A prospective, randomized study analyzing sartorius transposition following inguinal-femoral lymphadenectomy

OBJECTIVES: Based on the reduced morbidity seen in our retrospective study, we undertook a prospective, randomized trial to determine whether transposition of the sartorius muscle improves post-operative morbidity in women with squamous cell carcinoma of the vulva undergoing inguinal-femoral lymphadenectomy. METHODS: Patients with squamous carcinoma of the vulva requiring inguinal-femoral lymphadenectomy were randomized to undergo sartorius transposition or not. All patients received perioperative antibiotics, DVT prophylaxis, and closed suction surgical site drainage. Outcomes assessed include wound cellulitis, wound breakdown, lymphocyst formation, lymphedema, and/or rehospitalization. Cohorts were compared using Fisher's exact test. Baseline characteristics were compared using Student's t test or Fischer's exact test as appropriate. Logistic regression was used to assess the impact of sartorius transposition, after adjusting for other factors. RESULTS: From June 1996 to December 2002, 61 patients underwent 99 inguinal-femoral lymphadenectomies, 28 with sartorius transposition, and 33 without. The mean (SD) age for controls and patients undergoing sartorius transposition was 63.5 (15.2) and 73.8 (13.7) years, respectively (P < 0.05). There were no statistically significant differences in BSA, tobacco use, co-morbid medical conditions, past surgical history, medication use, size of incision, duration of surgery, number of positive lymph nodes, pathologic stage, pathologic grade, pre- or postoperative hemoglobin, or length of hospitalization. There were no statistically significant differences in the incidence of wound cellulitis, wound breakdown, lymphedema, or rehospitalization. The incidence of lymphocyst formation was increased in the sartorius transposition group. After adjusting for age, however, the groups appeared similar. CONCLUSIONS: Sartorius transposition after inguinal-femoral lymphadenectomy does not reduce postoperative wound morbidity.     

Long-acting erythropoietin: clinical studies and potential uses in neonates

Aranesp (darbepoietin alfa) is a biologically modified form of recombinant human erythropoietin (rHuEpo). Two additional carbohydrate-binding sites give Aranesp a half-life about three times that of rHuEpo. Extensive studies in adults and early studies in children indicate that Aranesp can be administered far less frequently than rHuEpo with an equivalent erythropoietic effect.This article reviews these studies and reports on the in vitro effects of Aranesp on human fetal and neonatal erythroid progenitors.     

The ponderal index in triplets: III. Association with birth weight discordance

Our objective was to determine the association of the ponderal index with birth weight discordance in triplets. We analyzed data from triplets delivered at 28-37 weeks for birth weight discordance (>25% difference between the heaviest and lightest triplet). Three categories of discordance (low skew, symmetrical, and high skew) were classified according to the relative position of the middle triplet. Birth weights and the ponderal index (birth weight/[length]3) of all concordant and discordant triplet groups were compared. Of 752 triplet sets included, 184 (24.5%) were discordant. Total triplet birth weight was higher in the concordant compared to all discordant categories. As opposed to birth weight, where only the middle triplet differed according to discordance pattern, the ponderal index for the largest triplet was significantly higher in the low skew discordant group compared to the concordant and other discordant triplet groups. In contrast, the ponderal index for the smallest and middle triplets were similar among the discordant groups. We concluded that discordance in triplet pregnancies exhibits different patterns of mass (birth weight) versus size (ponderal index). Our findings suggest that it may be the size of largest triplet that determines the presence or absence or discordance in triplet gestations.     

Leadership in nursing informatics

Nursing informatics is a 21st century science with great potential for improving the quality, safety, and efficiency of health care. Perinatal, neonatal, and women's health nurses have an opportunity to contribute and lead in informatics. Leaders must learn about current informatics issues from essential resources, including the literature, professional organizations, and education programs, to develop successful strategies for innovation, collaboration, and implementation. Most important, nurses must be accountable for humanizing the use of technology using a nursing model.     

The impact of economic information on medical decision making in primary care

BACKGROUND: Many general practitioners (GPs) are concerned about the increasing dominance of economic issues in major decisions about clinical care, and feel their opinions on economic matters have not been heard. It is unclear whether this information has any impact on everyday clinical practice in a primary care setting. AIM: To investigate GPs' perspectives on the use of economic information in medical decision making. DESIGN OF STUDY: Cross-sectional survey. SETTING: GP members of the West of Scotland Primary Care Research and Development Network (WestNet). METHODS: Questionnaire survey sent to GPs by post and by email. RESULTS: The overall response rate was 44%, favouring postal over email responses. All respondents indicated that economic information has previously influenced them and should be incorporated into their medical decision making. The most common source of this information was generated by local authorities such as health boards, primary care groups and local prescribing advisors--used by 80% of the respondents. However, publications, such as the British Journal of General Practice, locally produced newsletters and prescribing formularies, and feedback from the General Practice Administration System for Scotland, were used as sources of economic information by 20%, 27% and 33%, respectively. Published materials--in particular, locally specific information and summarized information in leaflet format--were favoured (54%) in comparison to verbally presented material. CONCLUSIONS: GPs believe that economic information should be incorporated in medical decision making. The need for precise and summarized information, produced locally, has been highlighted. Better understanding towards the type of economic evidence GPs find useful and comprehensible is required.