New anatomic repair of midline abdominal wall incisions extending to suprapubic region

This article describes a new technique to close infraumbilical midline abdominal wall incisions extending to the suprapubic region. This repair is technically easy to perform, saves time, reduces the risk of bowel and bladder injury and takes into consideration the anatomical landmarks of the peritoneum, the rectus sheath and the arcuate line. Abdominal wall closure with this repair is especially useful in obese patients. Furthermore, with this repair the pelvic cavity is lined with smooth peritoneum, which may reduce postoperative adhesions in the pelvis. Technically easy to perform and saves time Very useful technique for obese patients Reduced risk of bowel and bladder injury Anatomical in nature Potentially minimizes postoperative adhesions.     

Variation in non-invasive measurements of vascular function in healthy volunteers during daytime

Although it is often recommended to standardize the time of day when performing non-invasive measurements of vascular function, the exact influence of the time of day on the outcome of IMT (intima-media thickness), PWV (pulse wave velocity), AIX (augmentation index) and FMD (flow-mediated dilatation) measurements has not been reported before. Nineteen healthy volunteers visited our department on two different occasions: the first visit was at 09:00 hours after an overnight fast, and the second visit was at 14:00 hours after a standardized breakfast. Non-invasive measurements of atherosclerosis were performed twice at 09:00 hours and once on the second visit at 14:00 hours. Measurement of IMT, PWV, AIX and FMD was reproducible according to the method of Bland and Altman. The absolute difference between repeated measurements at 09:00 hours showed no significant difference compared with the absolute difference between 09:00 and 14:00 hours for IMT (0.029+/-0.014 compared with 0.021+/-0.014 mm; P = 0.27), PWV (0.63+/-0.50 compared with 0.75+/-0.74 m/s; P = 0.52), AIX (4.0+/-4.0 compared with 5.5+/-5.2%; P = 0.35) and FMD (3.8+/-3.7 compared with 4.2+/-2.9%; P = 0.70). In conclusion, our results show that, in healthy volunteers during the daytime, IMT, PWV, AIX and FMD outcomes are not confounded by variation in the exact time of the examination as long as other (exogenous) conditions, including food intake, smoking and intake of alcohol, are carefully controlled for.     

Maternal efforts to prevent type 1 diabetes in at-risk children

OBJECTIVE: The aim of this study was to assess maternal diabetes prevention efforts aimed at children identified as at risk through newborn genetic screening. RESEARCH DESIGN AND METHODS: A total of 192 mothers of children identified as at risk for type 1 diabetes through newborn genetic screening were administered a structured interview 3.6 +/- 0.8 years after risk notification. The interview assessed possible diabetes prevention behaviors across six domains: health surveillance, diet, physical activity, illness prevention, medications, and stress reduction. A mother's cognitive (diabetes risk perception and perceived control), affective (anxiety), and coping responses to the child's at-risk status were assessed. RESULTS: A total of 67% of mothers reported one or more diabetes prevention behaviors. Monitoring behaviors (e.g., watching for signs of diabetes and checking blood glucose) were the most common, reported in 59%, followed by modifications in the child's diet in 34% and physical activity in 14%. Potentially harmful prevention behaviors (e.g., limiting contact with other children, delaying immunizations, and giving medications including insulin) were rare. Mothers who engaged in diabetes prevention behaviors reported higher diabetes risk perception, greater anxiety, and more use of certain coping styles. Infants of these mothers were more likely to have a first-degree relative with diabetes. CONCLUSIONS: In the absence of known methods of preventing type 1 diabetes, most mothers of at-risk children report diabetes prevention behaviors. Such behaviors must be more carefully assessed to ensure accurate interpretation of data obtained from natural history studies and prevention trials.     

Active error management: use of a Web-based reporting system to support patient safety initiatives

The authors examine the implementation of a Web-based reporting system in a rural academic medical center to support patient safety initiatives. Discussion centers on how an online support system can support active error management and help identify latent errors. This strategy can help administrators in their efforts to develop and institute improvements to prevent subsequent errors. By making changes in clinical process and refinement in policies and procedures, administrators can uncover trends and patterns across settings.     

Aging effects on the metabolic and cognitive energy cost of interlimb coordination

Many everyday motor tasks have high metabolic energy demands, and some require extended practice to learn the required coordination between limbs. Eight older (73.1 +/- 4.4 years) and 8 younger (23.3 +/- 5.9) men practiced a high-energy two-hand coordination task with both 180 degrees and 90 degrees target relative phase. The older group showed greater performance error in both conditions, and performance at 90 degrees was strongly attracted to antiphase coordination (180 degrees). In a retention test one week following the acquisition trials, the older group had learned the 180 degrees condition but did not learn the 90 degrees condition. Metabolic energy cost was not different between groups, but the older men showed higher heart rate and both conditions imposed greater cognitive demands as revealed in auditory probe reaction time. Older adults' motor learning may be inhibited by elevated heart rate at the same oxygen cost, increased cognitive cost, and an attraction toward more established low-energy in-phase or antiphase coordination.