Can patient satisfaction with decisions predict compliance with surgery?

Background: Patient satisfaction with treatment decisions is a discrete and measurable component of the satisfaction paradigm, distinct from satisfaction with health care services.

Objective: The study goal was to determine if the Satisfaction With Decision (SWD) scale, a valid and reliable 6-item survey, can predict patient compliance with surgery proposed by their otolaryngologist.

Design: Prospective study using the SWD scale plus measures of office visit satisfaction, provider satisfaction, and disease-specific quality of life.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva: disabling angina and syncope with noninterarterial courses case report of two patients.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva or the right coronary artery is a rare coronary anomaly. This anomaly has been associated with sudden cardiac death in younger patients, depending on its course relative to the pulmonary artery. The authors report this rare anomaly in two patients.

Withdrawal properties of a neuroactive steroid: implications for GABA(A) receptor gene regulation in the brain and anxiety behavior.

Early work in the field established that the 5 alpha-reduced metabolite of progesterone 3 alpha-OH-5 alpha-pregnan-20-one (allopregnanolone or 3 alpha,5 alpha-THP) is a potent positive modulator of the GABA(A) receptor (GABAR), the receptor mediating the effects of the primary inhibitory transmitter in the brain. This steroid acts in a manner similar to sedative drugs, such as the barbiturates, both in terms of potentiating GABA-induced inhibition in vitro and in behavioral assays, by reducing anxiety and seizure susceptibility. Because sedative compounds exhibit withdrawal properties that result in behavioral hyperexcitability, our laboratory has more recently investigated the effect of prolonged application and rapid removal (i.

Tension headaches and muscle tension: is there a role for magnesium?

Although many theories and hypotheses have been offered for the etiology of tension-type headache (TH), no one previous hypothesis seems to adequately explain TH. This may, in large measure, account for why it is often difficult to effectively treat TH. Herein, we review current and old hypotheses of TH and offer a new hypothesis which is consistent with what is known about TH.

Sponastrime dysplasia with abnormal urinary glycosaminoglycans and growth hormone unresponsiveness.

Sponastrime dysplasia is a rare skeletal dysplasia characterized by severe short stature, scoliosis, a saddle nose, frontal bossing, and increased upper/lower segment ratio. Etiology of this condition is unknown. Radiological findings include a concavity in the posterior two thirds of lumbar vertebral bodies, platyspondyly, thoracolumbar scoliosis, marginal irregularity and striations of metaphyses, and delayed bone age.

Isolated sarcoidosis of the lacrimal sac without systemic manifestations.

Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology. Although it most commonly affects African-Americans, Scandinavians, and the Irish, individuals of all races and ethnicities are susceptible. The otolaryngologist will most frequently encounter sarcoidosis involving the sinonasal region; however, other sites in the head and neck may be involved.

Implications of the AHRQ evidence report on acute otitis media.

Objective: To familiarize otolaryngologists with the Agency for Healthcare Research and Quality (AHRQ) Evidence Report on Acute Otitis Media (AOM) that reviews the natural history and role of antibiotics in management. The report, by the Southern California Evidence-Based Practice Center (SC-EPC), is the most recent of 15 literature syntheses published by the AHRQ.

Data Sources: MEDLINE (1966 to present), Cochrane Library, EMBASE, BIOSIS, HealthSTAR, and other computerized databases; manual reference search of proceedings, articles, reports, and guidelines.

Warp-averaging event-related potentials.

Objective: To align the repeated single trials of the event-related potential (ERP) in order to get an improved estimate of the ERP.

Methods: A new implementation of the dynamic time warping is applied to compute a warp-average of the single trials. The trilinear modeling method is applied to filter the single trials prior to alignment.

Current status of MIDCAB procedure.

The advent of cardiopulmonary bypass in the early 1960s allowed surgeons to safely perform complex reconstructions on the heart. Since then, the field of cardiac surgery has progressed to where surgical myocardial revascularization, or coronary artery bypass grafting (CABG), has become the most exhaustively studied operation in the history of surgery, and it has achieved widespread use because its benefits have been so thoroughly documented. The paradoxical fact is that more elderly and debilitated patients benefit the most from cardiac surgery compared with medical therapy, yet they sustain greater risk of morbidity and mortality after cardiac surgery.

Hemodynamics and emergence profile of remifentanil versus fentanyl prospectively compared in a large population of surgical patients.

Study Objective: To compare the responses to, and hemodynamics associated with surgical stress, recovery profiles, and anesthesiologists' satisfaction following balanced general anesthesia using either remifentanil or fentanyl in a large-scale population.

Design: Prospective, 1:1 single blind, randomized, controlled effectiveness study in which patients received either remifentanil or fentanyl in combination with a hypnotic-based anesthesia regimen of either isoflurane or propofol.

Setting: Multicenter study including 156 hospitals and ambulatory surgery facilities.

Pre-menstrual steroids.

A number of steroid hormones and their metabolites fluctuate in the circulation across the human menstrual cycle. In addition to their classic actions on the hypothalamo-pituitary-gonadal axis, many of these hormones act as 'neuroactive steroids' to alter the function of neurotransmitters, such as GABA, within central nervous system circuits. Clinically, these steroids are important because they have not only acute but also long-term effects, and 'withdrawal' properties.

Laboratory results. Timeliness as a quality attribute and strategy.

Although timeliness of results reporting has not been a major focus in clinical laboratories, there is increasing pressure from clinicians to report results rapidly. Even though there are only sparse data, timeliness in reporting of laboratory results undoubtedly affects clinician and patient satisfaction as well as length of hospital stay. Improving turnaround time (TAT) is a complex task involving education, equipment acquisition, and planning.

SOOF lift and lateral retinacular canthoplasty.

Eyelid rejuvenation surgery may be slowly shifting from pure fat removal techniques to those that preserve and reposition the periorbital fat. The traditional subciliary incision blepharoplasty was fraught with minor and major complications, and while the transconjunctival blepharoplasty afforded lower morbidity, its inability to address all aspects of periorbital rejuvenation eventually limited its popularity. Coincidentally, a search by aesthetic surgeons was on for better techniques to lift the midface, soften the nasolabial fold, and efface the tear trough deformity.

Short-term exposure to a neuroactive steroid increases alpha4 GABA(A) receptor subunit levels in association with increased anxiety in the female rat.

Previous work from this laboratory has demonstrated that withdrawal from the neuroactive steroid 3alpha,5alpha-THP (3alpha-hydroxy-5alpha-pregnan-20-one) after 3-week exposure to its parent compound, progesterone (P), increases anxiety and produces benzodiazepine (BDZ) insensitivity in female rats. These events were linked to upregulation of the alpha4 subunit of the GABA(A) receptor (GABAR) in the hippocampus [Brain Res. 507 (1998) 91; Nature 392 (1998) 926; J.

Interrupting the template strand of the T7 promoter facilitates translocation of the DNA during initiation, reducing transcript slippage and the release of abortive products.

We have explored the effects of a variety of structural and sequence changes in the initiation region of the phage T7 promoter on promoter function. At promoters in which the template strand (T strand) is intact, initiation is directed a minimal distance of 5 nt downstream from the binding region. Although the sequence of the DNA surrounding the start site is not critical for correct initiation, it is important for melting of the promoter and stabilization of the initiation complex.

Gender differences in vascular compliance in young, healthy subjects assessed by pulse contour analysis.

Objectives: Sex hormones exert important effects on the vasculature. Female sex hormones have been reported to enhance endothelial function, reduce oxidative stress, and protect against atherosclerosis. However, the effects of estrogen on vascular compliance have not been studied.

Rationalizing the treatment of hypertension.

Management of hypertension in this country is confounded by continual changes in recommended target blood pressure (BP) goals and a nonhomogeneous patient population who have a variety of demographic and clinical characteristics that influence treatment. This paper focuses on three major elements in managing hypertension: BP and the importance of reducing it to acceptably low levels; concomitant risk factors or cardiovascular and renal target involvement; and drug therapy that may confer prognostic advantages beyond those predicted by BP effects.

New onset diabetes mellitus in an HIV-positive adolescent.

The authors report an 18-year-old girl with HIV infection who developed new-onset insulin-dependent diabetes mellitus (IDDM) in association with anemia. IDDM among patients with HIV infection has been infrequently reported and suggested to be caused by different etiologies. Susceptibility to autoimmune diseases, such as IDDM, has been associated functionally with two members of a newly described multigene family called PERB11.

New neural theory of migraine.

Insufficient attention has been given to reports in the literature describing patients with symptomatic migraine who, in addition to, or instead of, the well-recognized zones of hypofusion, have zones of hyperperfusion, which can be interpreted as hypermetabolism due to neuronal activation. A new neural theory of migraine is proposed in which it is hypothesized that migraine is an electrical disease of the brain in which abnormally-functioning serotonergic pacemaker cells in the raphe nuclei inappropriately activate and inhibit wide areas of the brain. Excessive neuronal activation could cause migraine stroke by excitotoxicity and could explain the association of migraine with epilepsy.

Vascular insulin/insulin-like growth factor-1 resistance in female obese Zucker rats.

Because insulin resistance/diabetes may cause inordinate vascular complications in females, we have investigated the effects of insulin and insulin-like growth factor (IGF-1) on vascular reactivity in 12-week-old female Zucker obese (Ob) rats, a rodent model of insulin resistance and its lean (Ln) age-matched counterpart. Endothelium intact aortic rings from Ob animals and their Ln littermates (12 weeks of age) were subjected to contractile concentration responses to phenylephrine (PE) followed by relaxation to isoproterenol (Iso), with and without preincubation for 2 hours with cholera toxin (CTX; 1 microg/mL) or pertussis toxin (PTX; 2 microg/mL) and before and after incubation with either insulin or IGF-1 (100 nmol/L) for 1 hour. Systolic blood pressure was higher (138 +/- 3 v.

Auditory P3a deficits in male subjects at high risk for alcoholism.

Background: Substantial evidence indicates that alcoholism is biologically mediated by a genetic predisposition. As the decreased P300 (P3b) event-related brain potential component does not recover with prolonged abstinence, it is unlikely to be related to drinking history but is more likely to be genetically influenced. This is supported by findings that P3b amplitudes are reduced in subjects at high-risk compared to low-risk for alcoholism.

Meta-analysis of tympanostomy tube sequelae.

Objective: To estimate the incidence of tympanostomy tube sequelae based on systematic review of published case series and randomized studies.

Data Sources: English-language MEDLINE search from 1966 through April 1999 with manual reference search of proceedings, articles, reports, and guidelines.

Study Selection: Cohort studies with otitis media as the primary indication for tube placement.