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PubMed2004

Report of the National Heart, Lung and Blood Institute-National Institute of Allergy and Infectious Diseases working group on antimicrobial strategies and cardiothoracic surgery.

Infections related to cardiac surgery increase morbidity and mortality, and increase cost and use of health resources. With the widespread use of synthetic materials, whether in prosthetic valves or vascular conduits, bacterial infection and, more rarely, fungal complications can be devastating, requiring prolonged antimicrobial therapy and, at times, re-operations with high morbidity and mortality rates. With the US population aging and living longer, cardiac surgery is applied to an older population with significant comorbidities, making the threat from infectious complications significant. The dwindling armamentarium of existing antimicrobial agents, a limited pharmaceutical pipeline of future therapies, and the emergence of antimicrobial-resistant bacteria have increased the challenge of treating cardiothoracic infections. Thus, there is critical need for addressing the existing and emerging issues in this area to develop new safe and effective strategies to address the clinical challenges facing cardiothoracic surgeons. As a result of this need, the National Heart, Lung, and Blood Institute and the National Institute of Allergy and Infectious Diseases convened a Working Group on April 4 and 5, 2002, in Bethesda, Md, which explored both basic science and clinical research opportunities in the prevention and treatment of major infections after cardiac surgery. Because of its importance as the most common pathogen in this setting, the focus of discussions was on the prevention and treatment of Staphylococcus aureus infections. This report summarizes the 5 main areas that the Working Group targeted (epidemiology of infections, molecular mechanisms of infections and complications, current pharmacotherapy, new frontiers, and clinical trial design) and highlights the recommendations that were set forth by the Working Group.

Antibiotic Prophylaxis↗
PubMed2006

A place for fiber diffraction in the detection of breast cancer?

AIMS: To review the potential relevance and the place that a particular change in the fiber diffraction of hair might have in the future management of breast cancer and other pathologies. METHOD: A comprehensive overview was obtained using a complete search of the Australian National University Library (data range) and Medline (data range) using the search terms "review breast cancer screening/diagnosis/detection" and "X-ray diffraction of hair". Publications in the past 5 years were selected but older reports that were commonly referenced were not excluded. RESULTS: To date, our results have demonstrated that a specific change occurs in the diffraction pattern of hair for persons with breast cancer. Further research has shown that this change is present in the hair at an earlier stage of the cancer growth than is detectable by mammography. In addition, the change has been found to disappear when the cancer has been successfully removed. DISCUSSION/CONCLUSION: This technology uses only a few hairs, is totally user-friendly, non-invasive and does not require the patient to be exposed to any radiation. As a low-risk procedure, it could potentially provide a much needed, cost-effective early screening test for the presence of breast cancer in women of any age. As the patients are not required to be present during the test, it could also provide a testing service for women in remote areas. In this review, the origin of the diffraction pattern and the diagnostic information that can be gleaned from it are outlined.

Breast Neoplasms↗
PubMed2006

The future of forensic and crime scene science. Part I. A UK forensic science user and provider perspective.

This paper presents an overview of the views expressed by UK forensic science users and providers during the Centre for Forensic Investigation's 1 day conference 'The Future of Forensic and Crime Scene Science' and is set in the context of the changing national agenda and likely advances in current and future technology. It begins by examining the success of the Home Office DNA Expansion Programme and future demands of the Criminal Justice System, highlighting the changing use of forensic science both at the crime scene and within the forensic process itself. In particular, the use of forensic science at the early stages of an investigation to provide intelligence and support the decision making process is discussed together with the need to adopt a partnership approach to tackling crime and its causes. Key system and technological drivers for performance improvement and change are identified and the likely timescales and implications of their introduction are discussed. Finally, the Home Office plans to build on the success of the DNA Expansion Programme, through the introduction of the proposed Home Office Forensic Integration Strategy, are explored and the paper concludes by highlighting the benefits, implications and issues arising from the changing and developing use of forensic science.

Congresses as Topic↗
PubMed2006

Device closure rates of simple atrial septal defects optimized by the STARFlex device.

OBJECTIVES: This study sought to review the outcomes of 3 generations of closure devices for secundum atrial septal defects (ASDs) at a single institution. BACKGROUND: Transcatheter closure of ASDs is now increasingly performed with devices that have been modified over time to improve performance. METHODS: A review of prospective clinical trials of Clamshell (C.R. Bard Inc., Murray Hill, New Jersey), CardioSEAL (NMT Medical Inc., Boston, Massachusetts), and STARFlex (NMT Medical Inc.) closure devices for simple ASDs was performed. The entry criteria for these trials were age > or =2 years, isolated secundum ASD, evidence of right ventricular volume overload, and maximum stretched diameter varying from 20 to 25 mm. Successful outcomes were defined as no more than small residual leak (< or =2 mm) with absence of a severe complication or the need for an additional device or surgery. RESULTS: A total of 72 Clamshell, 30 CardioSEAL, and 42 STARFlex devices were placed in uncomplicated ASDs. Each device modification resulted in improved closure rates, with the STARFlex device achieving a 93% complete closure rate with a device/stretched diameter ratio significantly smaller than with the other devices (p = 0.001). Severe complications occurred in 5 Clamshell, 1 CardioSEAL, and 0 STARFlex cases. Successful outcomes increased for each generation of device (79%, 93%, and 98% respectively, p = 0.009). There have been no long-term complications for either the CardioSEAL or the STARFlex devices. CONCLUSIONS: Modifications in 3 generations of devices have resulted in improved results for percutaneous ASD closure.

Adolescent↗
PubMed1993

Epidemiologic methods in mastitis treatment and control.

Methods and concepts of epidemiology offer means whereby udder health can be monitored and evaluated. Prerequisite to a sound epidemiologic approach is development of measures of mastitis that minimize biases and that account for sensitivity and specificity of diagnostic tests. Mastitis surveillance offers an ongoing and passive system for evaluation of udder health, whereas clinical and observational trials offer a more proactive and developmental approach to improving udder health.

Animals↗
PubMed2002

Progress toward a global understanding of infective endocarditis. Early lessons from the International Collaboration on Endocarditis investigation.

In the century and a quarter since William Osler delivered his framed lectures on endocarditis substantial advancements have occurred in the understanding and treatment of this disease. This article summarizes current understanding of endocarditis in the areas of population epidemiology, host factors, microorganisms, diagnosis, and therapy. In addition, the authors discuss possible directions for investigation in the future, including a new multinational consortium, the International Collaboration on Endocarditis (ICE). This collaboration aims to provide a mechanism to advance the understanding of endocarditis in areas difficult to study without an established network. The multinational nature of the collaboration may also permit a more global view of IE and provide opportunities for studies such as randomized trials of therapeutic treatment strategies.

Bacteria↗
PubMed2001

Adolescent HMO enrollees' utilization of out-of-plan services.

PURPOSE: To examine use of reproductive health services, correlates of out-of-plan care, and reasons for seeking out-of-plan care among adolescent health maintenance organization (HMO) enrollees. METHODS: We mailed a self-administered questionnaire to a population-based random sample of 18-year-old members of Group Health Cooperative of Puget Sound (GHC) who had been enrolled for at least 12 months. The sample was selected from GHC's computerized enrollment database. Questionnaire topics included reproductive history, sexual behavior, and use of health services. Analysis included Chi-square tests to examine differences by gender and out-of-plan status and multivariate analysis using logistic regression. RESULTS: About one-half of the 997 respondents (69% response rate) reported using out-of-plan care. In multivariate analysis, the strongest correlate of out-of-plan care was having had sexual intercourse [odds ratio (OR) = 1.84; 95% confidence interval (CI) = 1.35-2.52]. Other correlates were using alcohol (OR = 1.79; 95% CI = 1.29-2.48), living with parents (OR = 0.65; 95% CI =.46-.92), and being female (OR = 1.60; 95% CI = 1.21-2.11). During the prior year, over 80% of sexually active respondents had obtained contraceptives out-of-plan and 45% of those tested for sexually transmitted diseases (STDs) reported out-of-plan testing. The primary reasons reported for using any out-of-plan care were lack of convenience (28%), being out of town (26%), and confidentiality (23%; only reported by sexually active respondents). CONCLUSIONS: A substantial proportion of GHC-enrolled adolescents used out-of-plan care. Those who did were more likely to have had STDs and other health problems than those who used only in-plan services. Without continuity of care, these at-risk adolescents may not be receiving optimal services.

Adolescent↗