Primary tracheoesophageal fistula procedure for voice restoration: The university of texas medical branch experience

Voice restoration for laryngectomees is challenging, but in recent years the tracheoesophageal (TE) fistula procedure using a oneway valved prosthesis has had relatively good success. The purposes of this study were to determine the success rate for the primary TE fistula procedure, analyze failures, and study methods for selection and training of these patients. In a prospective study, 21 consecutive patients had primary TE fistula procedures performed over an 18-month period. Thirteen of 20 who had adequate follow-up developed fluent, intelligible speech using either duckbill or low-pressure one-way valves. Complications included one stomal infection and one paratracheal fistula. This experience has led 1. to development of a protocol for selection and training of patients for this procedure and 2. to the conclusion that the procedure can improve voice restoration success without an increase in morbidity.     

The effect of occlusive patching on visually-directed tasks.

PURPOSE: Occlusive patching is used to treat a variety of ocular conditions. A paucity of literature exists regarding the effects of occlusion on functional tasks and driving performance. We investigated the immediate effects of occlusive patching on a variety of visually dependent tasks as well as driving performance on a simulator. METHODS: Thirty normally sighted subjects were examined in a prospective randomized manner. All subjects underwent a complete medical history and eye examination. All subjects performed a variety of near tasks and drove a driving simulator with and without patching. The tasks included traditional clinical depth tests, tests of visual memory, scanning, and tracking, and gross and fine-motor abilities. All subjects filled out a questionnaire relating to their perception of the effects of patching on functional tasks and driving ability. RESULTS: Visual memory, scanning, tracking, and perceptual constancy were unaffected by patching. However, there were significant differences between the patched and unpatched conditions for four of five of the three-dimensional visual coordination tasks. Eight of 19 (42%) of the fine-motor tasks and 4 of 9 gross-motor tasks (44%) showed significant differences between the patched and unpatched conditions. A greater frequency of out of lane events and more abrupt braking profiles were seen when subjects drove monocularly rather than binocularly. CONCLUSIONS: Sudden occlusion immediately changes perceptual ability by decreasing visual field and eliminating stereoacuity. This has important implications for the performance of everyday tasks.     

Metformin therapy for gestational diabetes mellitus: are we there yet?

Metformin is an effective alternative to insulin for nonpregnant women with type 2 diabetes mellitus; however, it has not yet been studied in the setting of gestational diabetes mellitus (GDM). Concerns have been raised about the effect of metformin on fetal development, particularly because it crosses the placenta. In this Practice Point commentary, I discuss the findings of an open-label, multicenter, prospective trial conducted by Rowan et al., in which women with GDM were randomly allocated to receive metformin (plus insulin when necessary) or insulin alone. The rate of a composite neonatal outcome and the efficiency of glycemic control were not significantly different between the groups. Compared with the insulin group, the prevalence of severe neonatal hypoglycemia was lower but the rate of preterm birth was higher in the metformin group. Of note, 46% of metformin-treated women required supplemental insulin. Although the results of this study are encouraging, further data are needed on the long-term safety of metformin before it can be considered as first-line therapy for women with GDM.     

Hospital readmission from a transitional care unit

The purpose of this project was to characterize patients readmitted to the hospital during a stay in a transitional care unit (TCUT). Typically, readmitted patients were females, widowed, with 8 medical diagnoses, and taking 12 different medications. Readmission from the TCU occurred within 7 days as a result of a newly developed problem. Most patients did not return home after readmission from the TCU. Understanding high-risk patients' characteristics that lead to costly hospital readmission during a stay in the TCU can assist clinicians and healthcare providers to plan and implement timely and effective interventions, and help facility personnel in fiscal and resource management issues.     

Reported Health Behaviour Changes after a Diagnosis of Gestational Diabetes Mellitus among Ethnic Minority Women Living in Canada

The aim of this cross-sectional study was to examine differences in health behaviours among ethnic minority and Caucasian women after a diagnosis of gestational diabetes mellitus (GDM). Data were derived from medical charts and a questionnaire among a multi-ethnic cohort of 898 Canadian pregnant women diagnosed with GDM attending prenatal diabetes clinics in Ontario, Canada. Health behaviours were compared between ethnic minority and Caucasian women, adjusting for relevant covariates. The mean age was 33.9 ± 6.1 years; 60.0 % self-reported to be part of an ethnic minority group. After adjustment for socio-demographic, behavioural and clinical characteristics, ethnic minority women were more likely to report reducing their meal portion sizes (odds ratio [OR] 1.98; 95.0 % confidence interval [CI] 1.20–3.26) and increasing their physical activity (OR 1.71; 95.0 % CI 1.12–2.62) in response to a GDM diagnosis compared to Caucasian women. Ethnic minority women were more likely to report changes in health behaviours after a GDM diagnosis. Further research is needed to determine the impact of these findings on maternal health and perinatal outcomes, during and after delivery.