BACKGROUND: Technology in orthopaedic surgery has become more widespread in the past 20 years, with emerging evidence of its benefits in arthroplasty. Although patients are aware of benefits of conventional joint replacement, little is known on patients' knowledge of the prevalence, benefits or drawbacks of surgery involving navigation or robotic systems. METHODS: In an outpatient arthroplasty clinic, 100 consecutive patients were approached and given questionnaires to assess their knowledge of navigation and robotics in orthopaedic surgery. Participation in the survey was voluntary. RESULTS: Ninety-eight patients volunteered to participate in the survey, mean age 56.2 years (range, 19 to 88 years; 52 female, 46 male). Forty percent of patients thought more than 30% of National Health Service (NHS) orthopaedic operations involved navigation or robotics; 80% believed this was the same level or less than the private sector. One-third believed most of an operation could be performed independently by a robotic/navigation system. Amongst perceived benefits of navigation/robotic surgery was more accurate surgery (47%), quicker surgery (50%), and making the surgeon's job easier (52%). Sixty-nine percent believed navigation/robotics was more expensive and 20% believed it held no benefit against conventional surgery, with only 9% believing it led to longer surgery. Almost 50% would not mind at least some of their operation being performed with use of robotics/navigation. CONCLUSIONS: Although few patients were familiar with this new technology, there appeared to be a strong consensus it was quicker and more accurate than conventional surgery. Many patients appear to believe navigation and robotics in orthopaedic surgery is largely the preserve of the private sector. This study demonstrates public knowledge of such new technologies is limited and a need to inform patients of the relative merits and drawbacks of such surgery prior to their more widespread implementation.
Adult ; Aged ; Aged, 80 and over ; *Comprehension ; Cross-Sectional Studies ; Female ; Health Care Surveys ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Orthopedic Procedures/*psychology ; Questionnaires ; Robotic Surgical Procedures/psychology ; Surgery, Computer-Assisted/*psychology ; Young Adult

OBJECTIVE: To determine the impact of monitoring pain as the 5th vital sign and the utilization of a protocolized analgesic regimen on pain treatment outcome among patients admitted in the Department of General Surgery.

METHODS: Eight hundred fifty (850)admitted patients were included in the study. These were patients who underwent surgery (either trauma or non-trauma cases) and may or may not have had any complaint of pain magnitude. The Department's post operative analgesic regimen protocol (composed of tramadol and ketorolac combination)was followed. Pain scores were monitored every eight hours throughout the patient's hospitalization up to discharge and were documented on the new monitoring sheet of Vicente Sotto Memorial Medical Center.

RESULTS: Of the 850 patients, 629 patients (74 percent) were non-trauma cases and 221 patients (26 percent) were trauma cases. On admission, 313 (51 percent) non-trauma patients and 171 (81 percent) trauma patients experienced severe pain. upon discharge, only 1 (0.6 percent) non-trauma patient continued to be suffering from severe pain and non from trauma cases. Five hundred five (80 percent) non-trauma patients and 140 (63 percent) trauma patients had mild pain, 114 (18 percent) non-trauma patients and 81 (37 percent) trauma patients were totally pain free.

CONCLUSION: There was a significant reduction to pain from admission to discharge because patients were intervened appropriately of their respective symptoms by using proactive pain monitoring and providing analgesia using a protocolized analgesic regimen.

Human ; Male ; Female ; Tramadol ; Ketorolac ; Analgesics ; Pain ; Pain Management ; Analgesia ; Treatment Outcome ; Hospitalization

OBJECTIVE: Bedside consultation by cardiologists may facilitate safe discharge of selected patients from the emergency department (ED) even when admission is recommended by the History, Electrocardiogram, Age, Risk factors, Troponin (HEART) pathway. If bedside evaluation is unavailable, phone consultation between emergency physicians and cardiologists would be most impactful if the resultant disposition is discordant with the HEART pathway. We therefore evaluate discordance between actual disposition and that suggested by the HEART pathway in patients presenting to the ED with chest pain for whom cardiology consultation occurred exclusively by phone and to assess the impact of phone-consultation on disposition.METHODS: We performed a single-center, retrospective study of adults presenting to the ED with chest pain whose emergency physician had a phone consultation with a cardiologist. Actual disposition was abstracted from the medical record. HEART pathway category (low-risk, discharge; high-risk, admit) was derived from ED documentation. For discharged patients, major adverse cardiac events were assessed at 30 days by chart review and phone follow-up.RESULTS: For the 170 patients that had cardiologist phone consultation, discordance between actual disposition and the HEART pathway was 17%. The HEART pathway recommended admission for nearly 80% of discharged patients. Following cardiologist phone-consultation, 10% of high-risk patients were discharged, with the majority having undergone a functional study recommended by the cardiologist. At 30 days, discharged patients had experienced no episodes of major adverse cardiac events or rehospitalization for cardiac reasons.CONCLUSION: For patients presenting to the ED with chest pain, cardiology phone-consultation has the potential to safely impact disposition, primarily by facilitating functional testing in high-risk individuals.
Acute Coronary Syndrome ; Adult ; Cardiology ; Chest Pain ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Follow-Up Studies ; Heart ; Humans ; Medical Records ; Retrospective Studies ; Risk Factors ; Troponin

Acute limb ischemia (ALI) represents one of the most common emergent scenarios encountered by a vascular specialist. Despite expedient revascularization, high rates of limb loss are reported along with high mortality rates which are second only to ruptured abdominal aortic aneurysms. Surgical revascularization is standard of care. Endovascular techniques as an alternative have emerged to be appropriate first line therapy when addressing the threatened limb. We review the etiology and classification of ALI and current endovascular techniques and evidence to date in the management of patients acutely presenting with extremity ischemia.
Aortic Aneurysm, Abdominal ; Classification ; Embolism and Thrombosis ; Endovascular Procedures ; Extremities ; Humans ; Ischemia ; Mortality ; Peripheral Arterial Disease ; Specialization ; Standard of Care

Fatty acid binding and oxidation kinetics for wild type P450(BM3) (CYP102A1) from Bacillus megaterium have been found to display chain length-dependent homotropic behavior. Laurate and 13-methyl-myristate display Michaelis-Menten behavior while there are slight deviations with myristate at low ionic strengths. Palmitate shows Michaelis-Menten kinetics and hyperbolic binding behavior in 100 mmol/L phosphate, pH 7.4, but sigmoidal kinetics (with an apparent intercept) in low ionic strength buffers and at physiological phosphate concentrations. In low ionic strength buffers both the heme domain and the full-length enzyme show complex palmitate binding behavior that indicates a minimum of four fatty acid binding sites, with high cooperativity for the binding of the fourth palmitate molecule, and the full-length enzyme showing tighter palmitate binding than the heme domain. The first flavin-to-heme electron transfer is faster for laurate, myristate and palmitate in 100 mmol/L phosphate than in 50 mmol/L Tris (pH 7.4), yet each substrate induces similar high-spin heme content. For palmitate in low phosphate buffer concentrations, the rate constant of the first electron transfer is much larger than k (cat). The results suggest that phosphate has a specific effect in promoting the first electron transfer step, and that P450(BM3) could modulate Bacillus membrane morphology and fluidity via palmitate oxidation in response to the external phosphate concentration.
Bacterial Proteins ; metabolism ; Cytochrome P-450 Enzyme System ; metabolism ; Fatty Acids ; chemistry ; metabolism ; Lauric Acids ; chemistry ; metabolism ; Myristic Acid ; chemistry ; metabolism ; NADPH-Ferrihemoprotein Reductase ; metabolism ; Osmolar Concentration ; Oxidation-Reduction ; Palmitic Acid ; chemistry ; metabolism ; Structure-Activity Relationship

Gastric cancer (GC) has a good prognosis, if detected at an early stage. The intestinal subtype of GC follows a stepwise progression to carcinoma, which is treatable with early detection and intervention using high-quality endoscopy. Premalignant lesions and gastric epithelial polyps are commonly encountered in clinical practice. Surveillance of patients with premalignant gastric lesions may aid in early diagnosis of GC, and thus improve chances of survival. An expert professional workgroup was formed to summarise the current evidence and provide recommendations on the management of patients with gastric premalignant lesions in Singapore. Twenty-five recommendations were made to address screening and surveillance, strategies for detection and management of gastric premalignant lesions, management of gastric epithelial polyps, and pathological reporting of gastric premalignant lesions.
Adenomatous Polyps ; Endoscopy ; Humans ; Precancerous Conditions/therapy* ; Singapore ; Stomach Neoplasms/therapy*

Objective: To evaluate the antidiabetic effect of galactomannans extracted from Adenanthera pavonina's L. seeds (GAP) in streptozotocin (STZ) induced diabetic mice. Methods: The preliminary galactomannan yield from Adenanthera pavonina L. plant and extraction products composition were evaluated. Various chemical characterization methods like thin layer chromatography, Fourier transform infrared spectroscopy,

Objective: To investigate the effect of administration of Passiflora glandulosa (P. glandulosa) fruit rinds flour on streptozotocin (STZ)-induced diabetic mice. Methods: The preliminary phytochemical screening and parameters such as centesimal composition and brine shrimp toxicity were evaluated. For in vivo study Swiss female mice were divided into four groups: NC-normal control; DC-diabetic control animals receiving saline; MET-diabetic animals receiving metformin (200 mg/kg); PFRF-diabetic animals receiving P. glandulosa fruit rinds flour (200 mg/kg). All of them were treated for 28 d. STZ was used in a single dose of 120 mg/kg to establish diabetic models. Body weight, water and food intake, fasting blood glucose were measured. Histopathological analysis of pancreas and liver were performed to evaluate STZ-induced tissue injuries. Results: Phytochemical screening showed the presence of flavanones and triterpenoids. The P. glandulosa fruit rinds flour was non-toxic by the brine shrimp test. The fruit rinds flour also reduced the loss of body weight and significantly decreased food intake in the diabetic mice. Additionally, a significant reduction in blood glucose was observed for 15 d and this was maintained on 21 d and 28 d when compared with diabetic mice. Furthermore, the P. glandulosa fruit rinds flour has a favourable effect on the histopathological changes of the pancreas in STZ induced diabetes. Conclusions: It is concluded that P. glandulosa fruit rinds flour is a natural product that contains potent antioxidant compounds and presents good prospects for the improvement of diabetic mellitus by reducing serum glucose levels.

Objective: To evaluate the chemical components of active extract from Cnidoscolus quercifolius root bark and its cytotoxic potential against several tumor strains. Methods: The high-performance liquid chromatography with diode-array detection and