Implementing Adult Hepatitis B Immunization and Screening Using Electronic Health Records: A Practical Guide.

Importance: Hepatitis B is a serious problem in the United States (US), with up to 2.4 million Americans living with a chronic infection. Only 26-32% of people living with hepatitis B in the US are diagnosed.

Quality of Life With a Hernia-A Novel Patient Led Study.

Abdominal wall hernia surgery aims to relieve symptoms and to improve quality of life (QoL). The aim of this novel patient led research, was to help surgeons understand how hernias impact on patients' wellbeing. A questionnaire was developed by patient advocates.

Definitions for Loss of Domain: An International Delphi Consensus of Expert Surgeons.

Background: No standardized written or volumetric definition exists for 'loss of domain' (LOD). This limits the utility of LOD as a morphological descriptor and as a predictor of peri- and postoperative outcomes. Consequently, our aim was to establish definitions for LOD via consensus of expert abdominal wall surgeons.

Nomenclature in Abdominal Wall Hernias: Is It Time for Consensus?

Abdominal wall reconstruction is a rapidly evolving area of surgical interest. Due to the increase in prevalence and size of ventral hernias and the high recurrence rates, the academic community has become motivated to find the best reconstruction techniques. Whilst interrogating the abdominal wall reconstruction literature, we discovered an inconsistency in hernia nomenclature that must be addressed.

An in vitro study assessing the infection risk of low-cost polyethylene mosquito net compared with commercial hernia prosthetics.

Background: The innovative use of sterilized mosquito net as a cheaper alternative to commercial mesh for hernia repair has gained increasing recognition. Developing health care systems have inherently higher surgical site infection rates, and concerns regarding the introduction of untested prosthetic hernia meshes have been raised. This in vitro study assesses the infection risk of polyethylene (PE) mosquito net mesh compared with commercial hernia prosthetics by assessing the essential (first) step in the pathogenesis of mesh infections.

Mosquito net mesh for abdominal wall hernioplasty: a comparison of material characteristics with commercial prosthetics.

Background: The use of sterilized mosquito net as a cheaper alternative to commercial mesh used in hernia repair has previously been published. However, as no standards with regard to the material have been documented, we aimed to define the characteristics of a commonly available and low-cost mosquito net, which has already been shown to be clinically efficacious in groin hernia repair. We compared its characteristics to other commercially available meshes, in keeping with the well-established FDA and MHRA regulatory processes.

Cost-effectiveness of inguinal hernia surgery in northwestern Ecuador.

Background: Cost-effectiveness of tension-free inguinal hernia repair at a private 20-bed rural hospital in Esmeraldas Province, Ecuador, was calculated relative to no treatment.

Methods: Lichtenstein repair using mosquito net or polypropylene commercial mesh was provided to patients with inguinal hernia by surgeons from Europe and North America. Prospective data were collected from provider, patient, and societal perspectives, with component costs collected on site and from local supply companies or published literature.

An experimental study exploring the relationship between the size of bacterial inoculum and bacterial adherence to prosthetic mesh.

Background: Infection is a major concern with medical implants. Surgical meshes used for the repair of abdominal wall hernias are associated with wound infection rates ranging from 7 to 18 %. Although mesh infection is relatively rare, once a patient shows clinical signs of mesh infection, the surgeon may be required to remove the mesh, resulting in additional surgery, morbidity, and cost.

Design and validation of a novel quantitative method for rapid bacterial enumeration using programmed stage movement scanning electron microscopy.

The adhesion of bacteria to surgical implants is the first stage of implant infection. The method for detecting bound bacteria is an important consideration in the study of bacterial adherence and colonisation. Enumeration of bacteria by direct visualisation techniques is labour intensive and time consuming.

Worlds apart: training in rural South Africa.

Background: Reforms in the delivery of surgical and anaesthetic services in the UK have reduced the opportunity for trainees to acquire 'hands-on' training. These problems are seen in other European countries and in North America.

Context: Surgical and anaesthetic services within developed health care systems tend to be specialised, and are often consultant led.

Prosthetic mesh materials used in hernia surgery.

It is estimated that 20 million prosthetic meshes are implanted each year worldwide. It is clear that the evolution of meshes is not yet complete and the ideal mesh is yet to be found. There is a vast array of prosthetics available for hernia repair.

Prompting clinicians about preventive care measures: a systematic review of randomized controlled trials.

Preventive care measures remain underutilized despite recommendations to increase their use. The objective of this review was to examine the characteristics, types, and effects of paper- and computer-based interventions for preventive care measures. The study provides an update to a previous systematic review.

Prospective evaluation of a Bayesian Network for detecting asthma exacerbations in a Pediatric Emergency Department.

Early detection of asthma exacerbations may allow for automated guideline enrollment. We developed and prospectively evaluated a real-time Bayesian network to predict the presence of acute asthma after patient triage using only routinely available electronic data. 2,006 patients were enrolled, including 153 guideline-eligible patients.

Detecting asthma exacerbations in a pediatric emergency department using a Bayesian network.

Objective: To develop and evaluate a Bayesian network to identify patients eligible for an asthma-care guideline using only data available electronically at the time of patient triage.

Population: Consecutive patients 2-18 years old who presented to a pediatric emergency department during a 2-month period.

Methods: A network was developed and evaluated using clinical data from patient visits.

Prompting clinicians: a systematic review of preventive care reminders.

Prompting clinicians to offer preventive care procedures has been shown to increase the use of these procedures. This study is an update of a systematic review examining the effect of reminder systems on offers of preventive care to patients. Of 1,404 eligible studies, 23 were included.

Identifying asthma exacerbations in a pediatric emergency department: a feasibility study.

Background: Asthma is a common pediatric chronic disease and is estimated to account for more than 2million emergency department visits per year. Asthma guidelines have demonstrated improved outcomes, but remain underutilized due to several barriers. Computerized methods to automatically identify asthma exacerbations may be beneficial to initiate guideline recommended treatment, but have not been described.

Biomedical informatics applications for asthma care: a systematic review.

Asthma is a common condition associated with significant patient morbidity and health care costs. Although widely accepted evidence-based guidelines for asthma management exist, unnecessary variation in patient care remains. Application of biomedical informatics techniques is one potential way to improve care for asthmatic patients.

Primary hemiarthroplasty for treatment of proximal humeral fractures.

Background: Primary hemiarthroplasty of the shoulder is used to treat complex proximal humeral fractures, although the reported functional results following this method of treatment have varied widely. The aim of this study was to prospectively assess the prosthetic survival and functional outcomes in a large series of patients treated with shoulder hemiarthroplasty for a proximal humeral fracture. By determining the factors that affected the outcome, we also aimed to produce models that could be used clinically to estimate the functional outcome at one year following surgery.