A direct comparison of seprafilm, adept, intercoat, and spraygel for adhesion prophylaxis.

BACKGROUND: Commercially available agents for adhesion prophylaxis are legion but there is a lack of direct comparisons between them. Here we compare four of the most commonly used adhesion barriers against a control group in a clinically relevant rat model. MATERIAL AND METHODS: Standardized lesions were created in Wistar rats using electrocautery and suturing. Subsequently, the experimental lesions were treated with Seprafilm (n = 30), Adept (n = 30), Intercoat (n = 30), Spraygel (n = 30), or no barrier (n = 30). The resulting adhesions were examined 14 d postoperatively. RESULTS: The mean area covered by adhesion was 77% in the control group, 46% in animals treated with Seprafilm, 54% in animals treated with Adept, 55% in animals treated with Intercoat, and 68% in animals treated with Spraygel. The adhesion-free incidence was 20% (n = 6) of lesions treated with Seprafilm, 20% (n = 6) of lesions treated with Intercoat, 3% of lesions treated with Spraygel (n = 1), and 0% of lesions treated with Adept or the control group. CONCLUSIONS: There were statistically significant differences between the barriers with regards to the area covered by adhesions and the adhesion-free incidence. In spite of this, a significant adhesion burden remains with all of the tested barriers.

Impact of electronic messaging on the patient-physician interaction.

Patients are interested in secure electronic communication with their health-care providers, but physicians have been slow to adopt the technique into their practice. We have therefore reviewed the literature on secure patient messaging. Relevant studies were identified by Medline search which produced 1065 publications. Of these, 71 relevant articles were read independently by two reviewers. Currently available messaging systems allow for asynchronous communication, physician reimbursement and automated supporting functions such as triaging of patient messages and integration of messaging into medical records. The review showed that patients are satisfied with the use of secure physician messaging systems and find such services to be convenient, time-saving and useful. Physicians do not report adverse effects from their use. Legal concerns with electronic messaging include compliance with privacy standards. The economic benefits of secure messaging systems are most immediately apparent for larger health-care groups and hospitals, although smaller practices will also benefit in the long run. Secure patient-physician messaging is a convenient and useful addition to the health-care infrastructure. It can be expected that the identification of secure providers, integration with reimbursement systems and initial uptake by larger health-care organizations will speed up the adoption into routine health care.

Adhesion prophylaxis using a copolymer with rationally designed material properties.

BACKGROUND: Physical barriers are the only licensed adjuncts for adhesion prophylaxis in the United States and Europe. Here, we investigate D,L-polylactide-epsilon-caprolactonetrimethylenecarbonate (PCT copolymer), which is a rationally designed biomaterial, as an adhesion barrier. METHODS: PCT copolymer membranes were produced by polymerization of the monomers, dissolution in organic solvents, and subsequently processing them by means of modified phase inversion and freeze drying. In vitro cytotoxicity was assayed by fibroblast culture. In vivo adhesion prophylaxis was studied in a rat model that involved standardized traumatization by electrocautery and suturing. The quantity and quality of the resulting adhesions were scored 14 days postoperatively. Complete autopsy was performed in each animal, and the implantation sites were examined histologically. The suitability for human laparoscopic application was investigated in a patient admitted for routine myomectomy. RESULTS: The PCT copolymer had no effect on the proliferation of cultured cells in vitro. The in vivo model showed that the quantity of adhesions that cover the traumatized areas was significantly less in animals treated with PCT copolymer membrane (32%) than in untreated animals (78%) (P < .01). Adhesions of both dense and filmy quality were affected. In the animals, autopsy and histologic examination of the relevant tissues revealed no indication of adverse reactions to the PCT copolymer. Human laparoscopic application was successful. CONCLUSION: The PCT copolymer membrane is biocompatible with the abdominal cavity and decreased adhesions in the animal model. It is also suitable for human laparoscopic application. Therefore, the PCT copolymer represents a candidate for additional clinical evaluation.