How much does it cost to be fit for operation? The economics of prehabilitation

PURPOSE OF REVIEW

Prehabilitation before elective surgery can include physical, nutritional, and psychological interventions or a combination of these to allow patients to return postoperatively to baseline status as soon as possible. The purpose of this review is to analyse the current date related to the cost-effectiveness of such programs.

RECENT FINDINGS

The current literature regarding the economics of prehabilitation is limited. However, such programs have been mainly associated with either a reduction in total healthcare related costs or no increase.

SUMMARY

Prehabilitation before elective surgery has been shown to minimize the periprocedural complications and optimization of short term follow up after surgical procedures. Recent studies included cost analysis, either based on hospital accounting data or on estimates costs. The healthcare cost was mainly reduced by shortening the number of hospitalization day. Other factors included length of ICU stay, place of the prehabilitation program (in-hospital vs. home-based) and compliance to the program.

Strategies of feigning mild head injuries related to validity indicators and types of coaching: Results of two experimental studies

OBJECTIVE

In this paper, we analyzed differences between uncoached, symptom-coached, and test-coached simulators regarding strategies of feigning mild head injuries.

METHOD

Healthy undergraduates (n = 67 in the first study; n = 48 in the second study), randomized into three simulator groups, were assessed with four experimental memory tests. In the first study, tests were administered face-to-face, while in the second study, the procedure was adapted for online testing.

RESULTS

Online simulators showed a different approach to testing than face-to-face participants (U tests  < 920, p < .05). Nevertheless, both samples favored strategies like memory loss, error making, concentration difficulties, and slow responding. Except for slow responding and concentration difficulties, the favorite strategies correlated with validity indicators. In the first study, test-coached simulators (m = 4.58-5.68, SD = 2.2-3) used strategies less than uncoached participants (m = 5.25-5.88, SD = 2.26-2.84). In the second study, test-coached participants (m = 3.8-5.6, SD = 1.51-2.2) employed strategies less than uncoached (m = 6.21-7.29, SD = 1.25-1.85) and symptom-coached participants (m = 6.14-6.79, SD = 1.69-2.76).

DISCUSSION

Similarities and differences between online and face-to-face assessments are discussed. Recommendations to associate heterogeneous indicators for detecting feigning strategies are issued.

Examining the cross-cultural validity of the test of memory malingering and the Rey 15-item test

OBJECTIVE

This study was designed to investigate the cross-cultural validity of two freestanding performance validity tests (PVTs), the Test of Memory Malingering - Trial 1 (TOMM-1) and the Rey Fifteen Item Test (Rey-15) in Romanian-speaking patients.

METHODS

The TOMM-1 and Rey-15 free recall (FR) and the combination score incorporating the recognition trial (COMB) were administered to a mixed clinical sample of 61 adults referred for cognitive evaluation, 24 of whom had external incentives to appear impaired. Average scores on PVTs were compared between the two groups. Classification accuracies were computed using one PVT against another.

RESULTS

Patients with identifiable external incentives to appear impaired produced significantly lower scores and more errors on validity indicators. The largest effect sizes emerged on TOMM-1 (Cohen's d = 1.00-1.19). TOMM-1 was a significant predictor of the Rey-15 COMB ≤20 (AUC = .80; .38 sensitivity; .89 specificity at a cutoff of ≤39). Similarly, both Rey-15 indicators were significant predictors of TOMM-1 at ≤39 as the criterion (AUCs = .73-.76; .33 sensitivity; .89-.90 specificity).

CONCLUSION

Results offer a proof of concept for the cross-cultural validity of the TOMM-1 and Rey-15 in a Romanian clinical sample.

Evaluation of Various Detection Strategies in the Assessment of Noncredible Memory Performance: Results of Two Experimental Studies

OBJECTIVE

This article investigates the accuracy of individual and combined indicators based on different strategies for detecting noncredible performance as part of a new test for the continuous assessment of short-term memory.

METHOD

In two independent studies, we assessed three groups of simulators, cognitively impaired patients, and nonimpaired community members with four tasks separated by a distractor.

RESULTS

Pairwise comparisons between receiver operating characteristic (ROC) curves revealed significant differences between two clusters of indicators: mean recognition, inconsistent responses in recognition, and false positives (area under the ROC curves > .800) proved more accurate than delayed recall and false negatives (area under the ROC curves < .800) in discriminating simulators from patients. Likewise, both studies revealed that adding the false positives indicator based on cued recall to mean recognition incrementally improved classification accuracy (including sensitivity, positive predictive value, and negative predictive value ) compared with the recognition indicator alone.

CONCLUSIONS

Our results support the association of two distinct indicators for the assessment of noncredible performance, of which one should be a forced-choice indicator.

Assessment trials of the therapeutic efficacy of the drug "Zovirax" in some recurrent ocular and genital herpetic infections

In this work are reported the results of the researches performed by the authors more than a decade ago, aimed at assessing the clinical benefit of the introduction of the drug "Zovirax" in the treatment of recurrent herpetic infections with genital or ocular location. The results of the treatment carried out on a restricted group of patients were positive both in cases of genital herpes and of herpetic keratitis. The clinical benefit consisted in the reduction of the mean duration of the disease, in the shortening of the period of the infective virus elimination from the lesion, as well as in the decrease of the intensity and duration of the clinical symptomatology as a whole. With respect to these clinical parameters, the observations of the authors performed on a low number of cases are consistent with the data obtained by other authors in the framework of more extensive studies. The renewed discussion of these clinical and laboratory observations carried out by the authors during the first years after the introduction in our country of this drug in the therapeutic arsenal of herpetic infections is aimed at establishing a landmark for the comparison with more recent results of similar studies, starting from the idea of the opportunity of assessing periodically the sensitivity of herpes simplex virus strains, circulating among the autochthonous population, to the inhibitory action of some antiviral drugs. In other words, the in vitro testing of the susceptibility of these strains to the chemotherapeutic agents in current use is predictive for the efficacy degree of these drugs in the treatment of some forms of herpetic infections. This evaluation represents at the same time, undoubtedly, a useful epidemiological surveillance means of the circulation of human herpes viruses among the population. We refer especially to the risk of appearance of pharmacoresistant mutants, a risk possible under the conditions of the increased access of patients to the antiviral chemotherapeutic medication, which implicitly augments the probability of a fortuitous administration of treatments insufficient as regards the dose or the duration. In this work there are also shown the results regarding some experimental aspects related to the immune control mechanisms of the herpetic infection, which may complement the chemotherapeutic action. Under the treatment with acycloguanosine the synthesis of herpetic antigens is kept at a level sufficient for the circulating antibody synthesis induction and the HSV infected cells treated with the drug are recognized and lysed by effectors of the cell-mediated immune response of the host. Hence, it may be asserted that, in some clinical cases of recurrent herpes with frequent episodes, it is useful to perform immunostimulating treatments, able to potentiate the cell-mediated immune mechanisms possibly involved in the limitation of the herpetic infection at the peripheral level and of its spreading in the central nervous system.

Observations regarding the neurocytokaryological study of the experimental infection with herpes simplex virus type 1 and type 2 in the white mouse

Mice distributed in groups were inoculated with the herpes virus simplex type 1 and type 2 strains in various dilutions (10(-1)-10(-7)), which had been maintained on primary human embryo cell cultures. The animals were killed and homogenates were prepared of their brains, which were used for testing the infective titre in vivo and for the isolation of nuclei, by means of the Hymer-Kuff technique. For the cytokaryological examinations, smears were prepared from the homogenate, which were stained by May-Grünwald-Giemsa and Mann methods. The cell and nucleus types were evaluated morphologically, descriptively, according to the size and structure. On the basis of three criteria the following groups were set up: large sized cells with bulky nuclei; middle sized cells with nuclei of a medium size; small sized cells with small nuclei and visible nucleoli; small sized cells with small, tachychromatic nuclei; cells exhibiting karyolysis. In both the infection with herpes virus simplex type 1 and type 2, the small sized cells with small tachychromatic nuclei represent the highest rate. Between the variants of the elaborated models no significant differences regarding the cell and nucleus types are recorded. On the whole, the cytokaryological picture does not exhibit notable differences, but rather resemblances with respect to the proportionality of the nucleus types in the experimental variants studied, in the case of herpes simplex virus type 1 and 2 induced infections.

Spectral and biological characteristics of some Acyclovir salts

In the present work there are described some spectral characteristics in the ultraviolet and infrared region under various environment conditions for a series of synthetic analogues of deoxyguanosine, substances possessing antiviral properties. The study is performed on the Acyclovir compounds and on its Na, K and Li salts, synthetized in Romania, in comparison with the similar product Zovirax, of the "Wellcome" firm (England), used in the clinical practice for several years. The results show a very marked resemblance of the spectral behavior for all these products, a conclusion confirmed by the similar biological effects in the herpetic infection.

Testing of the in vivo therapeutic efficacy on the cutaneous herpes simplex infections of the autochthonous product 5% Acyclovir ointment

The experimental results of the in vivo testing of an autochthonous pharmaceutical Acyclovir form prepared for the topical treatment of herpetic infections with a mucocutaneous location are shown in this paper. This testing on laboratory animals continues the in vivo performed investigations regarding the antiviral activity of this compound, which have proved that the efficacy of the inhibitory action exerted by the product on the Herpes simplex virus multiplication is comparable with the characteristics of the standard substance (Acyclovir-Zovirax Wellcome). By testing the therapeutic efficacy of the autochthonous Acyclovir preparation on an experimental model of cutaneous herpes infection in the newborn rat, it is demonstrated in a statistically significant manner that the product exerts a strong inhibitory action on the virus multiplication at the level of epidermis (proved by the lowering of virus production in the cutaneous tissue); the result is a drastic reduction of local herpes vesicles and of virus propagation in the neuraxis attended by the appearance of herpes meningo-encephalitis with a lethal course. The preparation is well tolerated (phenomena of local intolerance or remote toxicity were not observed). These in vivo positive results corroborated by those obtained in vitro complete the experimental argumentation necessary to support the proposal regarding the clinical trial of the product.

Natural propolis extract NIVCRISOL in the treatment of acute and chronic rhinopharyngitis in children

In the work there are shown the results of a "case control" study carried out in a children collectivity (preschool children and school-children), regarding the action of an aqueous propolis extract, NIVCRISOL, in acute and chronic inflammatory diseases of the upper airways. The preparation, which had a rich content of flavonoids, was administered to a group of preschool children and school-children treated during the whole cold season 1994-1995. The monitoring of the subgroups investigated was performed by clinical observation of the health state and recording of the incidence of symptoms characteristic to acute or chronic rhinopharyngeal diseases, as well as by a periodical laboratory examination for the detection and characterization of viral, microbial and fungal germs carriage. The analysis of the data obtained pointed out the favourable effects of this local treatment, expressed by lowering of the number of cases with acute or chronic symptoms, and decrease and sometimes suppression of the viral-microbial flora carriage of the upper airways. These positive results, the good tolerance of the preparation, the advantages of the therapy with natural products and more economic criteria entitle us to propose the administration of this preparation as an adjuvant medication in the local treatment of some clinical forms of acute or chronic rhinopharyngeal diseases.

Testing of some pharmacological characteristics of the autochthonous product Acyclovir

In the present work, the preliminary results of a study regarding the pharmacokinetic properties of the autochthonous synthetic drug Acyclovir are shown. The in vitro and in vivo toxicologic test demonstrates a low toxicity of this product, the drug being well tolerated both by the laboratory animal and by the fibroblasts of the human embryo. The specific antiviral action of the product on the multiplication in vitro of the Herpes simplex virus types 1 and 2, appreciated by the lowering capacity of the infection titre and by the determination of the inhibitory concentration 50% (IC50), is significant and comparable with previous results obtained by the authors by testing the drug Zovirax of the Welcome firm.

[Morphologic changes following experimental influenza virus infection and the therapeutic administration of flavonoids in aqueous extract]

Influenza virus strain A/PR8/34(H1N1) and flavonoid aqueous extract with therapeutical function were administered by intranasal route. Pathological examinations were done three and ten days after administration to evaluate the morphological modifications established in the lung parenchyma. Results showed that therapeutical administration of flavonoids had good effects on interstitial bronchopneumonia evolution till complete recovery. Flavonoid aqueous extract administered by intranasal route was well tolerated by the organism.

[The mechanism of the antiherpetic action of an aqueous propolis extract. II. The action of the lectins of an aqueous propolis extract]

The report brings proofs of the presence of a lectin in the water propolis extract. It was detected in human fibroblast extracts previously treated with the propolis extract. Presence of the lectin was confirmed by polyacrylamide gel electrophoresis in the presence of SDS.

[Mechanism of the anti-herpetic activity of aqueous extract of propolis. II. Activity of lectins from the aqueous extract of propolis]

The report brings proofs of the presence of a lectin in the water propolis extract. It was detected in human fibroblast extracts previously treated with the propolis extract. Presence of the lectin was confirmed by polyacrylamide gel electrophoresis in the presence of SDS.

[The mechanisms of the antiherpetic action of aqueous propolis extracts. I. The antioxidant action on human fibroblast cultures]

A redox state modulation model was worked out in human fibroblast cultures treated with oxidation stress inducing agents and a redox agent, virtually protecting cell against the stress. Quantification of the global redox changes in fibroblasts was done using the hemoglobin electronic spectrum, in the presence and in the absence of H2O2.

[Treatment of cutaneous herpes and herpes zoster with Nivcrisol-D]

The results obtained at the Dermatological service of the Colentina Hospital show that the product NIVCRISOL-D, containing propolis, has a significant therapeutical effect against recurrent herpes and zona zoster.

The effect of an aqueous propolis extract, of rutin and of a rutin-quercetin mixture on experimental influenza virus infection in mice

Investigations were performed on the effect of an aqueous propolis extract, of rutin and of a rutin-quercetin mixture on experimental infection with influenza virus A/PR8/34 (H0N1) in mice. Propolis extract administered intranasally 3 hours before virus inoculation led to a reduction of the HA titers recorded in the lung suspensions from infected mice, but to no reduction in mortality or increase in mean survival length. When the extract was administered 3 hours after virus inoculation, the reduction in HA titer was accompanied by a slight decrease in mortality and increase in mean survival length, Rutin and the rutin-quercetin mixture caused an increase in both HA titer and mortality.

Investigations concerning the action of serveral chemical and biological agents on HBsAg

Native and purified HBsAg preparations were subjected in vitro to the action of cetylpyridinium bromide (Bromocet), hibitan-chlorhexidine (Hibiscrub), chloramine B and propolis extract, at different concentrations and for various time intervals. The effect of these agents on the serological reactivity of HBsAg was tested by electroimmunodiffusion (EID) and radioimmunoassay (RIA). Chloramine B and the propolis extract had a significant inhibitory effect-ascertained by both EID and RIA - on purified HBsAg, but not on the native preparation. The inhibition exerted by Bromocet and Hibiscrub indicated by EID results was not confirmed by RIA.

Influence of 2,4,6-triamino-pyrimidyl-5-azobenzene on the activities of acid phosphatase, alkaline phosphatase and lactate dehydrogenase in cell cultures infected with herpes simplex virus type 1

Treatment of VERO cells with 2,4,6-triamino-pyridimyl-5-azobenzene (10 gamma/ml) one hour after inoculation of herpes simplex virus type 1 limits the influence of the virus infection, consisting in the enchancement of the activities of alkaline phosphatase, acid phosphatase and LDH (especially of the latter two enzymes) and in changes in the isoenzyme patterns of acid and alkaline phosphatases and of peroxidase. In general the influence of the drug is expressed both by the fact that enzyme levels in homogenates of infected cells become closer to the values recorded in controls, and by modifications in the isoenzyme patterns altered by virus multiplication, making them more similar to those of uninfected, untreated cells.

Isoenzymes of lactate dehydrogenase, acid phosphatase, alkaline phosphatase and peroxidase in monkey kidney cell cultures inoculated with herpes virus type 1

The variation of lactate dehydrogenase, peroxidase, acid and alkaline phosphatase isoenzymes was studied in VERO cells inoculated with infectant and UV-inactivated herpes simplex virus type 1 (HSV--1). Infectant HSV--1 induced quantitative and qualitative modifications in isoenzyme patterns within the first 4 hours post inoculation (p.i.). The modifications caused by the UV-inactivated HSV--1 were similar, but appeared 8 hours p.i. The possibility of using isoenzyme modifications as rapid, sensitive and specific biochemical tests for virus detection and differentiation between infectant and inactivated virus is discussed.

Activity of lactate dehydrogenase, acid and alkaline phosphatases in measles virus-infected monkey kidney cell cultures

The influence of wild (Co-69) and attenuated (L-16) measles virus infection on the activity and activation energy of lactate dehydrogenase (LDH), acid and alkaline phosphatases (P-ase) was tested in R9CA monkey kidney cells at various time intervals after inoculation. With both virus strains significant changes in enzymatic activity occurred especially within the first 24 hours post inoculation. The two stains have a different influence on alkaline P-ase activity variation, which might therefore be used as a differentiation marker. Variations in LDH activation energy might be an early indicator of virus infection. LDH activity is significantly higher in cellular homogenates diluted 1:10, the dilution effect being more obvious in infected cells after a longer time interval post inoculation.