Ensayo clínico aleatorizado en pacientes COVID- 19 sobre el efecto de la fisioterapia precoz en su acondicionamiento físico / Randomized clinical trial in Covid-19 patients on the effect of early physiotherapy on their physical condition

Introducción La Organización Mundial de la Salud (OMS) recomienda las intervenciones tempranas de rehabilitación y movilización en pacientes hospitalizados por COVID-19. Los beneficios de la fisioterapia precoz, durante la estancia hospitalaria, no han sido probados en ensayos clínicos. Objetivo Evaluar los efectos de la fisioterapia precoz y educación para la salud en pacientes COVID-19 hospitalizados, en relación con los síntomas descritos en estudios previos, analizando diferencias entre grupos respecto a su acondicionamiento físico, necesidad de oxigenoterapia y estancia hospitalaria. Metodología Ensayo clínico aleatorizado con dos brazos, desarrollado en unidades de hospitalización y cuidados respiratorios intermedios (UCRI), con pacientes COVID-19. Se incluyeron 64 sujetos en el grupo experimental (implementación de un programa de fisioterapia precoz tras 48-72 horas de ingreso) y 62 en el grupo control (tratamiento habitual del centro). Variables sociodemográficas y clínicas: escala de disnea modified Medical Research Council (Mmrc), oxigenoterapia, Medical Research Council Scale sum score (MRC-SS), 30 segundos sit to stand test (30 s-STST), fuerza de prensión manual (FPM), Tinetti, escala de fragilidad (FRAIL-España) y escala Post-COVID-19 Functional Status (PCFS). Se evaluaron al ingreso, al alta y a los dos meses del alta. Resultados Los experimentales tuvieron menos días de ingreso y de oxigenoterapia convencional. Al alta, presentan menor riesgo de caída (72,9 vs. 95,8%) y menor debilidad en MRC-SS (2,1 vs. 14,6%). A los dos meses tenían menor fragilidad (5,0 vs. 14,5%), mayor fuerza de prensión manual, menos disnea, mejores resultados en 30s-STST y menos limitaciones post-COVID (86,5 vs. 96,4%) (AU)

Introduction The WHO recommends early rehabilitation and mobilization interventions in patients hospitalized for COVID-19. The benefits of early physiotherapy, during the hospital stay, have not been proven in clinical trials. Objective To evaluate the effects of early physiotherapy and health education in hospitalized COVID-19 patients, in relation to the symptoms described in previous studies, analyzing differences between groups regarding their physical conditioning, need for oxygen therapy and hospital stay. Methodology Randomized clinical trial with two arms, developed in hospitalization and intermediate respiratory care units, with COVID-19 patients. Sixty-four patients included in the experimental group (implementation of an early physiotherapy program after 48–72 h of admission) and 62 patients in the control group (usual treatment of the center). Sociodemographic and clinical variables: mMRC, oxygen therapy, MRC-SS, 30 s-STST, FPM, Tinetti, FRAIL-España and PCFS. They were evaluated on admission, discharge and two months after discharge. Results The experimental patients had fewer days of admission and conventional oxygen therapy. At discharge, they present a lower risk of falling (72.9% vs. 95.8%) and less weakness in MRC-SS (2.1% vs. 14.6%). At two months they had less frailty (5.0% vs. 14.5%), greater hand grip strength, less dyspnea, better results in 30s-STST and fewer post-COVID limitations (86.5% vs. 96.4%). Conclusión The intervention of early physiotherapy in COVID-19 patients and the health education received, prevents muscle weakness during admission, improves physical conditioning at discharge and two months later, and reduces the days of hospital stay (AU)

"Greenhouse gas dynamics in a coastal lagoon during the recovery of the macrophyte meadow (Mar Menor, SE Spain)".

The Mar Menor is a hypersaline coastal lagoon with salinity values ranging from 41.9 to 45.5. The system is subjected to a high anthropic pressure that causes an intense eutrophication process, followed by a recovery of the macrophyte meadows. This study focuses on the distribution of the main greenhouse gases (CO2, CH4 and N2O) and was carried out in the extreme seasonal conditions of winter and summer during the year 2018. Sediment-water-atmosphere exchanges and biochemical processes in the water column appeared to be the main factors to explain the variability of these gases. Dissolved Inorganic Carbon (DIC), CH4 and N2O benthic fluxes values obtained in this study, were of 91 ± 29 mmol m-2 d-1, 3.9 ± 1.9 µmol m-2 d-1 and -0.65 µmol m-2 d-1, respectively, along with an important seasonal variation observed, with an increase of DIC and CH4 benthic fluxes during the summer season. Mean values of partial pressure of CO2 (pCO2) in surface water were of 579 µatm in winter and 464 µatm in summer, therefore we can establish that the Mar Menor acts as a source of this gas emitting 3.3 ± 3.0 mmol CO2 m-2 d-1 to the atmosphere. In spite of this, the Mar Menor has a strong autotrophic behaviour partly due to the recovery of the macrophyte meadows, presenting an estimated NEP of 101 mmol m-2 d-1. Regarding to CH4, the mean fluxes to the atmosphere were of 8.0 ± 5.8 µmol m-2 d-1 and there was evidence of CH4 production in the water column that increased in summer. Last of all, in the case of N2O the system acts as a sink with values of -0.65 ± 0.5 µmol m-2 d-1, presenting an intake of N2O that is usually detected in pristine systems.

[Bases of deep brain stimulation]. / Bases de la estimulación cerebral profunda.

INTRODUCTION: Deep brain stimulation is an effective therapy that is being used in an increasing number of indications. The mechanisms by which it exerts its therapeutic effect are still largely unknown, although there is increasing evidence of its influence at various levels. AIM: To review the existing literature on the mechanism of action of deep brain stimulation. DEVELOPMENT: Deep brain stimulation acts on brain tissue that is stimulated at various levels: molecular, cellular and neural networks. Spatial, temporal and electrical factors are involved in its effectiveness, but it mainly seems to perform its function by replacing anomalous firing patterns, which are present in certain neurological and psychiatric diseases. Other mechanisms, such as neuroprotection or neurogenesis, remain under study. CONCLUSIONS: Although many of the effects by which deep brain stimulation acts on the brain are still unknown, it seems to be a complex treatment, with large-scale effects, in which the correction of circuitopathies seems to prevail as the main mechanism.

TITLE: Bases de la estimulación cerebral profunda.Introducción. La estimulación cerebral profunda es una terapia eficaz que está siendo utilizada en un número creciente de indicaciones. Los mecanismos mediante los cuales ejerce efecto terapéutico aún se desconocen en su mayor parte, si bien cada vez se dispone de más datos sobre su influencia en diversos niveles. Objetivo. Revisar la bibliografía existente sobre el mecanismo de acción de la estimulación cerebral profunda. Desarrollo. La estimulación cerebral profunda actúa sobre el tejido cerebral estimulado en varios niveles, molecular, celular y de redes neuronales. En su efectividad intervienen factores espaciales, temporales y eléctricos, pero fundamentalmente parece ejercer su función mediante la sustitución de patrones de disparo anómalos, presentes en ciertas enfermedades neurológicas y psiquiátricas. Otros mecanismos, como la neuroprotección o la neurogénesis, permanecen en estudio. Conclusiones. Aunque aún se desconocen muchos efectos por los cuales la estimulación cerebral profunda actúa en el cerebro, parece un tratamiento complejo, con efectos a gran escala, en los que parece primar la corrección de circuitopatías como mecanismo principal.

[Deep brain stimulation in drug-resistant epilepsy]. / Estimulación cerebral profunda en la epilepsia farmacorresistente.

INTRODUCTION: Deep brain stimulation (DBS) in drug-resistant epilepsy has been applied to several brain targets. However, its exact mechanism of action is not known, and the diversity of targets makes it difficult to know the degree of evidence that supports its use. DEVELOPMENT: A review of the literature on DBS for drug-resistant epilepsy was conducted. The efficacy of DBS in drug-resistant epilepsy seems to be mediated by a desynchronisation of neuronal activity at the epileptogenic focus or a modulation of the «circuitopathies¼ that exist in epilepsy, depending on the target. In DBS multiple cortical and subcortical structures have been used, but class I evidence exists only for DBS of the anterior nucleus of the thalamus. CONCLUSIONS: DBS in epilepsy is still under investigation, with class I evidence for DBS of the anterior nucleus of the thalamus. The rest of the targets have yielded variable results that must be confirmed with randomised designs in larger series.

TITLE: Estimulación cerebral profunda en la epilepsia farmacorresistente.Introducción. La estimulación cerebral profunda (ECP) en la epilepsia farmacorresistente se ha aplicado en varias dianas cerebrales. Sin embargo, su mecanismo de acción no se conoce con exactitud, y la diversidad de dianas hace difícil conocer el grado de evidencia que apoya su utilización. Desarrollo. Se realiza una revisión bibliográfica sobre la ECP para la epilepsia farmacorresistente. La eficacia de la ECP en la epilepsia farmacorresistente parece mediada por una desincronización de la actividad neuronal en el foco epileptógeno o una modulación de las circuitopatías que existen en la epilepsia, dependiendo de la diana. En la ECP se han utilizado múltiples estructuras corticales y subcorticales, pero solamente la ECP del núcleo anterior del tálamo tiene una evidencia de clase I. Conclusiones. La ECP en la epilepsia es aún objeto de investigación, con evidencia de clase I en la ECP del núcleo anterior del tálamo. El resto de las dianas ha arrojado resultados variables que deben confirmarse con diseños aleatorizados en series de mayor tamaño.

[A new case of "olfactory schwannoma"; presentation and literature review]. / Un nuevo caso de "schwannoma del olfatorio"; presentación y revisión de laliteratura.

We report the case of a 54-year-old man who presented at the Emergency Department with intense headache of 6-days duration and sporadic nominal dysphasia. He did not present anosmia and the rest of the examination was normal. The emergency CT and the posterior cerebral MR showed a great subfrontal extra-axial mass of 7 x 6 x 5 cm, over the right side of the cribiform plate, hetereogeneously enhancing after gadolinium administration. Preoperative diagnosis was olfactory groove meningioma. After total removal by bifrontal craniotomy the histopathological diagnosis was schwannoma of the conventional type. Owing to the unusual frequency of this kind of tumors (26 to the date), we review the literature, the possible radiological differences with olfactory groove meningiomas and the different theories about their origin.

Un nuevo caso de "schwannoma del olfatorio"; presentación y revisión de laliteratura / A new case of “olfactory schwannoma”; presentation and literature review

Presentamos el caso de un paciente varón de 54 añosque acude a Urgencias por cefalea importante de 6 díasde evolución así como por una disfasia nominal ocasional.No presentaba anosmia ni otra sintomatología. ElTAC urgente y la RM craneal posterior muestran unagran tumoración extra-axial frontobasal de 7×6×5 cmde diámetro, localizada mas sobre el lado derecho dela lámina cribosa, que capta contraste hetereogéneamentey cuyo diagnóstico de sospecha fue meningiomadel surco del olfatorio. Tras su exéresis total mediantecraneotomía bifrontal, la anatomía patológica es informadacomo schwanoma de tipo convencional. Dada larareza de este tipo de tumores (26 hasta la fecha), revisamosla literatura, sus posibles diferencias radiológicascon el meningioma del surco del olfatorio y las diversasteorías acerca de su origen (AU)

We report the case of a 54-year-old man who presentedat the Emergency Department with intenseheadache of 6-days duration and sporadic nominaldysphasia. He did not present anosmia and the rest ofthe examination was normal. The emergency CT andthe posterior cerebral MR showed a great subfrontalextra-axial mass of 7×6×5 cm, over the right side ofthe cribiform plate, hetereogeneously enhancing aftergadolinium administration. Preoperative diagnosis wasolfactory groove menigioma. After total removal bybifrontal craniotomy the histopathological diagnosiswas schwannoma of the conventional type. Owing to the unusual frequency of this kind of tumors (26 to thedate), we review the literature, the possible radiologicaldifferences with olfactory groove meningiomas and thedifferent theories about their origin (AU)

Síndrome de «cri du chat». Comunicación de un nuevo caso y revisión / Cri du chat syndrome: report of a new case and review

El síndrome de cri du chat, o monosomía 5p-, es una rara anomalía genética debida a la deleción de un segmento del brazo corto del cromosoma 5, que muestra una gran variabilidad fenotípica y citogenética. Su incidencia varía de 1/15.000 a 1/50.000 recién nacidos vivos, aunque es posible que su frecuencia sea mayor. Se comunica un nuevo caso neonatal con algunas de las características fenotípicas del síndrome, con una deleción en 5p15.2 por translocación materna, que precisó técnicas moleculares para su confirmación; asimismo, se revisan los aspectos clínicos y citogenéticos más interesantes de esta afección

Cri-du-chat syndrome, or monosomy 5p-, is an uncommon genetic anomaly, caused by the deletion of a segment of the short arm of chromosome 5, that exhibits a wide phenotypic and cytogenetic variability. The incidence ranges from 1/15,000 to 1/50,000 live-born infants, although the frequency may be higher. We report the case of a newborn infant with some of the phenotypic characteristics associated with the syndrome and a deletion in 5p15.2 due to a maternal translocation, which required confirmation by molecular techniques. We also review the more interesting clinical and cytogenetic aspects of this condition

[Intraventricular tension pneumocephalus after transsphenoidal surgery: a case report and literature review]. / Neumoencéfalo intraventricular a tensión secundario a cirugía transesfenoidal: presentación de un caso y revisión de la literatura.

Tension pneumocephalus is a rare complication of transsphenoidal approaches. The case of a 37 year old woman with a transsphenoidal resection of a pituitary adenoma who presented self-limited rhinoliquorrhea postoperatively is reported. Three days later the patient developed progressive decreased consciousness, amnesia and headache, showing an intraventricular tension pneumocephalus on CT scan. Urgent treatment with bilateral external ventricular drainage and anterior nasal tamponade was performed with good clinical outcome. Later transsphenoidal sealing of the dural defect was achieved without recurrence. Tension pneumocephalus following transsphenoidal surgery usually occurs after the presentation of a cerebrospinal fluid leak due to an incomplete sealing of the sphenoid sinus. The postoperative insertion of a lumbar drainage seems to be a predisposing condition for this complication. The combined approach of tension pneumocephalus with external ventricular drainage and repair of the sphenoid sinus offers optimal results solving the acute neurological deterioration and avoiding recurrence.

Neumoencéfalo intraventricular a tensión secundario a cirugía transesfenoidal: presentación de un caso y revisión de la literatura / Intraventricular tensión pneumocephalus after transsphenoidal surgery: a case report and literature review

El neumoencéfalo a tensión (NT) es una complicaciónrara de los abordajes transesfenoidales. Se describeel caso de una mujer de 37 años intervenida de unadenoma de hipófisis por vía transesfenoidal que presentórinolicuorrea autolimitada en el postoperatorio.A los tres días la paciente desarrolló un deterioro progresivode conciencia, amnesia anterógrada y cefalea,detectándose en la TC un NT intraventricular. Se realizóun tratamiento urgente con drenaje ventricularexterno bilateral y taponamiento nasal anterior conbuena respuesta clínica. De modo diferido se procedió ala revisión del abordaje esfenoidal lográndose el cierredefinitivo del defecto dural sin recidiva posterior.El NT después de la cirugía por vía esfenoidal sueleocurrir tras la aparición de una fístula de LCR debido alsellado incompleto del seno esfenoidal. La colocación deun drenaje lumbar postoperatorio parece predisponera esta complicación. El enfoque terapéutico combinadodel NT mediante drenaje ventricular externo y reparacióndel seno esfenoidal ofrece un resultado óptimo conuna solución rápida para el deterioro neurológico delpaciente y evita las recidivas

Tension pneumocephalus is a rare complication of transsphenoidal approaches. The case of a 37 yearold woman with a transsphenoidal resection of a pituitaryadenoma who presented self-limited rhinoliquorrheapostoperatively is reported. Three days later thepatient developed progressive decreased consciousness,amnesia and headache, showing an intraventriculartension pneumocephalus on CT scan. Urgent treatmentwith bilateral external ventricular drainage and anteriornasal tamponade was performed with good clinicaloutcome. Later transsphenoidal sealing of the duraldefect was achieved without recurrence.Tension pneumocephalus following transsphenoidalsurgery usually occurs after the presentation of a cerebrospinalfluid leak due to an incomplete sealing of thesphenoid sinus. The postoperative insertion of a lumbardrainage seems to be a predisposing condition for thiscomplication. The combined approach of tension pneumocephaluswith external ventricular drainage andrepair of the sphenoid sinus offers optimal results solvingthe acute neurological deterioration and avoidingrecurrence

Bultoma cérvico-escapular / Cervicoscapular mass

No disponible

[Cerebral cavernomas. A review and update of aetiological, clinical and therapeutic features]. / Cavernomas cerebrales. Revisión y actualización etiológica, clínica y terapéutica.

INTRODUCTION: Cavernous angiomas are uncommon lesions, with a reported incidence of 0.4 to 0.8%, presenting a controversial management especially regarding their surgical treatment. AIM: To update cavernous angiomas characteristics and management through a deep review of the literature concerning their aetiology, epidemiology, history, signs and symptoms, diagnosis, and surgical and radiosurgical treatment. DEVELOPMENT AND CONCLUSIONS: Most important advances found in the recent literature include the identification of the genetic basis responsible for the familial form of cavernomatosis (CCM1, CCM2 and CCM3), the identification of the dynamic pattern of these lesions based on their pathology and imaging features, the deeper knowledge on their natural history depending on their supra/infratentorial location, and the main indications for surgical treatment and radiosurgical therapy suggested by the recent series.

Cavernomas cerebrales. Revisión y actualización etiológica, clínica y terapéutica / Cerebral cavernomas. A review and update of aetiological, clinical and therapeutic features

Introducción. Los cavernomas son lesiones poco habituales, con una incidencia estimada del 0,4 al 0,8%, y que plantean múltiples controversias especialmente en lo que concierne a su tratamiento. Objetivo. Actualizar mediante una revisión bibliográfica extensa las principales características etiológicas, epidemiológicas, históricas, clínicas, diagnósticas y de tratamiento de los angiomas cavernosos en el sistema nervioso central. Desarrollo y conclusiones. Entre los principales hallazgos obtenidos destacan los avances en el origen genético de las cavernomatosis familiares, con la identificación de los genes responsables (CCM1, CCM2 y CCM3), la condición dinámica de los angiomas cavernosos según los estudios histológicos y de imagen, los avances en el conocimiento de su historia natural según su localización supra/infratentorial, y las indicaciones de tratamiento quirúrgico sugeridas por las distintas series revisadas, así como el papel actual del tratamiento mediante radiocirugía de los cavernomas no accesibles quirúrgicamente

Introduction. Cavernous angiomas are uncommon lesions, with a reported incidence of 0,4 to 0,8%, presenting a controversial management especially regarding their surgical treatment. Aim. To update cavernous angiomas characteristics and management through a deep review of the literature concerning their aetiology, epidemiology, history, signs and symptoms, diagnosis, and surgical and radiosurgical treatment. Development and conclusions. Most important advances found in the recent literature include the identification of the genetic basis responsible for the familial form of cavernomatosis (CCM1, CCM2 and CCM3), the identification of the dynamic pattern of these lesions based on their pathology and imaging features, the deeper knowledge on their natural history depending on their supra/infratentorial location, and the main indications for surgical treatment and radiosurgical therapy suggested by the recent series

Bioremediation of an area contaminated by a fuel spill.

In order to decontaminate a large area of restricted access contaminated by a fuel spill, laboratory and field studies were developed in two steps: (a) monitoring of the laboratory experiment on bacterial growth under aerobic and anaerobic conditions with and without addition of nutrients; and (b) use of the best conditions obtained in (a) for the decontamination of the soil. A hydraulic barrier was installed both to clean the aquifer and to avoid migration of hydrocarbons as a consequence of their solution in the groundwater and subsequent displacement. The objective was to create an ideal environment for the treatment of the affected area that favoured the growth of the indigenous bacteria (Pseudomonas and Arthrobacter) that biodegrade the hydrocarbons. Monitoring of the changes in the total concentration of petroleum hydrocarbons in the soil subjected to bacterial action was performed by gas chromatography. In a field study, the progress of biodegradation of hydrocarbons was evaluated in situ by changes in subsurface CO2/O2 levels by means of an analyser equipped with an infrared detector. Biostimulation and oxygen were the most influential factors for the biodegradation of the hydrocarbons. The use of bioventing of the soil was shown as an excellent technology to promote in situ bioremediation of the polluted area.

Estudio de la carga física postural en la intervención de linfadenectomía axilar en las lesiones malignas de la mama / Study of physical postural load in axillary lymphadenotomy in malignant breast lesions

Se realiza un estudio de la carga postural utilizando un método ergonómico OWAS y grabación en vídeo en formato digital. El análisis postural tiene en cuenta los niveles de acción (si son elevados, la probabilidad de lesiones es alta) y las posiciones de la espalda, de los brazos, de las piernas y el peso sostenido o elevado. El estudio estadístico de las frecuencias observadas se realiza mediante el análisis de correspondencias simple (análisis factorial de correspondencias).El número de posturas codificadas como de nivel 4 (el más elevado) corresponde al 17,3 por ciento de todas las adoptadas por el cirujano, mientras que en la instrumentista es del 2 por ciento. En el ayudante no hay posturas de nivel 3 o de nivel 4. Los cirujanos asocian la inclinación de la espalda y la rotación de la misma en 41 posturas, mientras que para el ayudante son 12 y para la instrumentista 15. En la instrumentista la posición de la espalda más frecuente es la rotación de la misma Los estudios del análisis de correspondencias demuestran que la actividad de cirujano (con una correlación de 0,661) se halla relacionada con un nivel 4 (correlación 0,707).Como conclusiones se obtiene una sobrecarga en el cirujano, asociando posturas de la columna inclinada o rotada con las piernas flexionadas, consecuencia de la posición en pie. Es posible reducir la sobrecarga realizando la intervención sentado (AU)

Fiber optic monitoring of carbamate pesticides using porous glass with covalently bound chlorophenol red.

An optical fiber biosensor for the determination of the pesticides propoxur (Baygon) and carbaryl, two of the most commonly used carbamate insecticides in vegetable crops, is described. A pH indicator, chlorophenol red, is used as optical transducer of the inhibition of the enzyme acetylcholinesterase by the analytes. The biorecognition element is covalently immobilized onto controlled pore glass beads (CPG) and packed in a thermostatized bioreactor connected to a flow-through cell that contains CPG-immobilized chlorophenol red placed at the common end of a bifurcated fiber optic bundle. In the presence of a constant acetylcholine concentration, the colour of the pH sensitive layer changes and the measured reflectance signal can be related to the carbamate concentration in the sample solution. The performance of the biosensor has been optimized using a flow injection system. The linear dynamic range for the determination of carbaryl and propoxur spans from 0.8 to 3.0 mg l(-1) and from 0.03 to 0.50 mg l(-1), respectively. The detection limit (3 s) of the biosensor for propoxur (0.4 ng) is lower than that measured for carbaryl (25 ng). Reproducibility, stability and interference studies of the optical device are reported. The biosensor has been applied to the determination of propoxur in spiked vegetables (onion and lettuce) using ultrasound extraction, achieving recovery values between 93 and 95% for onion samples at the different concentration levels assayed.

Cement for stabilisation of industrial residues containing heavy metals.

A method aimed at decreasing the toxicity of heavy metals [namely, Zn(II) and Cr(III)] in real polluted residues by immobilisation has been developed. The residues were processed either with two cement-type stabilisers or lime. The cement-type stabilisers were Portland cement and Depocrete SM/2 at the self-generated pH (ca. 11) which afforded physical as well as chemical potential for the immobilisation of heavy metals. The other stabiliser, lime, reduced organic compounds, thus favouring the decrease of the chemical oxygen demand (COD) and endowing the residue with better mechanical properties for transport. After leaching the stabilised residues using the standard leaching test [Order 13/10/89, Boletín Oficial del Estado (BOE) 270 10/11/89], three ways for establishing the toxicity of the treated residues were used, namely: (1) the ecotoxicity test using Photobacterium phosphoreum (DIN 38 412); (2) determination of the concentration of heavy metals by atomic absorption spectrometry (AAS); (3) determination of the COD or oxygen required for complete chemical oxidation of a water sample. Portland cement (20%) blended with Depocrete SM/2 (3%) acted as an effective stabiliser for residues containing heavy metals as it increased the ecotoxicity index (EC50) by more than five times. Thus the heavy metal concentration in the leaching liquid was lowered to less than 0.1 mg l-1. The addition of 5% of lime afforded a residue easily transportable from the place of treatment to the landfill. The precision of the method was studied in terms of both repeatability and reproducibility. The values found with respect to EC50 and expressed as the relative standard deviation (RSD) were 1.6% and 5.1%, respectively.

Is structured pre-surgical education more effective than non-structured education?

Provision of patient education is an integral part of health care. Furthermore, it is essential that educational techniques result in desired outcomes. The purpose of this literature synthesis is to measure the effects of structured presurgical patient education programs on post-surgical compliance with a therapeutic regimen. A computer-based literature search identified acceptable studies that were evaluated by the following literature synthesis techniques: vote counting, meta-analysis, and study characteristic coding. The synthesis findings were inconsistent and failed to indicate that structured education was more effective than unstructured education in promoting compliance with a therapeutic regimen. These findings may be due to flaws in the individual studies, incomplete reporting of descriptive statistics in the individual studies, imperfections in the education programs, or a lack of impact of educational programs on patient compliance.