BACKGROUND: The application of image analysis technologies for the interpretation of microbiological cultures is evolving rapidly. The primary aim of this study was to establish whether the image analysis system named Automated Plate Assessment System (APAS; LBT Innovations Ltd., Australia) could be applied to screen urine cultures. A secondary aim was to evaluate differences between traditional plate reading (TPR) and the reading of cultures from images, or digital plate reading (DPR). METHODS: A total of 9,224 urine samples submitted for culture to three clinical laboratories, two in Australia and one in the USA, were included in the study. Cultures were prepared on sheep blood and MacConkey agar plates and read by panels of three microbiologists. The plates were then presented to APAS for image capture and analysis, and the images and results were stored for later review. RESULTS: Image analysis of cultures using APAS produced a diagnostic sensitivity and specificity of 99.0% and 84.5%, respectively. Colonies were detected by APAS on 99.0% of blood agar plates with growth and on 99.5% of MacConkey agar plates. DPR agreed with TPR for colony enumeration on 92.1% of the plates, with a sensitivity of 90.8% and specificity of 92.8% for case designation. However, several differences in the classification of colony morphologies using DPR were identified. CONCLUSIONS: APAS was shown to be a reliable screening system for urine cultures. The study also showed acceptable concordance between DPR and TPR for colony detection, enumeration, and case designation.
Agar ; Australia ; Classification ; Mass Screening ; Sensitivity and Specificity ; Sheep

One of the hazards of colorectal surgery is ureteric injury. The aim of this study was to evaluate the results of ureteric catheterization regarding its safety and operative time. One-hundred sixty two patients underwent laparoscopic segmental left or right colectomy. The mean time for placement of ureteric catheters was 11.4 min for the right hemicolectomy and 11.3 min for the left hemicolectomy group. The mean preparation times for right hemicolectomy and left hemicolectomy (group 1 vs. group 2) were 54.7 vs. 39.1 min (p=0.00001) and 61.4 vs. 47.6 min (p=0.006), respectively. There were no significant differences in the laparoscopic operative time in either the right or left hemicolectomy groups (134.2 vs. 145.5 min and 198.4 vs. 170.1 min, respectively). There was no morbidity directly related to the ureteric catheters and in fact the incidence of postoperative urinary tract infection was lower in group 1 (1.5%) than in group 2 (5.3%) (p<0.05). Although the use of ureteric catheters added a mean of 11.3 min to the surgical procedure, the overall anesthetic time for right hemicolectomy was no longer than that for left hemicolectomy. The morbidity rate was quite acceptable. Thus, ureteric catheters may be useful in selected cases of laparoscopic left and right colorectal resections.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects/*methods ; Female ; Humans ; Laparoscopy ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Safety ; Time Factors ; Ureter/injuries ; *Urinary Catheterization

BACKGROUND: There are few reports about the reproducibility of colonic transit studies. Major therapeutic decisions are rendered based upon a single colonic transit study. Therefore, the aim of this study was to access the reproducibility of colonic transit studies in patients with chronic constipation. METHODS: Fifty one (51) patients with chronic constipation underwent two separate colonic transit studies. All clinical conditions, methodologies, and patients' instructions were identical on both occasions. The gamma rate (linear correlation analysis) was taken between the first and the second colonic transit studies. The patients were subdivided into those tested within the same year and those whose tests occurred more than 12 months apart. These two groups were further divided according to the diagnosis of colonic inertia, paradoxical puborectalis contraction, and chronic idiopathic constipation. RESULTS: In 35 of the 51 patients (69%), the results were identical between the two studies; however, in 16 patients (31%), the results were disparate (gamma correlation coefficient=0.53; p<0.01). The correlation coefficient for tests repeated within one year was 0.38 (p<0.05) whereas for periods greater than one year it was 0.72 (p<0.01). The specific correlation coefficients for patients with colonic inertia, paradoxical puborectalis contraction, and chronic idiopathic constipation were 0.12, 0.21, and 0.60 (p<0.05), respectively. CONCLUSIONS: Colonic transit studies are reproducible in patients with chronic constipation, regardless of the duration between tests. The correlation coefficient is best for patients with idiopathic constipation and worst for patients with colonic inertia.
Colon* ; Constipation* ; Diagnosis ; Humans

PURPOSE: The results of a subtotal colectomy in colonic inertia, even those reported in the most recent literature, vary dramatically. The purpose of this study was to assess the effect of a colonic transit study on the results of a subtotal colectomy in colonic inertia. METHODS: Between 1992 and 1997, 30 patients underwent a subtotal colectomy with ileorectal anastomosis due to colonic inertia. Twenty-one of them underwent a colonic transit study only one time preoperatively, and 9 patients underwent such a study two times. The success rate was calculated using traditional definition with two sets of criteria. We modi fied the criteria of success by including new symptoms, such as abdominal, pelvic, or rectal pain, difficult evacuation, and loose stool or diarrhea. The success rate was recalculated using our more stringent cri teria, and compared between group 1 and group 2. RESULTS: By the traditional definition, the functional success rate was 100% for patients undergoing a colonic transit study two times preoperatively and 90% for patients undergoing only one study (p=0.34). By our more stringent criteria, the success rate was 100% for patients undergoing studies two times and 62% for those undergoing only one study (p=0.03). CONCLUSIONS: The success rate of a colectomy for colonic inertia was significantly higher for patients who underwent a repeat transit study than for those who underwent a single study. Patients who have two or more transit studies to confirm the diagnosis of inertia have a significantly higher probability of postoperative improvement of both bowel frequency and associated symptoms, such as pain and difficult evacuation. The mechanism for this discriminatory effect of repeated colonic transit studies requires elucidation by further study.
Colectomy* ; Colon* ; Constipation* ; Diagnosis ; Diarrhea ; Humans

BACKGROUND: Patients with neocortical temporal lobe epilepsy(NTLE) are reported to have less favorable outcome with anterior temporal lobectomy, and the prognostic factors for patients with non-lesional NTLE are not well defined. METHODS: We analyzed the multiple potential predictors of outcome for 26 consecutive medically intractable non-lesional NTLE patients who have had both extracranial and intracranial EEG monitoring during their presurgical evaluation prior to surgery: age, age at seizure onset, sex, seizure semiology, seizure duration and frequency, an etiology, the site of the surgery, the region of intracranial ictal onset, intracranial amobarbital procedure, neuropsychology test, neuroimaging, multiple subpial transection(MST) and surgical pathology. The average follow up period was 37.0+/-11.1(range 20-60) months. The outcome factors analyzed were compared to two types of outcome group; seizure free group(class I) and persistent seizure group(class II-IV) according to Engel's classification. RESULTS: Seventeen of 26 non-lesional NTLE patients(65.4%) were seizure free during follow up. Intracranial ictal onset confined to anterior temporal region only significantly predicted seizure free(p<0.001). Earlier seizure onset(p=0.08) and resection without MST(p=0.10) tended to be seizure free, but not statistically significant. CONCLUSION: Patients with non-lesional NTLE can be a good candidate for a tailored anterior temporal neocorticectomy with/without MST after intracranial EEG monitoring and functional mapping.
Amobarbital ; Anterior Temporal Lobectomy ; Classification ; Electroencephalography ; Epilepsy, Temporal Lobe* ; Follow-Up Studies ; Humans ; Neuroimaging ; Neuropsychology ; Pathology, Surgical ; Seizures ; Temporal Lobe*

In the last quarter of a century, the backdrop of appropriate ambulatory and office-based surgeries has changed dramatically. Procedures that were traditionally done in hospitals or patients being admitted after surgery are migrating to the outpatient setting and being discharged on the same day, respectively, at a remarkable rate. In the face of this exponential growth, anesthesiologists are constantly being challenged to maintain patient safety by understanding the appropriate patient selection, procedure, and surgical location. Recently published literature supports the trend of higher, more medically complex patients, and more complicated procedures shifting towards the outpatient arena. Several reasons that may account for this include cost incentives, advancement in anesthesia techniques, enhanced recovery after surgery (ERAS) protocols, and increased patient satisfaction. Anesthesiologists must understand that there is a lack of standardized state regulations regarding ambulatory surgery centers (ASCs) and office-based surgery (OBS) centers. Current and recently graduated anesthesiologists should be aware of the safety concerns related to the various non-hospital-based locations, the sustained growth and demand for anesthesia in the office, and the expansion of mobile anesthesia practices in the US in order to keep up and practice safely with the professional trends. Continuing procedural ambulatory shifts will require ongoing outcomes research, likely prospective in nature, on these novel outpatient procedures, in order to develop risk stratification and prediction models for the selection of the proper patient, procedure, and surgery location.

The aims of this study were to analyze annual trends of charcoal burning (CB) suicide, 2000 to 2011, and to examine the risk factors of CB suicide in Korea. Data on suicides (n=138,938) were obtained from the Statistics Korea. The proportion of CB suicides among all suicide deaths reported was 0.7% (84 cases) in 2007, and since 2008 it has rapidly increased to 7.9% (1,251 cases) in 2011. Of significant risk factors of CB suicide, the presence of the media report of Ahn's suicide was the greatest risk factor (adjusted odds ratio, 11.69; 95% CI, 10.30-13.23) of the initial phase of the continuing CB suicides since 2008. Korean Government should urgently consider effective measures against CB suicide, including enforced media regulations on reporting such suicides.
Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Charcoal ; Child ; Female ; Humans ; Incidence ; Male ; Mass Media/*statistics & numerical data ; Middle Aged ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Sex Distribution ; Suicide/psychology/*statistics & numerical data/*trends ; Young Adult

The aims of this study were to analyze annual trends of charcoal burning (CB) suicide, 2000 to 2011, and to examine the risk factors of CB suicide in Korea. Data on suicides (n=138,938) were obtained from the Statistics Korea. The proportion of CB suicides among all suicide deaths reported was 0.7% (84 cases) in 2007, and since 2008 it has rapidly increased to 7.9% (1,251 cases) in 2011. Of significant risk factors of CB suicide, the presence of the media report of Ahn's suicide was the greatest risk factor (adjusted odds ratio, 11.69; 95% CI, 10.30-13.23) of the initial phase of the continuing CB suicides since 2008. Korean Government should urgently consider effective measures against CB suicide, including enforced media regulations on reporting such suicides.
Adolescent ; Adult ; Age Distribution ; Aged ; Aged, 80 and over ; Charcoal ; Child ; Female ; Humans ; Incidence ; Male ; Mass Media/*statistics & numerical data ; Middle Aged ; Republic of Korea/epidemiology ; Risk Assessment ; Risk Factors ; Sex Distribution ; Suicide/psychology/*statistics & numerical data/*trends ; Young Adult

PURPOSE: To investigate that the effects of early wound healing stage after corneal epithelial scrape injury. METHODS: We studied the change of scraped corneal wound like corneal cells, corneal thickness, acelluar zone, and celluar morphology occurring at the time points of 1, 4, 12, 24, 48, 72 hours, and 7 days after corneal epithelial scrape injury by the confocal microscopy and EM findings in 4 each group rabbits. RESULTS: By normal confocal microscopy, the mean cell density was 891 cells/mm2 in the anterior stroma and decreased to 814 cells/mm2 in the middle stroma, 731 cells/mm2 in the posterior stroma, and the endothelial density was 3236 cells/mm2. The change in the morphology of the keratocyte nuclei from an elliptical shape anteriorly, to a more elongated shape posteriorly. Apoptosis revealed like as condensation or fragmentation of chromatin and nuclei, vesicle formation, apoptotic bodies after corneal scraped injury by EM findings. The mean thickness of normal cornea was as follow; 47 micrometer in the epithelium, 334 micrometer in the stroma, and 392 micrometer in total cornea. The thickness of postoperative cornea including stromal thickness and total thickness increased at the early wound healing stage, and then decreased to the postoperative 48 hours(P<0.001). Mean range of acellular zone in the stroma increased at the early wound healing, but significantly decreased at the postoperative 48 hours, 79 micrometer(P<0.001). CONCLUSIONS: Keratocyte cell density and corneal thickness at the three portions of cornea, the thickness of stromal acelluar zone, and the changes of cellular morphology were related with a kind of the early post-inflammatory reaction, especially 24 hours, of corneal scraped injury. It should be needed more studies concerned with control of early post-inflammatory reaction.
Apoptosis ; Cell Count ; Chromatin ; Cornea ; Epithelium ; Microscopy, Confocal ; Rabbits ; Wound Healing ; Wounds and Injuries

Clinical reasoning has been characterized as being an essential aspect of being a physician. Despite this, clinical reasoning has a variety of definitions and medical error, which is often attributed to clinical reasoning, has been reported to be a leading cause of death in the United States and abroad. Further, instructors struggle with teaching this essential ability which often does not play a significant role in the curriculum. In this article, we begin with defining clinical reasoning and then discuss four principles from the literature as well as a variety of techniques for teaching these principles to help ground an instructors’ understanding in clinical reasoning. We also tackle contemporary challenges in teaching clinical reasoning such as the integration of artificial intelligence and strategies to help with transitions in instruction (e.g., from the classroom to the clinic or from medical school to residency/registrar training) and suggest next steps for research and innovation in clinical reasoning.