Preoperative optimization and rapid discharge after coronary artery bypass grafting.

PURPOSE OF REVIEW: This review discusses current guidelines and evidence-based care for the preoperative optimization of patients who are undergoing coronary artery bypass grafting (CABG) and for enabling rapid discharge after surgery. RECENT FINDINGS: Since the Enhanced Recovery After Cardiac Surgery Society (ERAS Cardiac) issued guidelines for perioperative care, in 2019, there has been a significant body of research that has added to and provided further guidance regarding preoperative optimization and accelerated recovery after CABG. SUMMARY: A review of the current literature provides a framework for a pragmatic approach to preoperative optimization, utilizing the time from referral to surgery to mitigate multiple aspects of the patient condition, leading to improved patient outcomes and reduced length of stay and cost to the healthcare system.

Driving toward guiding principles: a goal for privacy, confidentiality, and security of health information.

As health care moves from paper to electronic data collection, providing easier access and dissemination of health information, the development of guiding privacy, confidentiality, and security principles is necessary to help balance the protection of patients' privacy interests against appropriate information access. A comparative review and analysis was done, based on a compilation of privacy, confidentiality, and security principles from many sources. Principles derived from ten identified sources were compared with each of the compiled principles to assess support level, uniformity, and inconsistencies. Of 28 compiled principles, 23 were supported by at least 50 percent of the sources. Technology could address at least 12 of the principles. Notable consistencies among the principles could provide a basis for consensus for further legislative and organizational work. It is imperative that all participants in our health care system work actively toward a viable resolution of this information privacy debate.

Community health information networks. Threat or opportunity in the doctor-patient relationship?

The last half of the 20th Century has been witness to numerous changes in the delivery and financing of health care services. These changes have impacted the one-to-one doctor-patient relationship that may have existed in the past to become a complex of relationships. The contemporary physician collaborates with many other professionals to assist in the delivery, financing, and monitoring of health care services. These clinicians and other professionals require access to patient information to deliver care and secure payment. The patient understands this. Yet the patient has concerns about the widening circle of persons authorized to access his or her information. These concerns have been amplified by the development of community health information networks--(CHINs). This article focuses on CHINs, both patient concerns and the role physicians can take in developing them.

The CTFA Evaluation of Alternatives Program: an evaluation of in vitro alternatives to the Draize primary eye irritation test. (Phase III) surfactant-based formulations.

The CTFA Evaluation of Alternatives Program is an evaluation of the relationship between data from the Draize primary eye irritation test and comparable data from a selection of promising in vitro eye irritation tests. In Phase III, data from the Draize test and 41 in vitro endpoints on 25 representative surfactant-based personal care formulations were compared. As in Phase I and Phase II, regression modelling of the relationship between maximum average Draize score (MAS) and in vitro endpoint was the primary approach adopted for evaluating in vitro assay performance. The degree of confidence in prediction of MAS for a given in vitro endpoint is quantified in terms of the relative widths of prediction intervals constructed about the fitted regression curve. Prediction intervals reflect not only the error attributed to the model but also the material-specific components of variation in both the Draize and the in vitro assays. Among the in vitro assays selected for regression modeling in Phase III, the relationship between MAS and in vitro score was relatively well defined. The prediction bounds on MAS were most narrow for materials at the lower or upper end of the effective irritation range (MAS = 0-45), where variability in MAS was smallest. This, the confidence with which the MAS of surfactant-based formulations is predicted is greatest when MAS approaches zero or when MAS approaches 45 (no comment is made on prediction of MAS > 45 since extrapolation beyond the range of observed data is not possible). No single in vitro endpoint was found to exhibit relative superiority with regard to prediction of MAS. Variability associated with Draize test outcome (e.g. in MAS values) must be considered in any future comparisons of in vivo and in vitro test results if the purpose is to predict in vivo response using in vitro data.

The effect of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusions in patients with degenerative disc disease.

STUDY DESIGN: A prospective, multi-center Investigational Device Exemption Study was carried out in the United States using a pedicle screw and plate system to perform a fusion in patients with degenerative disc disease or spondylolisthesis. The patients' pain function, complications, and fusion status were evaluated and compared with literature controls. OBJECTIVES: To study the safety and efficacy of the ISF pedicle screw/plate system. This article focuses only on those study patients with degenerative disc disease treated with autogenous bone grafts and compares the results to those of similar patients treated without instrumentation, as reported in the literature. SUMMARY OF BACKGROUND DATA: Twenty-eight patients were in the subgroup studied--patients with degenerative disc disease who had fusions with autogenous bone graft. This study was conducted at four clinical sites with a 2-year follow-up. Patient follow-up was greater than 95% at all time points. METHODS: To be considered a patient with degenerative disc disease, radiographs had to demonstrate a collapse of the disc, the presence of bone erosion, or the compression of the vertebrae as the primary spinal abnormality. Spinal fusion must have been the recommended surgical treatment for discogenic pain. The fusion status was evaluated by the operating surgeon and an independent reviewer. RESULTS: After 2 years, this subset of patients (n = 28) with degenerative disc disease who had lumbar/lumbosacral fusion with autogenous bone graft was found to have a pseudarthrosis rate of 0%. Eight articles in the literature were found to be valid noninstrumented literature controls with which this subgroup could be compared. The average pseudarthrosis rate in the control group was 32%. CONCLUSIONS: A statistical analysis showed that patients with degenerative disc disease who underwent fusion without pedicle screw instrumentation were over 24 times more likely to have a pseudarthrosis than comparable patients implanted with a pedicle screw/plate system. Regarding the most important goal in performing a spinal fusion--fusion of the spine--the pedicle screw/plate system used in this study was shown to be a safe and efficacious method of facilitating fusion with autogenous bone graft for this patient population.

[Adsorption of pesticides on synthetic adsorption polymers]. / Adsorpcja pestycydów na syntetycznych polimerach adsorpcyjnych.

On the basis of adsorption of selected pesticides on synthetic adsorption polymers it has been shown that both the adsorption balances as well as kinetics and dynamics of the adsorption strongly depend on the concentration of hydrogen ions of the liquid phase. The dependence of adsorption isotherms on pH value was demonstrated with sufficient accuracy by resorting to the models having been suggested on the ground of IAS theory and the potential one. The kinetic investigations have revealed that the surface diffusion proceeds extremely rapidly in pH ranges that lodge between sorptive pK value and the isoelectric point of the adsorbent surface. The known solutions of transportation and balance equations, which in this case were transferred on the pH-dependent adsorption processes, were implemented for simulating the breakthrough curves. The investigation, covering the effect of the presence of heavy metals in a solution exerted on the pesticides adsorption properties, has shown that the formation of model-pesticide type connections improves the adsorption properties of pesticides to a lesser or greater extent.

Prolonged red blood cell glycerol hemolysis in mice inhaling benzene.

Inhalation of benzene produces a prolongation of mouse red blood cell glycerol hemolysis time. This was not observed in red blood cells directly incubated in benzene. Increased resistance to the hemolytic action of glycerol should be explored as a potentially useful biological monitoring procedure in the red blood cells of benzene-exposed humans.

Protracted exposure of C57BL/6 mice to 300 ppm benzene depresses B- and T-lymphocyte numbers and mitogen responses. Evidence for thymic and bone marrow proliferation in response to the exposures.

Groups of C57BL/6J, male mice were exposed to 300 ppm benzene via inhalation for 115 exposures (6 h/day, 5 days/week), a regimen known to cause thymic lymphoma in these animals. The effects of these exposures on lymphoid parameters were determined by measuring the numbers of B- and T-lymphocytes and mitogen-induced proliferation of B- and T-lymphocytes in bone marrow, spleen, and thymus after 6, 30, and 115 exposures. The numbers of B-lymphocytes in bone marrow and spleen and the numbers of T-lymphocytes in thymus and spleen were found to be markedly reduced after all 3 periods. Mitogen-induced proliferation of bone marrow and splenic B-lymphocytes exhibited a progressive depression throughout the exposure period reaching a point of no observable response after 115 exposures. Splenic T-cell mitogen-induced proliferation was also markedly depressed throughout the exposures, but there was no evidence of a progressive decline in this response during the exposures. Bone marrow cellularity increased 3-fold and the numbers of thymic T-cells increased 15-fold in benzene-exposed mice between the 6th and 30th exposure. No corresponding increase in splenic cells was observed in benzene-exposed mice during this interval. The marked increases in the numbers of cells in bone marrow and thymus are interpreted as arising from compensatory proliferation of a subpopulation of cells in response to the exposures. The absence of increases in cell number in the spleen is interpreted as reflecting the lack of lymphoid restorative capacity in this organ. The marked increases of thymic and bone marrow cellularity are discussed relative to the known ability of this benzene exposure regimen to produce thymic lymphoma in these animals.

Depressions in B- and T-lymphocyte mitogen-induced blastogenesis in mice exposed to low concentrations of benzene.

In a short-term (6 h/day X 6 days) benzene inhalation dose-response study, mitogen-induced blastogenesis of both B- and T-lymphocytes in male, C57Bl mice was observed to be significantly depressed at relatively low levels of benzene. Exposure to 10 ppm benzene resulted in a significant depression in femoral lipopolysaccharide (LPS)-induced B-colony-forming ability, while total numbers of B-lymphocytes at this concentration were not significantly depressed. Similarly, splenic phytohemagglutinin (PHA)-induced blastogenesis was significantly depressed at 31 ppm, without a concomitant significant depression in numbers of T-lymphocytes. These data indicate that concentrations of benzene at or near the current standard for occupational exposure (10 ppm) can affect certain immune-associated processes.

Relation of fluorescence in lipid-containing red cell membrane extracts to in vivo lipid peroxidation.

Previous studies have demonstrated that the abnormal fluorescent peak consistent with the crosslinking of red cell membrane constituents by the lipid-peroxide decomposition product MDA is demonstrable in lipid-containing extracts of red cells obtained from patients treated with the oxidizing hemolytic agent diaminodiphenylsulfone. The present studies were primarily aimed at ascertaining the specificity of this fluorescence as an indicator of in vivo red cell lipid peroxidation. Repetitive injection of phenylhydrazine or acetylphenylhydrazine in rats resulted in gradually increasing levels of fluorescence despite the return in hematocrit toward normal. Chromatography on Sephadex LH-20 of lipid-containing extracts obtained from the red cells of rats and rabbits treated with phenylhydrazine revealed fluorescent peaks similar to those observed in red cell lipid incubated with MDA. In addition, increased levels of fluorescence were observed in the extracts of red cells obtained from three vitamin E--deficient premature infants. These findings suggest that the fluorescence assay is a sensitive indicator of in vivo red cell lipid peroxidation.