Anxiety, Appearance Contingent Self-Worth, and Appearance Conversations with Friends in Relation to Disordered Eating: Examining Moderator Models

This study examined whether anxiety, combined with a focus on appearance, would identify individuals most likely to exhibit eating pathology, conceptualized as safety behaviors/avoidance strategies. In particular, we examined appearance contingent self-worth and appearance conversations with friends as possible moderators of the anxiety-disordered eating relation. Participants were 441 women attending a Southeastern university who completed an online survey. Results indicated that those with the three-way combination of high anxiety, high appearance contingent self-worth, and frequent appearance conversations exhibited the most frequent binge eating. While no significant three-way interactions emerged for broad eating pathology and dietary restraint, in both models it was the anxiety × appearance contingent self-worth interaction that accounted for unique variance in these eating patterns. Results provide researchers and clinicians with a better understanding of who experiences various types of disordered eating in association with anxiety and possible points of intervention.     

Confirmation of correct tracheal tube placement in newborn infants

Tracheal intubation remains a common procedure during neonatal intensive care. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes. The current gold standard test to confirm tube position is a chest radiograph, however this is often delayed until after ventilation has commenced. Hence, point of care methods to confirm correct tube placement have been developed. The aim of this article is to review the available literature on tube placement in newborn infants. We reviewed books, resuscitation manuals and articles from 1830 to the present with the search terms “Infant, Newborn”, “Endotracheal intubation”, “Resuscitation”, “Clinical signs”, “Radiography”, “Respiratory Function Tests”, “Laryngoscopy”, “Ultrasonography”, and “Bronchoscopy”. Various techniques have been studied to help clinicians assess tube placement. However, despite 85 years of clinical practice, the search for higher success rates and quicker intubation continues. Currently, chest radiography remains the gold standard test to confirm tube position. However, rigorous evaluation of new techniques is required to ensure the safety of newborn infants.     

Risk factors leading to midurethral sling revision: a multicenter case-control study

Introduction and hypothesis

To determine risk factors for sling revision after midurethral sling (MUS) placement.

Methods

This multicenter case-control study included patients who underwent MUS placement and subsequent revision secondary to voiding dysfunction from January 1999–2007 from nine Urogynecology centers across the USA. Direct logistic regression analysis was used to determine which diagnostic variables predicted sling revision.

Results

Of the patients, 197 met the study criteria. Patient demographics, urodynamic findings, and operative differences did not increase the risk for sling revision. Risk factors for sling revision did include: pre-existing voiding symptoms (OR 2.76, 95% CI 1.32–5.79; p?=?0.004) retropubic sling type (OR?=?2.28, 95% CI 1.08–4.78; p?=?0.04) and concurrent surgery (OR?=?4.88, 95% CI 2.16–11.05; p?<?0.001)

Conclusions

This study determined that pre-existing obstructive voiding symptoms, retropubic sling type, and concurrent surgery at the time of sling placement are risk factors for sling revision.     

Family-centered Preparation for Surgery Improves Perioperative Outcomes in Children: A Randomized Controlled Trial

Background: Children and parents experience significant anxiety and distress during the preoperative period. Currently available interventions are having limited efficacy. Based on an integration of the literature in both the anesthesia and psychological milieus, the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole.

Methods: Children and their parents (n = 408) were randomly assigned to one of four groups: (1) control: received standard of care; (2) parental presence: received standard parental presence during induction of anesthesia; (3) ADVANCE: received family-centered behavioral preparation; and (4) oral midazolam. The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium.

Results: Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups (34.4 +/- 16 vs. 39.7 +/- 15; P = 0.007) and were less anxious during induction of anesthesia as compared with the control and parental presence groups (44.9 +/- 22 vs. 51.6 +/- 25 and 53.6 +/- 25, respectively; P = 0.006). Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups (44.9 +/- 22 vs. 42.9 +/- 24; P = 0.904). Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery (P = 0.038), required significantly less analgesia in the recovery room (P = 0.016), and were discharged from the recovery room earlier (P = 0.04) as compared with children in the three other groups.     

Suberoyl Bishydroxamic Acid Inhibits Cellular Proliferation by Inducing Cell Cycle Arrest in Carcinoid Cancer Cells

Carcinoid cancers arise from the neuroendocrine cell system of the gastrointestinal tract, lungs, and other organs. Hepatic metastases are common, and patients often suffer from endocrinopathies secondary to tumor secretion of various hormones and peptides. As complete surgical resection is often not possible because of widespread disease, new therapeutic and palliative treatments are needed. In this study, we characterized the effects of suberoyl bishydroxamic acid (SBHA), a histone deacetylase inhibitor, on the growth and neuroendocrine phenotype of carcinoid cancer cells. SBHA treatment of human gastrointestinal and pulmonary carcinoid cancer cells resulted in a dose-dependent inhibition of cell proliferation. Western blot analysis showed a decrease in cyclin D1 and an increase in p21 and p27, indicating that the mechanism of this growth inhibition is cell cycle arrest. Furthermore, SBHA treatment suppressed two neuroendocrine tumor markers, chromogranin A and achaete-scute complex-like 1. These changes in the growth and neuroendocrine phenotype of carcinoid cells were associated with activation of the Notch1 signaling cascade. We conclude that SBHA shows promise as a potential anticancer agent for the treatment of patients with advanced carcinoid tumor disease. This paper was presented at the 48th Annual Meeting of the Society for Surgery of the Alimentary Tract, May 19–23, 2007, Washington, DC, USA.     

The impact of work hour restrictions on surgical resident education

OBJECTIVE: Resident work-hour restrictions were instituted in July 2003 based on ACGME mandates. The American Board of Surgery In-Training Examination (ABSITE), American Board of Surgery Qualifying Examination (ABSQE), and operative volume traditionally have been measures of surgical resident education and competency. The objective of this study was to determine the effect of reduced work hours on resident standardized test scores and operative volume at our institution. DESIGN: We reviewed ABSITE scores, ABSQE scores, and operative logs from 1997 to 2005 of all general surgery residents. Linear mixed-effects models were fitted for each component ABSITE score (total, basic science, and clinical management), and they were compared using a chi-squared likelihood ratio. Operative logs of graduating residents were compared before and after the work restrictions and were evaluated for association with ABSITE score. p-values less than 0.05 were considered significant. RESULTS: The program was compliant with ACGME mandates within 6 months of institution. ABSITE scores improved significantly after the restriction of work hours in both basic science (p = 0.003) and total score (p = 0.008). Clinical management scores were not affected. The number of major cases recorded by graduating residents did not change. A positive correlation was found between number of cases performed during residency and clinical management ABSITE scores (p = 0.045). ABSQE scores were not impacted by operative volume during residency. CONCLUSIONS: ABSITE scores improved significantly after the restriction of resident work hours. Resident operative experience was not affected. An unexpected consequence of work-hour restrictions may be an improvement in surgical resident education.     

Posttraumatic stress symptoms, PTSD, and risk factors among lower Manhattan residents 2-3 years after the September 11, 2001 terrorist attacks

Manhattan residents living near the World Trade Center may have been particularly vulnerable to posttraumatic stress disorder (PTSD) after the September 11, 2001 (9/11) terrorist attacks. In 2003-2004, the authors administered the PTSD Checklist to 11,037 adults who lived south of Canal Street in New York City on 9/11. The prevalence of probable PTSD was 12.6% and associated with older age, female gender, Hispanic ethnicity, low education and income, and divorce. Injury, witnessing horror, and dust cloud exposure on 9/11 increased risk for chronic PTSD. Postdisaster risk factors included evacuation and rescue and recovery work. The results indicate that PTSD is a continued health problem in the local community. The relationship between socioeconomic status and PTSD suggests services must target marginalized populations. Followup is necessary on the course and long-term consequences of PTSD.     

Porcelain gallbladder is not associated with gallbladder carcinoma

The surgical management of porcelain gallbladder is based on studies performed in 1931 and 1962, which indicated a correlation between porcelain gallbladder and carcinoma. We sought to evaluate the characteristics of patients with porcelain gallbladder and the risk for gallbladder carcinoma. The medical records of 10,741 cholecystectomies performed between 1955 and 1998 were reviewed and recorded. The pathology slides were evaluated for evidence of calcification and gallbladder carcinoma. Fifteen (0.14%) of 10,741 specimens were porcelain gallbladders. Ten patients (67%) had symptoms suggestive of biliary colic or cholecystitis. Five (33%) were asymptomatic and diagnosed incidentally. All specimens demonstrated chronic cholecystitis and partial calcification of the gallbladder wall. Nine (60%) had cholelithiasis. None had gallbladder carcinoma by recent review of pathologic material. During this same period 88 (0.82%) patients had gallbladder carcinoma, none of which showed calcification of the wall. This report represents the largest modern review of porcelain gallbladders. No carcinoma was identified among patients with porcelain gallbladder. In addition no patient with gallbladder carcinoma had calcified gallbladder. With a better understanding of the natural history of the porcelain gallbladder the current management of these patients may change.