CareSearch: finding and evaluating Australia's missing palliative care literature

Background  

Palliative care is an evolving specialty with a growing evidence base. However, evidence is less accessible than it could be with a lower than average conversion of conference abstracts to articles in peer-reviewed journals and the need for more accessible tools to support evidence-based practice (EBP) in palliative care. The CareSearch project involved identifying, collecting and evaluating Australia's "grey" palliative care literature and identifying international published literature missing from the electronic indexing systems. The literature was then catalogued and made publicly available through the CareSearch website.     

High sensitivity <Superscript>1</Superscript>H-NMR spectroscopy of homeopathic remedies made in water

Background  

The efficacy of homeopathy is controversial. Homeopathic remedies are made via iterated shaking and dilution, in ethanol or in water, from a starting substance. Remedies of potency 12 C or higher are ultra-dilute (UD), i.e. contain zero molecules of the starting material. Various hypotheses have been advanced to explain how a UD remedy might be different from unprepared solvent. One such hypothesis posits that a remedy contains stable clusters, i.e. localized regions where one or more hydrogen bonds remain fixed on a long time scale. High sensitivity proton nuclear magnetic resonance spectroscopy has not previously been used to look for evidence of differences between UD remedies and controls.     

Occupational risk for nephrolithiasis and bladder dysfunction in a chauffeur

The occupational risks for nephrolithiasis have not been widely studied. The published literature focuses on exposure to heat stress and toxic substances, not on the equally important behavioral risk factor of limited water consumption over many years. Urologic morbidity has been associated with suppressing the need to drink or void under restrictive work environments; however, no such studies link work related behavioral change with the development of kidney stones. This case report is the first to associate a restrictive work environment with limited fluid consumption, resulting in the development of nephrolithiasis.     

Pneumoperitoneum and peritoneal surface changes: a review

Background Recent evidence suggests that the use of carbon dioxide to create a pneumoperitoneum during laparoscopy can lead to adverse structural, metabolic, and immune derangements within the peritoneal cavity, and that these can be dependent on the specific insufflation gas used. These changes include structural alterations in the mesothelial lining, pH disturbances, and alterations in peritoneal macrophage responsiveness. This contrasts with an apparent systemic benefit associated with laparoscopic, as compared with open, surgery.Methods Recently published clinical and experimental studies related to the effect of pneumoperitoneum on the peritoneal surface are reviewed, and their relevance is discussed.Results Structural changes in the peritoneal mesothelial surface layer such as widening of the intercellular junctions can be demonstrated with electron microscopy. Acidification of the peritoneum in response to carbon dioxide insufflation occurs not only at the peritoneal surface, but also in the underlying connective tissue, resulting in disturbances in the electrical surface charge and the release of various immune mediators such as endotoxin. Pneumoperitoneum also affects the local peritoneal immune environment resulting in alterations in cytokine production and phagocytic function, as well as diminished antitumor cell cytotoxicity.Conclusions Ultrastructural, metabolic, and immune alterations are observed at the peritoneal surface in response to a pneumoperitoneum. Experimental evidence suggests that these changes are carbon dioxide–specific effects. The consequences of these alterations to the local peritoneal environment are not well understood, but they may facilitate tumor implantation within the peritoneal cavity and adversely affect the ability to clear intraperitoneal infections. Further investigation into this area is warranted.     

Pattern recognition approach to the detection of single-trial event-related functional magnetic resonance images

Functional magnetic resonance imaging (FMRI) is an imaging technique for determining which regions of the brain are activated in response to a stimulus or event. Early FMRI experiment paradigms were based upon those used in positron emission tomography (PET), i.e. employing a block design consisting of extended periods of ‘on’ against ‘off’ activations. More recent experiments were based on event-related FMRI, harnessing the fact that very short stimuli trains or single events can generate robust responses. FMRI data suffer from low signal-to-noise ratios, and typical event-related experiment paradigms employ selective averaging over many trials before using statistical methods for determining active brain regions. The paper reports a pattern recognition approach to the detection of single-trial FMRI responses without recourse to averaging and at modest field strengths (1.5T). Linear discriminant analysis (LDA) was applied in conjunction with different feature extraction techniques. Use of the unprocessed data samples as features resulted in singletrial events being classified with an accuracy of 61.0±9.5% over five subjects. To improve classification accuracy, knowledge of the ideal template haemodynamic response was used in the feature extraction stage. A novel application of parametric modelling yielded an accuracy of 69.8±6.3%, and a matched filtering approach yielded an accuracy of 71.9±5.4%. Single-trial detection of event-related FMRI may yield new ways of examining the brain by facilitating new adaptive experiment designs and enabling tight integration with other single-trial electrophysiological methods.     

Effect of continuous glucose therapy with uncooked cornstarch on the long-term clinical course of type 1a glycogen storage disease

To evaluate the effects of uncooked cornstarch (UCS) on metabolic control, growth, and complications of pubertal and postpubertal, subjects with type 1 a glycogen storage disease, we studied 26 subjects (16 males), mean age 20.8±5.1 years, in whom continuous glucose therapy with cornstarch began at 6.8±4.3 years. At the time of this analysis, subjects had received cornstarch for 14.1±3.5 years. Metabolic control was determined with subjects receiving their usual home dietary regimens: 4.1±1.3 doses of UCS in the day (9.7±2.6 g/h) and 2.0±0.4 doses at night (11.7±2.2 g/h). Mean height standard deviation score (SDS) was −1.2±1.3, significantly less than the mean target height of −0.2±1.1 (P<0.01). Mean weight SDS was 0.5±1.9 and body mass index SDS was 0.7±1.0. Of all subjects, 50% had at least one focal hepatic lesion consistent with an adenoma. Urinary albumin excretion was increased (>20 μg/min) in 31% of subjects; two subjects had clinical albuminuria (>300 mg per 24 h), but none has progressed to chronic renal insufficiency. Of 26 subjects, 13 (50%) had anemia. All of the complications were associated with evidence of suboptimal metabolic control, whereas subjects with no evidence of any long-term complications had near normal blood lactate and total CO₂ concentrations.Conclusion: The achievement of optimal biochemical control of glycogen storage disease type 1a continues to be a challenge, but is attainable by meticulous adherence to an individualized dietary regimen based on the results of periodic metabolic evaluation and home blood glucose monitoring. Minimizing the metabolic abnormalities of the disease may decrease the risk of long-term complications. Published online: 31 July 2002     

« Une semaine de coloscopie en France » : résultats 2017 de l’enquête annuelle de la Société française d’endoscopie digestive

Purpose

The SFED surveys, initiated in 1998 and performed every year since 2001, aim to describe the characteristics of patients who have underwent a colonoscopy, the conditions of care, the efficiency of diagnosis, and the complications.

Methods

Based on an e-questionnaire, the colonoscopic practices were evaluated on five consecutive days. The data of the survey were extrapolated to a total of 2,600 gastroenterologists performing digestive endoscopies and then compared to previous years of exercise. The survey was performed from January 16 to June 22, 2017.

Results

The 2017 SFED survey, evaluating the colonoscopic practices in France, highlighted the following several issues: an increase in participation, an increase in the number of colonoscopic interventions, and a permanent improvement in the quality of colonoscopy related to the following several issues: a better management of patients before the intervention, a better tailoring of products for bowel preparation, an increase in the use of laxative for patients with constipation before the intervention, and a better compliance with the guidelines except for the use of anticoagulant before colonoscopy.

Conclusion

The data provided by the SFED surveys represent a major tool evaluating the French colonoscopic practices, and are nearly a unique image in Europe. The improvement in the quality allows for an improvement in the performance of colonoscopy, highlighting the relevance of a better compliance with the guidelines.