with open surgical procedures. We describe a case in which a large, spontaneously acquired intercostal pulmonary hernia was successfully repaired by video-assisted thoracoscopic surgery (VATS).     

Charrettes as a Method for Engaging Industry in Best Practices Research

Gaining innovative and useful research findings concerning construction industry best practices requires an interaction and feedback mechanism between industry respondents and academia. Typical research methods such as surveys, source document reviews, and structured interviews will work, but suffer from barriers which can hamper results. Examples of these barriers include low response rates, asynchronous communication, time commitment of the researchers and respondents, access to project data, and travel costs. Structured workshops (research “charrettes”) are a unique and useful method for facilitating data collection between industry respondents and academic researchers. They combine the best tenets of surveys, interviews, and focus groups in an accelerated time frame. This paper will explain how these workshops provide a critical avenue for industry interaction. Characteristics leading to successful charrettes will be outlined. The paper will conclude by describing the benefits of these workshops to researchers including lessons learned from successful workshops.     

Regenerative periodontal therapy in mucogingival surgery for root coverage

This article illustrates the potential benefits of regenerative periodontal therapy in mucogingival surgery and esthetic dental treatment. Cases are described in which the treatment of soft-tissue recessions and root exposures are treated with surgical procedures where both clinical soft-tissue augmentation and the regeneration of periodontal attachment are obtained. Cases are also presented to illustrate the clinical application of guided tissue regeneration. Resorbable and nonresorbable barriers are placed over the root surface and bone and covered by the overlying flap, which allows the selective repopulation of the lesion by progenitor cells and the inhibition of a long junctional epithelium. Emphasis is placed on regenerative procedures in soft-tissue augmentation, particularly with respect to rationales, techniques, and indications.     

Cecal and sigmoid volvulus

The Authors present the etio-pathogenetic, clinical and diagnostic aspects of cecal and sigmoid volvulus. They discuss the therapeutic indications and possibilities comparing advantages and disadvantages of conservative and surgical treatment. Two cases of cecal volvulus and two of sigmoid volvulus, are presented and their peculiar aspects underlined as well as the surgical technique.     

Focus groups reveal perils and promises of managed care for nurse practitioners

Decades of practice and research suggest that nurse practitioners (NPs) provide cost-effective and high-quality care. Managed care's emphasis on prevention and cost savings led some policy makers to view NPs as a way to meet the need for primary care providers. However, access to and utilization of NPs has increasingly been controlled by managed care organizations (MCOs) through their selection of providers for primary care panels. This study employed qualitative methodology to examine NPs' experiences with MCOs. Three focus groups, comprising 27 NPs in New York and Connecticut, revealed NPs' mixed reactions to managed care and a range of sentiments regarding NPs' efforts to be listed as primary care providers. The results reflected NPs' concerns about their perceived "invisibility," as well as their sense of "invincibility" in the ways in which NPs are responding to the barriers posed by MCOs. They identified barriers to, as well as ways to facilitate, being listed by MCOs, and described the importance of NPs working individually and collectively in negotiating with MCOs.     

Improving glove barrier effectiveness

Perioperative staff members depend on surgical gloves to prevent disease transmission between themselves and patients, but these gloves frequently fail during use. Three approaches can make surgical gloves more effective barriers: preventing glove failures, monitoring glove integrity, and improving glove quality. Failure prevention includes modifying surgical techniques, improving instruments and equipment, streamlining teamwork, selecting the most appropriate gloves, double gloving, and performing preventive glove changes. Glove integrity monitoring can be performed visually or by feel, by wearing glove pairs with color-puncture indicators, or by using electronic monitoring devices. Glove quality improvements must be accompanied by testing methods that reflect in-use conditions. A glove rating system that is based on in-use performance may enhance glove safety substantially.