Role of the Internet as an information resource for surgical patients: a survey of 877 patients.

BACKGROUND: This study was conducted to provide preliminary data regarding current Internet use practices for information about anaesthesia in patients undergoing elective surgical procedures at a major academic institution. METHODS: With IRB approval, 2936 patients coming for preanaesthetic evaluation at a tertiary academic hospital's preadmission testing (PAT) centre were invited to voluntarily participate in a 20-item questionnaire designed to obtain participants' characteristics and Internet use for information pertaining to their upcoming surgery. Data were analysed using statistical software SAS (Cary, NC, USA). Descriptive statistics were calculated for continuous variables using mean (sd), and for categorical data using n (%). Association analysis was performed using the Fisher's exact test. RESULTS: Eight hundred and seventy-seven patients (30%) responded. Of these, 356 (41%) looked for information about their medical condition, 321 (37%) for their surgery, 279 (32%) for surgeon, 163 (19%) for the hospital, and only 36 (4%) for information regarding anaesthesia. Of these 36 patients, 14 (39%) said the sites they used helped answer their questions regarding anaesthesia. Of the 831 patients who did not use the Internet for anaesthesia, 503 (57%) indicated that they would be receptive to being directed to specific websites for anaesthesia. CONCLUSIONS: Of the patients coming for elective surgery who responded (30%), the majority did not use the Internet to seek information regarding anaesthesia. Respondents indicated a high degree of interest in being directed to appropriate websites for further information. These results suggest that it may be beneficial to include information regarding reliable web-based resources to interested patients at preoperative visits.

Annual surveillance by CA125 and transvaginal ultrasound for ovarian cancer in both high-risk and population risk women is ineffective.

OBJECTIVE: To assess the efficacy of annual CA125 and transvaginal ultrasound (TVU) scan as surveillance for ovarian cancer. DESIGN: Retrospective audit. SETTING: NHS Trust. POPULATION: Three hundred and forty-one asymptomatic women enrolled for ovarian cancer screening: 179 were in a high-risk group (>10% lifetime risk of developing ovarian cancer), 77 in a moderate risk group (4-10% lifetime risk of developing ovarian cancer) and 71 in a near population risk group (<4% lifetime risk). METHODS: Retrospective audit of case records, laboratory CA125 results, radiology reports, histology records and local cancer registry data. MAIN OUTCOME MEASURES: Ovarian cancers occurring in study population. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVU, and CA125 as a screening tool for ovarian cancer. RESULTS: Four ovarian cancers and one endometrial cancer occurred. One ovarian cancer was detected at surveillance, three occurred in women who presented symptomatically between screenings. Thirty women underwent exploratory surgery because of abnormal findings at surveillance. Two women had cancer (PPV = 6.7%); one had ovarian cancer and the other endometrial cancer. Twenty-eight women (93.3%) had no malignancy. Sensitivity, specificity, PPV and NPV for TVU in the whole cohort were 33.3, 85.8, 0.6 and 99.8%, respectively. For high-risk individuals, the figures for TVU were 33.3, 84.5, 1.1 and 99.6, respectively. Combining both modalities for the whole cohort, the sensitivity, specificity, PPV and NPV were 66.7, 82.9, 1.5 and 99.8% and 50.0, 82.8, 1.3 and 99.7%, respectively, for the high-risk group alone. CONCLUSIONS: Ovarian screening by annual TVU and CA125 is inefficient at detecting early-stage ovarian cancers.

Construction of K88- and K99-expressing clones of Salmonella typhimurium G30: immunogenicity following oral administration to pigs.

Salmonella typhimurium G30 was used as a vector to express the ETEC (enterotoxigenic Escherichia coli) fimbrial antigens K88 and K99. Two plasmids encoding K88 or K99 production and having a non-antibiotic selection marker (thyA+) were constructed. These were introduced into a thyA G30 derivative to give the vaccine strains EX841 and EX603, which were shown to express surface K88 or K99, respectively. When administered orally to adult pigs, a dose of 10(11) vaccine organisms elicited significant serum antibody responses to the respective fimbrial antigens. Two such immunizations with EX841 generated serum antibody levels comparable to those obtained with intramuscular injection of killed organisms. Attenuated salmonellae can thus be used to deliver ETEC fimbrial antigens to the porcine intestinal immune system.

Construction of plasmid vectors with a non-antibiotic selection system based on the Escherichia coli thyA+ gene: application to cholera vaccine development.

The construction of live oral carriers based on attenuated Salmonella strains as vectors offers a new approach to vaccine development. We have constructed a set of plasmid vectors which have the thyA gene of Escherichia coli (encoding thymidylate synthetase) as the marker for selection and maintenance of plasmid clones. The thyA system offers an alternative to antibiotic-resistance selection markers. It can be easily adapted to a particular host-vector combination since thyA chromosomal mutations can be readily introduced by trimethoprim selection. We also describe the construction of thyA-based plasmids with the Vibrio cholerae rfb genes (encoding O-antigen biosynthesis of the Inaba serotype). These have been found to be useful in the construction of candidate bivalent cholera-typhoid vaccines.

The use of time-out, peer retraining and differential reinforcement of other behaviours (DRO) to reduce disruptive behaviours in a profoundly retarded boy.

La conducta perturbadora de un nino con retardo profundo fue reducida empleando tiempo fuera (TF), reforzamiento diferencial de otras conductas (RDO) y el re-entrenamiento de companeros. Un diseno de linea base multiple a traves de los ambientes de aula y comedor, indico que la alta tasa de perturbaciones disminuyo como efecto de los procedimientos aplicados. La reduccion fue tambien observada en otros ambientes, como funcion de un periodo breve de tiempo fuera (TF), sin sacar al sujeto del ambiente