Can cardiac troponins be used to diagnose a perioperative myocardial infarction post cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether Troponin I or T can effectively diagnose a perioperative myocardial infarction after cardiac surgery. Altogether 191 papers were found using the reported search, of which 17 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that Troponin I and T can both be used to indicate myocardial damage, with the level correlating well with the level of injury. However until issues such as a 'gold standard' for peri-operative MI are addressed, one single cut-off point cannot be recommended for either test.     

The multidisciplinary rectal cancer treatment: main convergences, controversial aspects and investigational areas which support the need for an European Consensus.

BACKGROUND AND PURPOSE: During the past decades staging and treatment of rectal cancer are used different in Europe and in North America. To promote a process to integrate the daily practice with the best evidence of the literature an International Conference was organized in Italy. Agreement between Experts, Centres, and specialists who participated in the Conference are reported. METHODS: Five aspects were analyzed and a questionnaire was tailored for this purpose. The questionnaire had 159 questions. During the Conference, at the beginning of each Session, the moderators showed the answers from the Experts and the Centres, and, at the end of the session, the audience voted in all controversial issues. Agreements were scored at three levels: minimum, if it was between 51 and 74% of votes for each group; moderate, between 75 and 94%; large, more than 94%. RESULTS: The main results are: staging: endoanal ultrasound was considered as mandatory in T staging, in the evaluation of sphincter infiltration, and in the restaging of T after chemoradiotherapy (chRT). Magnetic Resonance Imaging is mandatory in the evaluation of mesorectal fascia infiltration. Endoscopy had a moderate agreement for the definition of tumour location, and the barium enema as optional. Digital rectal examination is complementary for staging and PET-CT investigational for T, N and yT staging. Preoperative radiotherapy: for T4 stage chRT was always the preferred treatment, often with moderate agreement, for any tumour location and N status. For T3, chRT received the same agreement except for high location and N0-N1. For T2 stage, N2 and positive nodes outside the mesorectum, chRT received minimum agreement for low and middle tumours; for high tumours only positive nodes outside the mesorectum was agreed upon. Preoperative radiotherapy, negative specimen and sphincter preservation: chRT was agreed by many for all T stages and N presentations of lower third tumours, except for T1-2 N0-N1. Postoperative treatments: the selection for these treatments often received moderate agreement according to the infiltration of surrounding organs, positive nodal status and circumferential radial margins. Therapy of metastatic disease: an agreement was found for FOLFOX as first-line therapy and for FOLFIRI as second-line, although comparative studies show similar activity of FOLFOX and FOLFIRI regimens. CONCLUSIONS: This process represents an expertise opinion process that may contribute to increased scientific debate and to promote the development of 'guidelines', 'clinical recommendations' and ultimately a Consensus on the evolving approach to rectal cancer treatment.     

The Brøset violence checklist (BVC)

OBJECTIVE: The Br?set violence checklist (BVC) is a short-term violence prediction instrument assessing confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects as either present or absent. The aim of this paper is to describe the evolution and usefulness of the BVC. METHOD: This paper reviews studies on the BVC and discusses implications for further research. RESULTS: Empirical research has shown that it has moderate sensitivity and high specificity with an adequate inter-rater reliability. CONCLUSION: The BVC is a useful instrument for predicting inpatient violence within the next 24-h period. The psychometric properties of the instrument are satisfactory. Results from ongoing studies will give important information on cultural differences, the validity of the BVC in less well staffed wards, the clinical use of the checklist and its ability to predict violence throughout all the hospital stay.     

Dental cost of deploying a National Guard unit to Bosnia

OBJECTIVES: To examine the dental readiness of a National Guard (NG) unit mobilizing to Bosnia, to estimate the civilian comparable cost for the necessary treatment to make the unit deployable, and to examine the effect on the active component (AC) dental readiness. MATERIALS AND METHODS: This study was a retrospective cohort analysis of dental fitness classifications (DFCs) and treatment provided for the 48th IN BDE (Mech) upon mobilization for a 6-month deployment to Bosnia. The NG unit mobilized through Fort Stewart, Georgia, from December 2000 through February 2001 en route to a 6-month deployment starting in February 2001. All soldiers received dental examinations and were classified in one of four DFCs. DFC 1 implies that the soldier has no dental treatment needs; DFC 2 indicates that the soldier needs dental treatment, but the condition is not expected to cause an emergency in the next 12 months; DFC 3 indicates that significant oral conditions present are expected to cause an emergency in the next 12 months; DFC 4 indicates that the soldier is in need of a dental examination. Dental treatment was provided for all DFC 3 soldiers. A database was created of DFCs of deploying soldiers upon arrival at the mobilization site and dental procedures performed. RESULTS: This retrospective review identified 1,378 soldiers who processed through the dental station at the mobilization site. Soldiers DFCs were as follows: DFC 1, 7.8%; DFC 2, 50.1%; DFC 3, 35.8%; DFC 4, 6.2%. Direct costs to the Fort Stewart Dental Activity were $95,602. The services provided to treat the DFC 3 patients are valued at $441,471. CONCLUSIONS: The dental readiness of this NG unit was greatly inferior to that of the AC, and there is a significant cost in personnel, dollars, and AC readiness to provide the needed dental treatment before mobilization.     

A retrospective case-control study of developmental and other outcomes in a cohort of Australian children conceived by intracytoplasmic sperm injection compared with a similar group in the United Kingdom

OBJECTIVE: To investigate the possibility that children born after ICSI were at increased risk for neurodevelopmental delay. DESIGN: Retrospective case-control study. SETTING: IVF clinic. PATIENT(S): Fifty-eight singleton children born after ICSI and 38 normally conceived singleton children (controls), matched for relevant sociodemographic characteristics, from Australia and 208 case-patients and 221 controls from the United Kingdom. MAIN OUTCOME MEASURE(S): Antenatal and perinatal, and sociodemographic characteristics; physical health, including congenital abnormalities; and neurodevelopment by using the Griffiths scales of mental development. RESULT(S): Eighty-five percent of case-patients and 96% controls were assessed at a mean age of 13 months. Neurodevelopmental scores were similar in all children. Perinatal outcome was similar, apart from more caesarean sections in the case-patients. Rates of congenital anomalies were similar (5.6% among case-patients vs. 5.7% among controls). Children from fathers with oligozoospermia showed no extra problems. Children born after ICSI in the United Kingdom and Australia were similar. CONCLUSION(S): Children conceived after ICSI did not differ from their naturally conceived peers in physical health or development at ages up to 15 months.