A reaction to: "Demand Forecasting for MRI Services"

In this short piece, the author outlines the efforts the American Hospital Association (AHA) has made to uncover the issues associated with MRI. In March of 1983, as part of its Hospital Technology Series, the AHA published a 60-page report on MRI. In January 1985, it published a 240-page report entitled, "NMR Issues for 1985 and Beyond," that probes the questions of utilization, magnetic field strength, and the future of MRI in spectroscopy.     

Longer Term Outcomes Following High Tibial Osteotomy for Osteoarthritis: A Prospective,Multi-Centre Observational Study Comparing Tomofix and OPTY-LINE Devices

PurposeAssessing surgical accuracy and patient-recorded outcome measures for patients fitted with either the OPTY-LINE intramedullary realignment system or the Tomofix plate for medial opening wedge high tibial osteotomy (HTO).Patients and methodsTwo matched case series of patients with symptomatic medial compartment osteoarthritis without other significant knee pathology. One group comprised of 19 patients receiving the Tomofix plate, whereas another comprised of 12 patients receiving the OPTY-LINE intramedullary nail. Patella-centred long leg alignment radiographs were assessed to calculate surgical accuracy in all cases. Patients completed knee injury osteoarthritis outcome scores (KOOS) and osteotomy surgery patient satisfaction questionnaires pre-operatively and at 24 months post-surgery.ResultsAbsolute surgical accuracy at 2 years post-surgery was a mean 4.2 [standard deviation 3.7] for OPTY-LINE versus 9.2 [SD 7.8] for Tomofix (p = 0.11, Mann–Whitney U test). On average, patients in either the OPTY-LINE or Tomofix cohort reported at least a minimal perceptible clinical improvement—minimum average improvement of 15—for all five KOOS themes. No significant difference in change of KOOS scores over time or patient satisfaction levels were observed between the two cohorts.ConclusionThe OPTY-LINE device for HTO performs to a similar level as the Tomofix device. Surgical accuracy data are promising for OPTY-LINE, but does not seem to readily translate into difference in patient-reported outcomes compared to Tomofix. Even longer follow-up periods, to measure survival rates, and true randomised trials on larger samples can elucidate if there is a benefit for using one device over the other.     

Age-related differences in distractor interference on line bisection

Using a bisection paradigm, we investigated age-related differences in susceptibility to distractor interference. Older and younger participants were asked to bisect a horizontal line flanked by a pair of distractors, placed in either left or right hemispace. The results showed that (1) in both groups the distractors interfered with line bisection so that the localization of subjective midpoint was selectively shifted away from their position; (2) the shifting of subjective midpoint was greater in the older than in the younger group when the distractors were placed in the left hemispace. We suggest that the increase of the bisection bias in the older group depends on changes in attentional mechanisms involved in inhibiting irrelevant information.     

Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: results of a randomized controlled study

Background

Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient’s life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications.

Methods

Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study.

Results

Group A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2.

Conclusion

Our experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime.

Trial registration

Retrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019).

     

Flanker interference effects in a line bisection task

Previous studies have shown that flanking distractors influence line bisection. In the present study, we examined if reaching the flanker after bisecting the line resulted in a variation of flanker interference on line bisection. Right- and left-handed participants were asked to bisect a horizontal line flanked by a dot (bisection task, B-task) or to bisect the line and then to reach the dot (bisection plus reaching task, BR-task). The dot was placed laterally to, and above or below, the line edge. The results showed that in both tasks the subjective midpoint was shifted away from the position of the dot. However, this effect was greater in the BR-task than in the B-task. We suggest that the requirement to perform an action to the flanker in the BR-task induced participants to pay more attention to the dot, enhancing its salience and distorting effects on line bisection.     

Prognostic Implications of Declining Hemoglobin Content in Patients Hospitalized With Acute Coronary Syndromes

BackgroundContemporary definitions of bleeding endpoints are restricted mostly to clinically overt events. Whether hemoglobin drop per se, with or without overt bleeding, adversely affects the prognosis of patients with acute coronary syndrome (ACS) remains unclear.ObjectivesThe aim of this study was to examine in the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox) trial the incidence, predictors, and prognostic implications of in-hospital hemoglobin drop in patients with ACS managed invasively stratified by the presence of in-hospital bleeding.MethodsPatients were categorized by the presence and amount of in-hospital hemoglobin drop on the basis of baseline and nadir hemoglobin values and further stratified by the occurrence of adjudicated in-hospital bleeding. Hemoglobin drop was defined as minimal (<3 g/dl), minor (≥3 and <5 g/dl), or major (≥5 g/dl). Using multivariate Cox regression, we modeled the association between hemoglobin drop and mortality in patients with and without overt bleeding.ResultsAmong 7,781 patients alive 24 h after randomization with available hemoglobin data, 6,504 patients (83.6%) had hemoglobin drop, of whom 5,756 (88.5%) did not have overt bleeding and 748 (11.5%) had overt bleeding. Among patients without overt bleeding, minor (hazard ratio [HR]: 2.37; 95% confidence interval [CI]: 1.32 to 4.24; p = 0.004) and major (HR: 2.58; 95% CI: 0.98 to 6.78; p = 0.054) hemoglobin drop were independently associated with higher 1-year mortality. Among patients with overt bleeding, the association of minor and major hemoglobin drop with 1-year mortality was directionally similar but had wider CIs (minor: HR: 3.53 [95% CI: 1.06 to 11.79]; major: HR: 13.32 [95% CI: 3.01 to 58.98]).ConclusionsAmong patients with ACS managed invasively, in-hospital hemoglobin drop ≥3 g/dl, even in the absence of overt bleeding, is common and is independently associated with increased risk for 1-year mortality. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox; NCT01433627)     

Laparoscopic Gastric Band Migration: Role of Environmental Factors in the Experience of a Single Team in Three Operating Rooms

Stomach erosion after gastric banding represents one of its least studied complications, despite the fact that the modalities of presentation and treatment have been clarified in recent years. Associations between this complication and specific surgical factors related to the patient have not been reported. We evaluated the incidence of this complication in various operating environments, to identify a possible association with a specific risk factor. A total of 250 patients underwent gastric banding between 2006 and 2008 and were followed for at least 1 year of follow-up. The procedure was performed in three Centers by the same surgical team. Center A was selected for the learning curve, in the initial phase of the study. All surgeries were performed with standardized techniques. An annual endoscopic evaluation was performed during first 12 months. The data from the three Centers were evaluated comparatively, to assess the incidence of migration and compare sterilization and perioperative preparation techniques. Between May 2006 and December 2008, 140 patients operated on at Center A, 70 at Center B, and 50 at Center C were included. Twelve cases of intragastric migration were observed (4.8% of the entire cohort): two cases at Center A (1.4%) and 10 cases at Center C (25%; A vs. C and A vs. B, p?<?0.05); no cases of erosions were observed in Center B of 50 patients (0%; reviewer 1, comment 1). From a retrospective observation, no significant difference in sterilization techniques was observed, while there were differences in perioperative preparation, although these are not objectifiable parameters.     

New and Low-Cost Auto-Algometry for Screening Hypertension-Associated Hypoalgesia

Objective:   The aim of the present work was to measure the pain threshold in hypertensive patients with a new auto-algometry method.
Design and Setting:   Auto-algometry consists of asking the subjects to push their fingers against a fixed round-tip needle until they feel a pain sensation. An electronic force transducer permits the measurement of the force applied by the subjects and storage of the data on a personal computer. Eight tests are performed twice on each subject on the tip and back of four fingers. For each test, the maximal applied force (grams) is defined as pain threshold. The overall discomfort during the entire procedure is reported by the subjects on a 0 (no discomfort) to 10 (intolerable pain) scale.
Patients and Interventions:   A group of hypertensive patients ( n  = 22) and a group of normotensive subjects ( n  = 22) underwent the auto-algometry examination.
Results:   The pain threshold was higher in hypertensive patients compared with normotensive subjects. All discomfort scores referred by the subjects fell within the 4–6 range.
Conclusion:   The data obtained from this study indicate that the auto-algometer as described here can detect hypoalgesia associated with hypertension.