Influence of Resident Involvement in Obstetrics and Gynaecology Surgery on Surgical Outcomes: Systematic Review and Meta-Analysis

Objective

The effect of resident involvement during obstetrics and gynaecology (OB/GYN) surgery on surgical outcomes is unclear. This study sought to review the evidence systematically for the influence of resident participation in OB/GYN surgery on (1) operative time, (2) estimated blood loss, and (3) perioperative complications.

Trends in the indications for pediatric tonsillectomy or adenotonsillectomy

Objective

To report trends in the indications for pediatric tonsillectomy or adenotonsillectomy.

Methods

To identify current indications, (1) a retrospective chart review analyzed all indications for procedures performed by a pediatric otolaryngologist on patients aged 0-3, 4-10, or 11-18 years, and (2) a cross-sectional survey to members of the American Society of Pediatric Otolaryngology asked for approximate percentages of children in the same age groups receiving procedures for obstruction, infection, or another indication. To assess changing indications over time, (3) a literature review was performed.

Results

(1) Chart review: 302 patients aged 5 months to 18 years (average: 6.34; median: 6) were analyzed. For the 0-3-year age group, obstruction was an indication in 100.0% of cases, and infection in 2.6%. For the 4-10-year age group: 91.9% and 13.4%, respectively. For the 11-18-year age group: 84.6% and 33.3%. (2) Survey: 120 surveys were returned (40% response rate), and 63 surveys were appropriate for analysis (21% completion rate). For the 0-3-year age group, obstruction was the primary indication in 91.8% of procedures and infection in 7.5%. For the 4-10-year age group: 73.2% and 25.3%, respectively. For the 11-18-year age group: 43.0% and 54.2%. (3) Literature review: 11 articles consistently illustrated a rise in obstruction and a decline in infection as an indication since 1978.

Conclusions

Obstruction has become a more prominent indication than infection for pediatric tonsillectomy or adenotonsillectomy in children, especially younger children. Infection becomes a more prominent indication as age increases. Data may not be absolutely reflective of all pediatric otolaryngologists or other otolaryngologists that treat children. Comparing studies is difficult owing to the variety of surgical procedures focused upon and terms used to define indications.     

Understanding the Relationships between Diverse Family Structures and the Development of Emotion Regulation of Mexican-Origin Children: Population-Based Estimates

Emotion regulation is the earliest indicator of self-regulation and can affect the subsequent development of other self-regulation behaviors. Thus, understanding how children of immigrants develop emotional regulation is imperative as it has important implications for their life course. Using a nationally representative sample of children in 2001 from the Early Childhood Longitudinal Study – Birth Cohort (ECLS-B), the study investigates the relationship between family structures – both nuclear and extended family structures – and child’s emotional regulation for Mexican-origin children. The study finds that the influences of family structures on children’s emotion regulation across racial and ethnic groups differ. Specifically, for U.S.-born children of Mexican immigrant parents, residing in vertically extended family structures (i.e., with grandparents) is negatively associated with children’s emotion regulation whereas residing in horizontally extended family structures (i.e., with aunt or uncle) is positively associated with children’s emotion regulation. However, the significant relationships between family structures and children’s emotion regulation disappear when controlling for parental sensitivity towards children.     

Clinical and immunological impact of HIV envelope V3 sequence variation after starting initial triple antiretroviral therapy

BACKGROUND: The HIV-1 envelope third variable loop (V3 loop) is an important determinant of viral phenotype and co-receptor usage. We wished to determine the impact of specific V3 genotypes associated with viral phenotype and co-receptor usage on response to initial triple antiretroviral therapy. METHODS: Pre-therapy plasma samples from the HOMER cohort of 1191 antiretroviral-naive, HIV-infected adults who initiated triple therapy in British Columbia, Canada between August 1996 and September 1999 were genotyped for V3 loop sequence. V3 sequences were dichotomized by the presence or absence of positively charged residues at codons 11 and/or 25 (an '11/25' genotype). Neural network (NN) and Position Specific Scoring Matrix (PSSM) approaches were used as alternative V3 sequence interpretation methods. The association of V3 genotypes with clinical endpoints was assessed over a median of 43 months of follow up. RESULTS: One-hundred and eighteen (10.9%) of the 1085 isolates successfully genotyped for V3 displayed the 11/25 genotype. In multivariate analyses, this genotype was associated with a more rapid CD4 decline [risk ratio, (RR), 1.38; P = 0.012] and earlier mortality (RR, 1.70; P = 0.027), despite comparable viral load suppression below 500 HIV RNA copies/ml. We observed no influence of the 11/25 genotype on time to viral rebound or the development of drug resistance. PSSM-based sequence categories were similarly predictive of outcomes. NN sequence categories were not associated with any endpoints. CONCLUSION: The 11/25 genotype of the HIV V3 loop is an independent predictor of poor immunological response and more rapid mortality even after starting triple antiretroviral therapy. These results may prove to be useful for the clinical management of HIV-infected individuals.     

The incidence of HIV-1 associated with injections and transfusions in a prospective cohort, Rakai, Uganda

The incidence of HIV associated with medical injections was assessed in a cohort of 6868 HIV-negative individuals; 42.8% reported injections and 0.5% reported transfusions. The Poisson adjusted rate ratios and 95% confidence intervals (CI) of incident HIV were 1.05% (CI 0.75-1.46) associated with medical injections, and 3.92 (CI 1.22-12.58) associated with transfusions. Sexual behaviours were significantly associated with HIV risk. Medical injections did not increase HIV acquisition in this rural Ugandan population.     

Percutaneous vertebroplasty in patients with spinal canal compromise

OBJECTIVE: The American College of Radiology Standard for Performance of Percutaneous Vertebroplasty lists as relative contraindications to the procedure conditions causing "significant spinal canal compromise." We believe percutaneous vertebroplasty can be performed safely and efficaciously in individuals without radicular symptoms who present with canal compromise, with or without cord compression. MATERIALS AND METHODS: We reviewed all vertebroplasties performed at our institution over the past 4 years. Cases in which vertebroplasty was performed at levels showing complete effacement of the epidural space, particularly those with cord compression, were included in the review. Follow-up data obtained from questionnaires routinely sent to our vertebroplasty patients were used to evaluate symptomatic response in this subset of patients as well as the occurrence of any complications. RESULTS: Of 686 levels treated over the past 4 years, 26 levels in 23 patients qualified for our review. Follow-up ranged from 6 months to 2 years. Patients were asked to rate the degree of their original pain as follows: gone, better than, the same as, or worse than before the procedure. Of the 23 patients, five (22%) reported complete resolution of pain, 15 (65%) reported their symptoms to be better, and three (13%) reported no appreciable change. No complications with clinical sequelae were encountered. CONCLUSION: Percutaneous vertebroplasty can be performed safely at levels showing spinal cord compression in patients without radicular signs. Most patients (87%) in our series showed some improvement or complete eradication of their symptoms. No patient reported worsening symptoms.