The Future of Teaching Epidemiology.

The rapid pace of technological advancements and the corresponding societal innovations and adaptations make it difficult to predict how teaching epidemiology will look in the coming decades. We discuss changes in the teaching of epidemiology that are currently unfolding. First, typical epidemiology curricula often lack formal instruction in important components of causal thinking, such as the formulation of well-defined research questions.

Hemodynamic effects of substance P and its receptor antagonist RP67580 in anesthetized rats with carbon tetrachloride-induced cirrhosis.

Objective: Substance P (SP) is a vasodilator that may contribute to systemic and splanchnic vasodilatation in cirrhosis. The aim of this study was to determine the effects of SP (dose--13 pg/kg) and its specific inhibitor, RP67580 (dose--300 microg/kg) on mean arterial pressure (MAP) and portal pressure (PP) in cirrhotic rats and controls.

Material And Methods: MAP and PP were measured before and after administering SP and RP67580.

Anti-Saccharomyces cerevisiae antibodies are associated with the development of postoperative fistulas following ileal pouch-anal anastomosis.

Although serologic testing for perinuclear antineutrophil cytoplasmic antibodies (pANCA) and anti-Saccharomyces cerevisiae antibodies (ASCA) is reportedly useful in distinguishing ulcerative colitis (UC) from Crohn's disease (CD), there are few and conflicting reports assessing their utility in predicting postoperative complications after ileal pouch-anal anastomosis (IPAA). We examined the associations between postoperative complications such as pouchitis or fistulas and pANCA and ASCA antibodies in a group of patients who underwent IPAA for UC. We conducted a retrospective chart review of 34 patients initially diagnosed with UC (four of these patients had a diagnosis of indeterminate colitis) who underwent IPAA by a single surgeon, and who had pANCA and ASCA antibody levels measured during their clinical course.

Characteristics and utilization of primary care services in a torture rehabilitation center.

We conducted a retrospective chart review to look into the utilization of healthcare services of refugees. Between December 1998 and June 2001, 146 refugees received care at the Boston Center for Refugee Health and Human Rights. The mean age was 39+/- 1 years; 57% were males, and 84% were survivors of torture.

Teaching surgical decision-making: an interactive, web-based approach.

Background: Skillful surgical care demands proper patient assessment and decision-making. These skills are honed through long hours and years of clinical practice. A decrease in work hours is reducing the number of cases managed by medical students and residents.

Differences in risk factors for lower extremity arterial occlusive disease.

Background: Patients undergoing lower extremity revascularization have associated cardiovascular risks: smoking, hypertension, dyslipidemia, and diabetes. This study evaluated the impact of cardiovascular risk factors on proximal versus distal arterial occlusive disease in patients undergoing lower extremity revascularization as adjusted to a control group without vascular disease.

Study Design: We performed a retrospective, case-control study that included 151 patients undergoing lower extremity revascularization and 229 patients undergoing knee and hip replacement (controls).

Factors associated with mortality in trauma: re-evaluation of the TRISS method using the National Trauma Data Bank.

Background: TRISS remains a standard method for predicting survival and correcting for severity in outcome analysis. The National Trauma Data Bank (NTDB) is emerging as a major source of trauma data that will be used for both primary research and outcome benchmarking. We used NTDB data, to determine whether TRISS is still an accurate predictor of survival coefficients and to determine whether the ability of TRISS to predict survival could be improved by updating the coefficients or by building predictive models that include information on co-morbidities.

Are varicose veins a marker for susceptibility to coronary heart disease in men? Results from the Normative Aging Study.

Clinical observations suggest that varicose veins (VV) are less frequent in patients undergoing infrainguinal bypass surgery for femoral artery occlusive disease. While some previous studies support this relationship, others report that VV are more prevalent in coronary heart disease patients (CHD). This study used the Normative Aging Study (NAS) population to examine the association between VV and symptomatic CHD.

Incision and abdominal wall hernias in patients with aneurysm or occlusive aortic disease.

Introduction: Patients undergoing midline incision for abdominal aortic reconstruction appear to be at greater risk for postoperative incision hernia compared with patients undergoing celiotomy for general surgical procedures. Controversy exists as to whether incidence of abdominal wall hernia and increased risk for incision hernia is higher in patients with abdominal aortic aneurysm (AAA) than in patients operated on because of aortoiliac occlusive disease (AOD). We conducted a prospective multi-institutional study to assess frequency of incision hernia after aortic surgery through a midline laparotomy and of previous abdominal wall hernia.

Organ-specific changes in high-energy phosphates after hemorrhagic shock and resuscitation in the rat.

Background: Adenosine nucleotides provide energy for many essential cellular functions. Liver and intestinal ATP and energy charge are known to decrease during hemorrhagic shock, and the ability to regenerate high-energy phosphates may have important implications for recovery. We measured organ-specific changes in energy charge after hemorrhagic shock and after shock followed by resuscitation.

Lymphedema and quality of life in survivors of early-stage breast cancer.

Background: The standard of care for early-stage breast cancer includes surgical removal of the tumor and axillary lymph node dissection (ALND). Despite increased use of breast-conserving surgery, lymphedema rates are similar to those with more radical surgery.

Hypothesis: Women who experience breast cancer-related lymphedema have a measurable reduction in quality of life compared with women without lymphedema.

Bovine pericardium vs dacron for patch angioplasty after carotid endarterectomy: a prospective randomized study.

Hypothesis: Bovine pericardium (BP) demonstrates improved intraoperative hemostasis and equivalent perioperative morbidity compared with Dacron when used as patch material for angioplasty following carotid endarterectomy.

Objective: To prospectively compare BP and Dacron patch angioplasty after carotid endarterectomy in a randomized fashion.

Methods: Ninety-five consecutive primary carotid endarterectomies were performed in a prospective randomized fashion in 92 patients.

Factors that predict site of outflow target artery anastomosis in infrainguinal revascularization.

Introduction: Lower extremity revascularization is indicated for limb salvage and incapacitating leg claudication. Many risk factors (age, hypertension, diabetes, tobacco use, dyslipidemia, etc) have been associated with atherosclerosis and the development of peripheral arterial occlusive disease. However, whether these risk factors or the surgical indication (claudication or limb salvage) influences the extent and location of infrainguinal disease and hence the target artery (distal anastomosis) is unclear.

Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury.

Purpose: The purpose of this study was to characterize the radiologic changes that are seen in the first 24 to 48 hours after head injury and to correlate those changes with clinical findings, to determine which children are at greatest risk for progression of their neurologic injury.

Methods: The authors identified 104 children (less-than-or-equal17 years of age) who had a second computed tomography (CT) scan of the head within 24 to 48 hours of admission. CT scans were evaluated systematically in a blinded fashion.

Pouchitis in a rat model of ileal J pouch-anal anastomosis.

Endorectal ileal pouch-anal anastomosis (IPAA) has become the operation of choice for patients with chronic ulcerative colitis. Although this procedure improves the quality of life, pouchitis remains a significant postoperative complication. Because our understanding of the pathophysiology of pouchitis may, in part, be due to the lack of small animal model, our aim was to develop a model of IPAA in a rat that mimics its clinical counterpart.

Complications in tunneled CVL versus PICC lines in very low birth weight infants.

Objective: Comparison of complications associated with tunneled central venous lines (TCVLs) versus peripherally inserted central catheters (PICCs) in infants <1500 g.

Study Design: A retrospective cohort study at a university medical center. A total of 96 catheters were placed in 60 infants between 4/94 and 3/99.

The role of a nurse case manager in implementing a critical pathway for infrainguinal bypass surgery.

Background: A previous study showed the effectiveness of a clinical pathway for infrainguinal bypass surgery in reducing postoperative length of stay (LOS) in an acute care setting. Most of the deviations from the pathway were due to patient factors (50%) and/or external disposition problems (30%), but 20% were related to physician or system problems that could potentially be modified. The current study examined those factors influencing LOS following infrainguinal bypass surgery and the impact of daily rounds by a nurse case manager--a vascular nurse specialist--on LOS and pathway deviations.

Role of stasis and oxidative stress in ileal pouch inflammation.

Background: Although ileal pouch-anal anastomosis has become the operation of choice for patients with chronic ulcerative colitis and familial adenomatous polyposis coli, ileal pouch inflammation or pouchitis remains a significant postoperative complication. Numerous factors such as fecal stasis have been implicated in the etiology of pouchitis; however, pouchitis remains poorly understood due to the lack of a small animal model. One of the primary goals of this study was to surgically create a reservoir or U-pouch in the ileum of a rat in which stasis would occur in a manner that was unimpeded by other complicating factors such as a colectomy.

Xenogeneic transplantation of porcine hepatocytes into the CCl4 cirrhotic rat model.

Liver support using extracorporeal devices and hepatocyte transplantation has received renewed interest for the management of acute and chronic liver failure. The aim of this study was to determine whether xenogeneic porcine hepatocytes could integrate into the liver parenchyma of cirrhotic Lewis rats when administered by an intrasplenic route. Cirrhosis was induced by carbon tetrachloride (CCl4) inhalation and confirmed histologically.

Ileal pouch salvage following failed ileal pouch- anal anastomosis.

Attempts have been made to salvage failed ileal pouch-anal anastomoses (IPAA) performed for ulcerative colitis or familial polyposis coli. These can be categorized as total reconstruction of the IPAA, partial transabdominal approach, and partial transperineal approach. The aims of our study were to determine the overall success of pouch salvage; to examine the demographics, indications, and outcomes for each approach; and to assess anorectal physiology and patient satisfaction in those with successful salvage operations.