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Stark M, Mynbaev O, Malvasi A, Tinelli A. Revolutionizing patient care: the harmonious blend of artificial intelligence and surgical tradition. Int J Clin Exp Pathol 2024; 17:47-50. [PMID: 38455508 PMCID: PMC10915289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/23/2024] [Indexed: 03/09/2024]
Abstract
Surgery has undergone remarkable evolution over the past decades, propelled by unprecedented technological advancement. Despite these changes, the role of surgeons and their irreplaceable qualities remains pivotal. This article delves into the intersection of surgery and artificial intelligence (AI), underscoring the enduring significance of human expertise and values. The potential of AI to learn and improve over time holds great promise for enhancing various facets of surgery, including diagnostics, personalized treatment, preoperative planning, real-time support in the operating room, and comprehensive postoperative analytics of the outcome. However, it is essential to emphasize the continued importance of the surgeon's role to uphold universal surgical principles. This includes a commitment to minimalism and the use of evidence-based practice, ensuring optimal outcomes and standardized procedures. By recognizing the synergies between AI and traditional surgical approaches, we can navigate the evolving landscape of surgery to achieve the highest standards of patient care.
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy10117 Berlin, Germany
| | - Ospan Mynbaev
- The New European Surgical Academy10117 Berlin, Germany
| | - Antonio Malvasi
- The New European Surgical Academy10117 Berlin, Germany
- Department of Biomedical Sciences and Human Oncology, University of Bari70121 Bari, Italy
| | - Andrea Tinelli
- The New European Surgical Academy10117 Berlin, Germany
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris delli Ponti HospitalScorrano, 73020 Lecce, Italy
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Meade M, Buchan L, Stark M, Woods B. Evidence-Based Medicine and Observational Studies. Clin Spine Surg 2023:01933606-990000000-00233. [PMID: 37941105 DOI: 10.1097/bsd.0000000000001550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
Evidence-based medicine drives medical decision-making in the modern era, which has historically favored randomized control trials. Despite their notoriety, randomized control trials have multiple disadvantages when applied to spinal surgery. Observational studies are popular in spinal surgery literature and are seen in various forms, such as retrospective studies and prospective cohort studies. For researchers, learners, and practicing spine surgeons, this paper describes options for study design when applied to spinal surgery.
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Affiliation(s)
- Matthew Meade
- Division of Orthopaedic Surgery, Jefferson Health, Stratford, NJ
| | - Levi Buchan
- Division of Orthopaedic Surgery, Jefferson Health, Stratford, NJ
| | - Michael Stark
- Division of Orthopaedic Surgery, Jefferson Health, Stratford, NJ
| | - Barrett Woods
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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McBride GM, Rumbold AR, Keir AK, Kunnel A, Buxton M, Jones S, Summers L, Stark M, Grzeskowiak LE. Longitudinal trends in domperidone dispensing to mothers of very preterm infants and its association with breast milk feeding at infant discharge: a retrospective study. BMJ Paediatr Open 2023; 7:e002195. [PMID: 37923344 PMCID: PMC10626788 DOI: 10.1136/bmjpo-2023-002195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE This study aims: (a) to evaluate patterns of domperidone dispensing to mothers of very preterm (<32 weeks gestation) infants born before and after 2014 when international recommendations were made to limit its use and (b) to examine characteristics associated with domperidone dispensing and impacts on breast milk feeding rates at infant hospital discharge. DESIGN Retrospective audit using linked electronic medical records and hospital pharmacy records. SETTING Tertiary-referral neonatal intensive care unit at the Women's and Children's Hospital in South Australia. PATIENTS Mothers of preterm infants admitted to neonatal intensive care from January 2004 to December 2018. MAIN OUTCOME MEASURES Rate of domperidone dispensing compared pre-2014 and post-2014 recommendations using interrupted time series analyses, and breast milk feeding rates at infant discharge based on domperidone treatment status, adjusted for other factors known to influence breast milk production. RESULTS Overall, domperidone was dispensed to 691 (41%) of 1688 mothers. Prior to 2014 recommendations, the proportion of women dispensed domperidone was stable. Following the recommendations, there was a significant reduction in trend (-2.55% per half year, 95% CI -4.57% to -0.53%;), reflecting less domperidone dispensing.Breast milk feeding rates at discharge remained consistently lower in infants of women dispensed domperidone than those who were not (adjusted OR 0.58, 95% CI 0.45 to 0.75). CONCLUSION Domperidone dispensing in mothers of hospitalised very preterm infants has declined over time following international regulatory warnings. Breast milk feeding rates remain lower in mothers prescribed domperidone, suggesting further research is needed to optimise lactation support for mothers of very preterm infants.
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Affiliation(s)
- Grace McKenzie McBride
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Alice R Rumbold
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Amy K Keir
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Aline Kunnel
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
| | - Michael Buxton
- SA Pharmacy, SA Health, Adelaide, South Australia, Australia
| | - Susanne Jones
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Laura Summers
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Michael Stark
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
- Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Luke E Grzeskowiak
- South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute, Adelaide, South Australia, Australia
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Hague WM, Briley A, Callaway L, Dekker Nitert M, Gehlert J, Graham D, Grzeskowiak L, Makris A, Markus C, Middleton P, Peek MJ, Shand A, Stark M, Waugh J. Intrahepatic cholestasis of pregnancy - Diagnosis and management: A consensus statement of the Society of Obstetric Medicine of Australia and New Zealand (SOMANZ): Executive summary. Aust N Z J Obstet Gynaecol 2023; 63:656-665. [PMID: 37431680 DOI: 10.1111/ajo.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/24/2023] [Indexed: 07/12/2023]
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy liver disease, characterised by pruritus and increased total serum bile acids (TSBA), Australian incidence 0.6-0.7%. ICP is diagnosed by non-fasting TSBA ≥19 μmol/L in a pregnant woman with pruritus without rash without a known pre-existing liver disorder. Peak TSBA ≥40 and ≥100 μmol/L identify severe and very severe disease respectively, associated with spontaneous preterm birth when severe, and with stillbirth, when very severe. Benefit-vs-risk for iatrogenic preterm birth in ICP remains uncertain. Ursodeoxycholic acid remains the best pharmacotherapy preterm, improving perinatal outcome and reducing pruritus, although it has not been shown to reduce stillbirth.
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Affiliation(s)
- William M Hague
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Annette Briley
- Women's Health & Midwifery Research, College of Nursing & Health Sciences, Bedford Park, South Australia, Australia
| | - Leonie Callaway
- Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marloes Dekker Nitert
- School of Chemistry and Molecular Biosciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Jessica Gehlert
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Dorothy Graham
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Luke Grzeskowiak
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Angela Makris
- Liverpool Hospital, Sydney, New South Wales, Australia
| | - Corey Markus
- College of Medicine & Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Philippa Middleton
- SA Health and Medical Research Institute, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Michael J Peek
- College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Antonia Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Michael Stark
- Women's and Children's Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jason Waugh
- Auckland City Hospital, Auckland, New Zealand
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Crawford T, Andersen C, Marks DC, Robertson SA, Stark M. Does donor sex influence the potential for transfusion with washed packed red blood cells to limit transfusion-related immune responses in preterm newborns? Arch Dis Child Fetal Neonatal Ed 2023; 108:471-477. [PMID: 36690436 DOI: 10.1136/archdischild-2022-324531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the association of donor sex with transfusion-associated recipient immune responses in preterm newborns receiving unwashed and washed blood. DESIGN A cohort study using data collected during the Effect of Washed versus Unwashed Packed Red Blood Cell Transfusion on Immune Responses in the Extremely Preterm Newborn randomised trial. SETTING Participants were recruited from two South Australian hospitals between September 2015 and December 2020. PATIENTS Preterm newborns (<29 weeks). INTERVENTIONS Transfusion with unwashed and washed packed red blood cells (PRBCs) from either exclusively male or any female donor for the first three transfusions. MAIN OUTCOMES MEASURES The primary outcome was the change from baseline in post-transfusion plasma cytokine concentrations, specifically interferon gamma, interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, IL-17A and tumour necrosis factor (TNF). RESULTS In total, 153 newborns were evaluated. By the third transfusion, the magnitude of pretransfusion to post-transfusion change in cytokines between the groups differed for IL-6 (p=0.003), IL-12 (p=0.008), IL-17A (p=0.003) and TNF (p=0.007). On post hoc comparison, compared with the unwashed-any female donor group, IL-6 (p<0.05), IL-12 (p<0.05) and IL-17A (p<0.01) were lower in the washed-exclusively male donor group, and IL-6 (p<0.01), IL-12 (p<0.05) and TNF (p<0.01) were lower in the washed-any female donor group. CONCLUSION These findings suggest that transfusion with unwashed PRBCs from female donors is associated with an increased recipient immune response, an effect that can be ameliorated with pretransfusion washing. Larger randomised controlled studies confirming this mechanistic link between donor sex and transfusion-associated morbidity are warranted. TRIAL REGISTRATION NUMBER ACTRN12613000237785.
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Affiliation(s)
- Tara Crawford
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Chad Andersen
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Denese C Marks
- Product Development and Storage, Australian Red Cross Blood Service New South Wales and Australian Capital Territory, Alexandria, New South Wales, Australia
| | - Sarah A Robertson
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Michael Stark
- Neonatal Medicine, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
- The University of Adelaide Robinson Research Institute, North Adelaide, South Australia, Australia
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Stark M, Mynbaev O, Malvasi A, Tinelli A. Inviting Newton to Visit the Delivery Room. The Role of Gravity During Childbirth. Int J Womens Health 2023; 15:1059-1061. [PMID: 37465720 PMCID: PMC10351960 DOI: 10.2147/ijwh.s405077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Throughout history, the upright position was the norm for most deliveries. However, due to cultural reasons, this practice was changed in the 17th century, and since then, the majority of deliveries have been conducted with the parturient lying on her back. The aim of this review article is to challenge the nowadays recumbent birth position and to emphasize the added value of gravity to the childbirth. Physiologically there is a strong argument for delivering in an upright position due to the significant role of gravity. The baby's presenting part does not move back between contractions as happens in today's recumbent position when due to the anatomy of the pelvis, the presenting part moves uphill. In this position, the second stage is shorter, and the signal for active pushing occurs spontaneously. It is recommended that any parturient should be informed about the risks and benefits of each birthing option to decide the birthing position that suits her.
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Affiliation(s)
| | | | - Antonio Malvasi
- The New European Surgical Academy, Berlin, Germany
- Department of Obstetrics and Gynecology, Santa Maria Hospital G.V.M. Care & Research, Bari, Italy
| | - Andrea Tinelli
- The New European Surgical Academy, Berlin, Germany
- Department of Obstetrics and Gynecology and CERICSAL (CEntro di RIcerca Clinico SALentino), Veris delli Ponti Hospital, Scorrano, Lecce, Italy
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Yanni M, Stark M, Francis L, Francis JR, McMillan M, Baird R, Heath PT, Gordon A, Riccardione J, Wilson A, Lee R, Chooi K, Quinn OP, Marshall HS. Neonatal Group B Streptococcal Infection in Australia: A Case-control Study. Pediatr Infect Dis J 2023; 42:429-435. [PMID: 36929884 DOI: 10.1097/inf.0000000000003881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND To determine maternal and neonatal risk factors for, and incidence of, neonatal early-onset group B streptococcus (EOGBS) and late-onset (LOGBS) infection in South Australia (SA) and the Northern Territory (NT). METHODS A case-control study with 2:1 matched controls to cases. The study included tertiary hospitals in South Australia and the Northern Territory, Australia. Retrospective data were collected from a 16-year epoch (2000-2015). RESULTS Of a total of 188 clinically suspected or confirmed cases, 139 were confirmed, of which 56.1% (n = 78) were EOGBS and 43.9% (n = 61) were LOGBS. The incidence of clinically suspected and confirmed cases of EOGBS was 0.26/1000 live births in SA and 0.73/1000 live births in the NT, and the incidence of confirmed cases was 0.19/1000 for SA and 0.36/1000 for the NT. The incidence of clinically suspected or confirmed LOGBS was 0.18/1000 live births in SA and 0.16/1000 for the NT. The majority of infants with GBS presented with sepsis, pneumonia, or meningitis. Developmental delay was the most commonly recorded long-term complication at 1 year old. Risk factors for EOGBS included maternal GBS carriage, previous fetal death, identifying as Aboriginal and/or Torres Strait Islander, and maternal fever in labor/chorioamnionitis. CONCLUSIONS GBS remains a leading cause of neonatal morbidity and mortality. Adding previous fetal death to GBS screening guidelines would improve GBS prevention. The introduction of maternal GBS vaccination programs should be guided by country-specific disease epidemiology.
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Affiliation(s)
- Marianne Yanni
- From the Department of Paediatrics, Women's and Children's Health Network, Adelaide, South Australia, Australia
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Stark
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Neonatology, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Laura Francis
- Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Joshua R Francis
- Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Mark McMillan
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Rob Baird
- Territory Pathology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group & Vaccine Institute St George's, University of London, London, United Kingdom
| | - Alex Gordon
- From the Department of Paediatrics, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - James Riccardione
- Territory Pathology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Angela Wilson
- Territory Pathology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Rebecca Lee
- Department of Paediatrics, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Kathrina Chooi
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Olivia-Paris Quinn
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Helen S Marshall
- From the Department of Paediatrics, Women's and Children's Health Network, Adelaide, South Australia, Australia
- Robinson Research Institute and Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Health Network, Adelaide, South Australia, Australia
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Mynbaev OA, Tzabari A, Idrissov KS, Stark M. Letter to the Editor: What is rationality in applying adhesion barriers during Cesarean sections? Surgery 2023:S0039-6060(23)00111-3. [PMID: 36997425 DOI: 10.1016/j.surg.2023.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 03/30/2023]
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Michael M, Stark M, Woods B. Effectiveness of Intraoperative Neuromonitoring in a Patient Undergoing a One-Level Transforaminal Lumbar Interbody Fusion: A Case Report. Cureus 2023; 15:e35580. [PMID: 37007300 PMCID: PMC10062402 DOI: 10.7759/cureus.35580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are common modes of operative treatment of lumbar radiculopathy and spondylolisthesis. An integral part of these procedures is the appropriate placement of pedicle screws to ensure proper fusion. Breach of the medial cortex during pedicle screw fixation can potentially cause permanent impairment for a patient; significant technology and resources have been universally devoted to preventing this complication. Intraoperative neuromonitoring (IONM) is a frequently used tool by spine surgeons, which, along with fluoroscopy, is traditionally thought to reduce the incidence of neurologic injury. Unfortunately, IONM is not infallible and, in certain studies, has not been shown to decrease the risk of neurologic compromise. This case presentation details the clinical course of a 55-year-old who underwent an L4-5 TLIF. Despite benign electromyography recordings intraoperatively, the patient presented postoperatively with a new-onset left foot drop and a CT scan that confirmed bilateral L4 screw malposition with a breach of the medial cortex. We hope to further advance the discussion regarding the dangerous inconsistency of IONM in hopes of identifying a multimodal approach to avoid dreaded complications like this one in the future.
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Stark M, Woods B. Developing an Idea into a Research Question. Clin Spine Surg 2023; 36:34-36. [PMID: 36097337 DOI: 10.1097/bsd.0000000000001393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/17/2022] [Indexed: 02/07/2023]
Abstract
The success of obtaining answers in any research project relies on how well the investigators are able to ask the right question. The PICO (Patient, Intervention, Comparator, Outcomes) approach provides a framework to develop this question utilizing four major elements: Population, Intervention, Comparison, Outcomes. This paper provides a framework for both the young and the experienced surgeon in the use of the PICO approach to construct a clear research question.
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Affiliation(s)
- Michael Stark
- Division of Orthopaedic Surgery, Rowan University, Stratford, NJ
| | - Barrett Woods
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Zeky N, Glisson K, LeBlanc C, Beyl R, Stark M. Establishing normal mucosal eosinophil counts in pediatric gastrointestinal biopsies in Lousiana. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00562-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Condon K, Anderson M, Stark M, Dietrich ML. Case of complex cutaneous leishmaniasis in four year old female with prior residence in honduras. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Fletcher R, Symonds I, StGeorge J, Warland J, Stark M. Testing the acceptability of stillbirth awareness messages in an SMS program for fathers. Health Promot J Austr 2023; 34:149-155. [PMID: 36450663 PMCID: PMC10107767 DOI: 10.1002/hpja.686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 10/04/2022] [Accepted: 11/20/2022] [Indexed: 12/04/2022] Open
Abstract
ISSUE ADDRESSED To raise expectant fathers' awareness of risk factors for stillbirth. METHODS A set of brief text messages was developed addressing recognised risk factors for stillbirth: avoidance of maternal cigarette smoking, maternal going to sleep on side messaging, awareness of the importance of noticing and reporting changes in foetal movement and fathers' involvement in shared decision making for timing of birth. Eight messages were inserted into the SMS4dads pilot program being conducted by NSW Health. Feedback on the messages was requested. Participants rated the quality of the messages on a three-point Likert scale and provided comments. RESULTS Overall, 2528 messages were sent to 626 fathers' mobile phones, 45% of fathers replied with 666 ratings and 115 comments evaluating the texts. The quantitative ratings indicated substantial overall approval of the messages. Within the coding category "Evaluation of Message Content," three themes described fathers' reactions and feelings about the smoking, movement, side sleeping and birth timing messages: "important-good information," "not appropriate/anxiety provoking" and "not relevant-obvious." Three themes reflecting the attributes of the messages within the "Service Quality" category were "need more information," "complements public health" and "child voice fit." CONCLUSIONS Results indicate that the messages are an acceptable way to provide information and suggested actions addressing stillbirth risk factors to fathers-to-be. SO WHAT?: Fathers' awareness of the risk factors for stillbirth can assist mothers to take appropriate actions for a healthy birth. Information on risk factors can be provided to fathers via a father-focused text messaging service.
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Affiliation(s)
- Richard Fletcher
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Ian Symonds
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Jennifer StGeorge
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Jane Warland
- School of Nursing, Curtin University, Perth, WA, Australia
| | - Michael Stark
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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Benhidjeb T, Benhidjeb I, Stark M, Kreisel S, Krüger M, Pfitzenmaier J, Schulte am Esch J. Women's Perception of Transgastric and Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) - Impact of Medical Education, Stage of Life and Cross-Cultural Aspects. Int J Womens Health 2022; 14:1881-1895. [PMID: 36601385 PMCID: PMC9807120 DOI: 10.2147/ijwh.s382457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/17/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Despite that NOTES produces at least matchable clinical long-term results when compared to laparoscopy, still a restraint within the medical community and among patients is evident. Consequently, it might be meaningful to evaluate factors of patient's NOTES perception to promote its acceptance. NOTES is still quite novel and questionnaires regarding its perception by the public is still lacking even so in the Middle East. Aim of our survey is to investigate the viewpoint of female healthcare staff on NOTES. Materials and Methods A total of 350 questionnaires along with written information about Minimally Invasive Surgery and NOTES were distributed among the female staff in a Tertiary-care Hospital in Abu Dhabi, 257 were returned completely anonymously and voluntarily and entered into a database with a response rate of 73%. We surveyed factors like religion, medical background, age as well as history of previous laparoscopy, endoscopy, birth and other aspects that may impact a woman's perception of both transgastric and transvaginal NOTES for cholecystectomy and ovariectomy, respectively. Results Univariate analyses revealed the majority of Muslim women to be more receptive to NOTES as a choice of surgical technique for cholecystectomy and for ovariectomy, respectively, when compared to Christians and Hindus. However, when compared to Muslims, Christian and Hindu groups had a larger share of medical professions. Women with a medical background would opt significantly less for NOTES. Among younger women, NOTES cholecystectomy was refused due to anxiety concerning future pregnancies and sexual dysfunction. Multinomial logistic regression analysis determined medical background and with independent predictive value for the overall choice of interventional technique (p<0.001). Marital status played a significant role only in the comparison of laparoscopy vs transgastric NOTES when performing cholecystectomy and ovariectomy (p<0.01). Conclusion In this first study emanating from the Middle East, medical education and partly life stage rather than cross-cultural differences seem to influence NOTES perception in women.
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Affiliation(s)
- Tahar Benhidjeb
- Department of General and Visceral Surgery, Center for General, Vascular, Thoracic and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany,The New European Surgical Academy (NESA), Berlin, Germany,Correspondence: Tahar Benhidjeb, Department of General and Visceral Surgery, Center for General, Vascular, Thoracic and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Schildescher Str. 99, Bielefeld, 33611, Germany, Email ;
| | - Isabel Benhidjeb
- Department of Urology, Center for Computer-Assisted and Robotic Urology, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
| | - Stefan Kreisel
- Department of Psychiatry and Psychotherapy, Section Gerontopsychiatry, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Martin Krüger
- Department of Internal Medicine and Gastroenterology, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Jesco Pfitzenmaier
- Department of Urology, Center for Computer-Assisted and Robotic Urology, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
| | - Jan Schulte am Esch
- Department of General and Visceral Surgery, Center for General, Vascular, Thoracic and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, Campus Bielefeld Bethel, University of Bielefeld, Bielefeld, Germany
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Baimaganbetov AK, Stark M, Tinelli A, Mynbaev OA, Mynbaev OA. Short- and Long-Term Consequences of CO2 Pneumoperitoneum Impact on Children's Health. Turk J Anaesthesiol Reanim 2022; 50:474-475. [PMID: 36511503 PMCID: PMC9885825 DOI: 10.5152/tjar.2021.21193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Amirkhan K. Baimaganbetov
- Department of Traumatology, Orthopaedics and Oncology, Khoja-Akhmet Yassawi International Kazakh-Turkish University, Turkestan Region, Kazakhstan
| | - Michael Stark
- Headquarters New European Surgical Academy, Berlin, Germany
| | - Andrea Tinelli
- Department of Obstetrics & Gynecology, Veris delli Ponti Hospital, Italy
| | - Ospan A. Mynbaev
- Laboratory of Human Physiology Moscow Institute of Physics and Technology, National Research Institute, Moscow, Russia,Corresponding author: Ospan A. Mynbaev, e-mail:
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Brzezinski RY, Melloul A, Berliner S, Goldiner I, Stark M, Rogowski O, Banai S, Shenhar-Tsarfaty S, Shacham Y. Early detection of inflammation-prone STEMI patients using the CRP Troponin Test (CTT). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Elevated concentrations of C-reactive protein (CRP) early after acute coronary syndrome (ACS) may reflect the magnitude of the inflammatory response to myocardial damage and are associated with worse outcome. However, the routine measurement of both CRP and cardiac troponin simultaneously in the setting of ST segment myocardial infarction (STEMI) is not used broadly. Here, we sought to identify and characterize individuals who are prone to an elevated inflammatory response following STEMI using the CRP Troponin test (CTT) and determine their short- and long-term outcome.
Material and methods
We retrospectively examined 1,186 patients with the diagnosis of acute STEMI, who had at least two successive measurements of combined CRP and cardiac troponin (up to 6 hours apart), all within the first 48 hours of admission. We used Chi-Square Automatic Interaction Detector (CHAID) tree analysis to determine which parameters, timing (baseline vs. serial measurements), and cut-offs should be used to predict mortality.
Results
Patients with high CRP concentrations (above 90th percentile, >33mg/L) had higher 30 day- and all-cause mortality rates regardless of their troponin test status (above or below 118,000 ng/L); 14.4% vs 2.7%, p<0.01. Furthermore, patients with both high CRP and high Troponin levels on their second measurement had the highest 30-day mortality rates compared to the rest of the cohort; 21.4% vs. 3.7%, p<0.01. These patients also had the highest all-cause mortality rates after a median follow up of 4.5 years compared to the rest of the cohort; 42.9% vs 12.7%, p<0.01 (Figure 1).
Conclusions
In conclusion, serial measurements of both CRP and cardiac troponin might detect patients at increased risk for short-and long-term mortality following STEMI. We suggest the future use of the combined CRP Troponin-test (CTT) as a potential early marker for inflammatory-prone patients with worse outcomes following ACS. This sub-type of patients might benefit from early anti-inflammatory therapy such as colchicine and anti-IL-1β agents.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Y Brzezinski
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - A Melloul
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - S Berliner
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - I Goldiner
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - M Stark
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - O Rogowski
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - S Banai
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - S Shenhar-Tsarfaty
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Y Shacham
- Tel Aviv University and Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
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18
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Stark M, Matzon JL. Cephalic Vein Intravascular Foreign Body After a Penetrating Injury: A Case Report. JBJS Case Connect 2022; 12:01709767-202212000-00019. [PMID: 36820849 DOI: 10.2106/jbjs.cc.22.00497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 06/18/2023]
Abstract
CASE A 65-year-old man presented with a right forearm metallic foreign body after a projectile injury while using a table saw. The area in question appeared infected prompting a surgical incision and drainage. In the operating room, the metallic foreign body was noted to be entirely intravascular within the lumen of the cephalic vein. It was ultimately removed, and the patient recovered without complication. CONCLUSION Although foreign bodies after traumatic injury are common, it is exceedingly rare to encounter an intravascular foreign body. However, the consequences of proximal migration can be devastating and thus should be in the differential diagnosis for all treating surgeons.
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Affiliation(s)
- Michael Stark
- Division of Orthopaedic Surgery, Rowan University, Stratford, New Jersey
| | - Jonas L Matzon
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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19
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Stark M, Malvasi A, Mynbaev O, Tinelli A. The Renaissance of the Vaginal Hysterectomy-A Due Act. Int J Environ Res Public Health 2022; 19:11381. [PMID: 36141653 PMCID: PMC9516991 DOI: 10.3390/ijerph191811381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
For many years, vaginal and abdominal hysterectomies were part of the routine procedures in many departments. Both of them lost their priority due to the introduction of endoscopy and robotic surgery. The disappearing abdominal hysterectomy is certainly reasonable, but the decline of using vaginal hysterectomy seems not to be justified, and it is an optimal example of the recent emergence of the Natural Orifice Surgery discipline. A modified method for vaginal hysterectomy is presented in order to encourage gynecologists to reconsider vaginal hysterectomy as a valid method. This method is the outcome of critical analyses of different vaginal hysterectomy methods. It is simple, reasonable, only ten steps, easy to learn, perform and teach, and proven to be a shorter operation with minimal blood loss and reduced need for analgesics when compared to the traditional way. Endoscopy or robotic surgery is not available everywhere. Therefore, it is important that gynecologists in low-resource settings be familiar with this simple method.
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
| | - Antonio Malvasi
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
| | - Ospan Mynbaev
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
| | - Andrea Tinelli
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow 141701, Russia
- Department of Obstetrics and Gynecology and CERICSAL (Centro di Ricerca Clinico Salentino), “Veris delli Ponti Hospital”, 73020 Scorrano, Lecce, Italy
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20
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Zaami S, Stark M. Fertility Preservation in Oncological Patients. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4909205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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21
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Kohse EK, Siebert HK, Sasu PB, Loock K, Dohrmann T, Breitfeld P, Barclay-Steuart A, Stark M, Sehner S, Zöllner C, Petzoldt M. A model to predict difficult airway alerts after videolaryngoscopy in adults with anticipated difficult airways - the VIDIAC score. Anaesthesia 2022; 77:1089-1096. [PMID: 36006056 DOI: 10.1111/anae.15841] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 12/31/2022]
Abstract
A model to classify the difficulty of videolaryngoscopic tracheal intubation has yet to be established. The videolaryngoscopic intubation and difficult airway classification (VIDIAC) study aimed to develop one based on variables associated with difficult videolaryngoscopic tracheal intubation. We studied 374 videolaryngoscopic tracheal intubations in 320 adults scheduled for ear, nose and throat or oral and maxillofacial surgery, for whom airway management was expected to be difficult. The primary outcome was whether an anaesthetist issued a 'difficult airway alert' after videolaryngoscopy. An alert was issued after 183 (49%) intubations. Random forest and lasso regression analysis selected six intubation-related variables associated with issuing an alert: impaired epiglottic movement; increased lifting force; direct epiglottic lifting; vocal cords clearly visible; vocal cords not visible; and enlarged arytenoids. Internal validation was performed by a 10-fold cross-validation, repeated 20 times. The mean (SD or 95%CI) area under the receiver operating characteristic curve was 0.92 (0.05) for the cross validated coefficient model and 0.92 (0.89-0.95) for a simplified unitary score (VIDIAC score with component values of -1 or 1 only). The calibration belt for the coefficient model was consistent with observed alert probabilities, from 0% to 100%, while the unitary VIDIAC score overestimated probabilities < 20% and underestimated probabilities > 70%. Discrimination of the VIDIAC score for patients more or less likely to be issued an alert was better than discrimination by the Cormack-Lehane classification, with mean (95%CI) areas under the receiver operating characteristic curve of 0.92 (0.89-0.95) vs. 0.75 (0.70-0.80), respectively, p < 0.001. Our model and score can be used to calculate the probabilities of difficult airway alerts after videolaryngoscopy.
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Affiliation(s)
- E K Kohse
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - H K Siebert
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - P B Sasu
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - K Loock
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - T Dohrmann
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - P Breitfeld
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A Barclay-Steuart
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Stark
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - C Zöllner
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - M Petzoldt
- Department of Anaesthesiology, Centre of Anaesthesiology and Intensive Care Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Stark M. Comment on "Characterization of Nanoplastics, Fibrils, and Microplastics Released during Washing and Abrasion of Polyester Textiles". Environ Sci Technol 2022; 56:10543-10544. [PMID: 35762687 DOI: 10.1021/acs.est.1c08880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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23
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Stark M, Markowitz M, Woods B. Predatory Publishing Practices. Clin Spine Surg 2022; 35:127-128. [PMID: 34907933 DOI: 10.1097/bsd.0000000000001275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022]
Abstract
With open access publishing surging in popularity, it has provided an opportunity for entities to take advantage of the unique business model. Known as predatory journals, these entities accept a large fee in exchange for publication, but do not maintain any form of standards or peer review. This article aims to introduce the history and rise of predatory journals in hopes to further raise awareness and limit their spread.
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Affiliation(s)
- Michael Stark
- Division of Orthopaedic Surgery, Rowan University, Stratford, NJ
| | | | - Barrett Woods
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA
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Abstract
PURPOSE Advances in cancer diagnostics and therapeutics have thankfully led to high numbers of young cancer survivors, although some interventions may sometimes threaten fertility. The authors aimed to assess how evidence-based oncofertility counselling can be adequately fulfilled for the sake of female cancer patients, in light of its complexities and multidisciplinary nature, which require thorough counselling and consent pathways. MATERIALS AND METHODS A search has been conducted in the databases PubMed/MEDLINE, Web of Science, Scopus, EMBASE and Google Scholar via search strings such as fertility preservation, reproductive counselling, oncofertility, cancer survivors, in order to identify relevant meaningful sources spanning the 2010-2021 period. RESULTS Counselling needs to be implemented in compliance with international guidelines, so as to avoid medicolegal repercussions. Albeit fertility preservation is supported by most health care institutions, actual conditions at health care facilities often reflect several lingering difficulties in the oncofertility process. Oncofertility counselling should foster access to fertility preservation procedures. To best serve that purpose, it should be implemented in a manner consistent with ethical and legal standards, so that patients can make an informed decision based on comprehensive and relevant data. CONCLUSIONS Counselling needs to be rooted in a close cooperation of oncologists, reproductive endocrinologists, mental health counsellors and clinical researchers. The provision of oncofertility services is grounded in the moral obligation to uphold individual autonomy, which is essential in a free society, unless the exercise thereof could pose a risk to the children conceived or to others.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
| | - Fabrizio Signore
- Obstetrics and Gynecology Department, USL Roma2, Sant'Eugenio Hospital, Rome, Italy
| | - Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, IVF UNIT, University of Palermo, Palermo, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
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Cheesman QT, Szukics PF, Stark M, Kramer SC, McMillan S. Arthroscopic Rotator Cuff Repair Technique Using a Bio-Composite Scaffold for Tissue Augmentation. Arthrosc Tech 2022; 11:e517-e522. [PMID: 35493048 PMCID: PMC9051668 DOI: 10.1016/j.eats.2021.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023] Open
Abstract
The use of biologics and rotator cuff augmentation have seen significant growth in interest to combat complications of rotator cuff retear after arthroscopic rotator cuff repair. Bio-inductive implants are used to induce new tissue formation; however, they lack structural strength at the time of implantation. Conversely, dermal allografts are used to provide structural strength at implantation, but they do not allow for sufficient tissue incorporation and carry inherent risks of allograft tissue. The BioBrace™ (Biorez, New Haven, CT) is a bio-inductive scaffold composed of highly porous type I collagen and bio-resorbable poly (l-lactide) microfilaments developed to combat the latter drawbacks. The unique bio-composite properties provide the ability to combine the benefits of bio-induction and strength into a single implant. We propose a successful, reproducible technique for the implantation of BioBrace for rotator cuff augmentation.
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Affiliation(s)
- Quincy T. Cheesman
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Patrick F. Szukics
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | - Michael Stark
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | | | - Sean McMillan
- Virtua Orthopedics, Burlington, New Jersey, U.S.A.,Address correspondence to Sean McMillan, DO, Virtua Orthopedics, 2103 Mount Holly Road, Burlington, NJ 09016, U.S.A.
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26
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Sibbin K, Crawford TM, Stark M, Battin M. Therapeutic hypothermia for neonatal encephalopathy with sepsis: a retrospective cohort study. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001420. [PMID: 36053591 PMCID: PMC8943717 DOI: 10.1136/bmjpo-2022-001420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/05/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Neonatal encephalopathy remains a major cause of infant mortality and neurodevelopmental impairment. Infection may exacerbate brain injury and mitigate the effect of therapeutic hypothermia (TH). Additionally, infants with sepsis treated with TH may be at increased risk of adverse effects. This study aimed to review the clinical characteristics and outcomes for infants with sepsis treated with TH. DESIGN AND SETTING Retrospective cohort study of infants treated with TH within Australia and New Zealand. PATIENTS 1522 infants treated with TH, including 38 with culture-positive sepsis from 2014 to 2018. INTERVENTION Anonymised retrospective review of data from Australian and New Zealand Neonatal Network. Infants with culture-positive sepsis within 48 hours were compared with those without sepsis. MAIN OUTCOME MEASURES Key outcomes include in-hospital mortality, intensive care support requirements and length of stay. RESULTS Overall the rate of mortality was similar between the groups (13% vs 13%). Infants with sepsis received a higher rate of mechanical ventilation (89% vs 70%, p=0.01), high-frequency oscillatory ventilation (32% vs 13%, p=0.003) and inhaled nitric oxide for persistent pulmonary hypertension (38% vs 16%, p<0.001). Additionally, the sepsis group had a longer length of stay (20 vs 11 days, p<0.001). CONCLUSION Infants with sepsis treated with TH required significantly more respiratory support and had a longer length of stay. Although this may suggest a more severe illness the rate of mortality was similar. Further research is warranted to review the neurodevelopmental outcomes for these infants.
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Affiliation(s)
- Kristina Sibbin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
| | - Tara M Crawford
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Stark
- Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia
| | - Malcolm Battin
- Newborn Services, Auckland City Hospital, Auckland, New Zealand
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Stark M, Witzel K, Benhidjeb T. Transoral thyroidectomy on the way back to Babylon. Surgery 2022; 171:1133. [PMID: 35074176 DOI: 10.1016/j.surg.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 11/24/2022]
Affiliation(s)
| | - Kai Witzel
- The New European Surgical Academy, Berlin, Germany; Minimal Invasive Centre, Hünfeld, Germany
| | - Tahar Benhidjeb
- The New European Surgical Academy, Berlin, Germany; Department of General and Visceral Surgery, Protestant Hospital of Bethel Foundation, University Hospital OWL, University of Bielefeld, Germany
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28
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Moore V, Rumbold A, Fernandez R, McElroy H, Moore L, Giles L, Grzeskowiak L, Roughead E, Stark M, Davies M. Dispensing of clomiphene citrate to treat infertility: medication supplied and population prevalence of assisted pregnancies and multiple births. Fertil Steril 2021; 117:202-212. [PMID: 34656304 DOI: 10.1016/j.fertnstert.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the proportion of pregnancies resulting in birth that were conceived with the use of clomiphene citrate (CC) and the frequency of multiple pregnancy. DESIGN Whole-of-population cohort study, constructed through data linkage. Comprehensive Australian Government records of dispensed medications were linked to state Perinatal Registry records for all births of at least 20 weeks' gestation. SETTING The state of South Australia. PATIENT(S) Women who maintained pregnancy for at least 20 weeks and gave birth between July 2003 and December 2015, a total of 150,713 women with 241,561 pregnancies. INTERVENTION(S) Not applicable. MAIN OUTCOME MEASURE(S) Ongoing pregnancy occurring in proximity to CC, defined as dispensing from 90 days before to the end of a conception window derived from newborn date of birth and gestational age. RESULT(S) Linkage to dispensed prescription records was achieved for 97.9% of women. Women who conceived with CC tended to be older and socioeconomically advantaged and more likely than other women to have a history of miscarriage. Ongoing pregnancies associated with CC comprised 1.6% of the total; 5.7% were multiple births (mostly twins, 94.6%) compared with 1.5% in the remainder (98.5% twins). CONCLUSION(S) In South Australia, 1.6% of pregnancies (1 in 60) of at least 20 weeks' gestation were conceived proximal to CC dispensing. Of these, 5.7% were multiple pregnancies. This takes the proportion of women who achieved an ongoing pregnancy with medical assistance from 4.4%, based on reports from assisted reproductive technology clinics, to 6% in total.
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Affiliation(s)
- Vivienne Moore
- School of Public Health, The University of Adelaide, South Australia; Robinson Research Institute, The University of Adelaide, South Australia.
| | - Alice Rumbold
- Robinson Research Institute, The University of Adelaide, South Australia; South Australian Health and Medical Research Institute, South Australia
| | - Renae Fernandez
- Robinson Research Institute, The University of Adelaide, South Australia; Discipline of Obstetrics and Gynaecology, The University of Adelaide, South Australia
| | - Heather McElroy
- Discipline of Obstetrics and Gynaecology, The University of Adelaide, South Australia
| | - Lynette Moore
- SA Pathology, Women's and Children's Hospital, Adelaide, South Australia; Discipline of Medical Sciences, The University of Adelaide, South Australia
| | - Lynne Giles
- School of Public Health, The University of Adelaide, South Australia; Robinson Research Institute, The University of Adelaide, South Australia
| | - Luke Grzeskowiak
- Robinson Research Institute, The University of Adelaide, South Australia; South Australian Health and Medical Research Institute, South Australia; Discipline of Obstetrics and Gynaecology, The University of Adelaide, South Australia; College of Medicine and Public Health, Flinders University, South Australia
| | - Elizabeth Roughead
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, South Australia
| | - Michael Stark
- Robinson Research Institute, The University of Adelaide, South Australia; Discipline of Obstetrics and Gynaecology, The University of Adelaide, South Australia
| | - Michael Davies
- Robinson Research Institute, The University of Adelaide, South Australia; Discipline of Obstetrics and Gynaecology, The University of Adelaide, South Australia
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Abstract
OBJECTIVES This article suggests a unified way to perform Cesarean sections. Even in the same departments, different modifications are in use. Therefore, one cannot rely on the early or late outcome of the procedure as long as all the surgical steps are not standardized. METHODS The Misgav Ladach (Stark) Cesarean Section presented here is an evidence-based operation. Its basic principles are a modified Joel-Cohen abdominal incision, one-layer continuous suturing of the uterus using a big needle, leaving peritoneum open, closing fascia continuously and a few Donati skin sutures. RESULTS This method has been subjected to scores of comparative studies with other methods in use, proving its advantages over them concerning duration, blood loss, febrile morbidity, need for analgesics, and costs. CONCLUSIONS It is suggested that this method should be used as the standardized universal method which will enable comparison between obstetricians and institutions, and offer the parturient the best possible outcome.
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
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30
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Stark M. Introduction to the cesarean section articles. J Perinat Med 2021; 49:759-762. [PMID: 34407330 DOI: 10.1515/jpm-2021-0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
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Mynbaev OA, Baimaganbetov AK, Stark M. Correction to: Postsurgical adhesion formation score pitfalls in endometriosis surgery. Langenbecks Arch Surg 2021; 407:3887. [PMID: 34350482 DOI: 10.1007/s00423-021-02268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ospan A Mynbaev
- Department of Traumatology, Orthopedics and Oncology, Khoja Akhmet Yassawi International Kazakh-Turkish University, Bekzat Sattarkhanov Avenue, 29, Turkistan, Kazakhstan. .,Moscow Institute of Physics and Technology, National Research University, Dolgoprudny, Moscow region, Russia.
| | - Amirkhan K Baimaganbetov
- Department of Traumatology, Orthopedics and Oncology, Khoja Akhmet Yassawi International Kazakh-Turkish University, Bekzat Sattarkhanov Avenue, 29, Turkistan, Kazakhstan
| | - Michael Stark
- Department of Traumatology, Orthopedics and Oncology, Khoja Akhmet Yassawi International Kazakh-Turkish University, Bekzat Sattarkhanov Avenue, 29, Turkistan, Kazakhstan.,New Europen Surgical Academy, Berlin, Germany
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Stark M, Rao S, Gleason B, Jack RA, Tucker B, Hammoud S, Freedman KB. Rehabilitation and Return-to-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211017135. [PMID: 34377714 PMCID: PMC8320585 DOI: 10.1177/23259671211017135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport. Purpose: To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols. Results: A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol. Conclusion: There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.
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Affiliation(s)
- Michael Stark
- Division of Orthopaedic Surgery, Rowan University, Stratford, New Jersey, USA
| | - Somnath Rao
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brendan Gleason
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Robert A Jack
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
| | - Bradford Tucker
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sommer Hammoud
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kevin B Freedman
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Mynbaev OA, Baimaganbetov AK, Tinelli A, Stark M. Studies which are not well designed produces misleading results concerning the CO2 pneumoperitoneum impact on postsurgical ovarian function. Ann Palliat Med 2021; 10:9324-9325. [PMID: 34263618 DOI: 10.21037/apm-21-1451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Ospan A Mynbaev
- Laboratory of Human Physiology, Moscow Institute of Physics and Technology National research university, Moscow, Russia; Khoja-Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan
| | - Amirkhan K Baimaganbetov
- Department Traumatology, Orthopedics and Oncology, Khoja-Akhmet Yassawi International Kazakh-Turkish University, Turkestan, Kazakhstan
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, Veris delli Ponti Hospital, Lecce, Italy
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Stark M, Witzel K, Benhidjeb T, Becker S. Added value of surgical interdisciplinarity- The Joel-Cohen's abdominal incision. Ann Med Surg (Lond) 2021; 67:102455. [PMID: 34158931 PMCID: PMC8196051 DOI: 10.1016/j.amsu.2021.102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 10/27/2022] Open
Abstract
Background Surgical methods have profited from the exchange of knowledge among different specialties. Endoscopy which was introduced by gynecologists, surgeons, and internists is used now by all disciplines, and most of yesterday's laparotomies have now endoscopic alternatives. However, laparotomies are still needed, and there is no agreement among surgeons about what is the optimal abdominal incision. The Joel-Cohen incision which is used by gynecologists and obstetricians could become a valid alternative to the methods in use. Method The Joel-Cohen Method, which was evolved for abdominal hysterectomy is described here in detail. Only two instruments are used to open the abdomen, usually with no need for hemostasis. Conclusion The Joel-Cohen incision is suggested as a valid alternative for any emergency or elective surgical or urological abdominal operation. Its benefits are short operation time diminished blood loss and less need for analgesics.
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Affiliation(s)
| | - Kai Witzel
- The New European Surgical Academy, Berlin, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - Tahar Benhidjeb
- The New European Surgical Academy, Berlin, Germany.,Department of General and Visceral Surgery, Center of Visceral Medicine, Evangelisches Klinikum Bethel, Bielefeld, Germany
| | - Sven Becker
- The New European Surgical Academy, Berlin, Germany.,Dep. of Gynaecologic Oncology and Specialities, University Hospital Frankfurt, Germany
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Mc Millan S, Fliegel B, Stark M, Ford E, Pontes M, Markowitz M. Recurrent Instability after Arthroscopic Glenoid Labral Repair with a Minimum of Three Points of Fixation: Do the Number of Anchors or Fixation Points Correlate to Outcomes? Surg Technol Int 2021; 38:433-439. [PMID: 33724436 DOI: 10.52198/21.sti.38.os1411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The goal of this study was to evaluate the recurrence rate of instability following arthroscopic Bankart repairs in regard to the number and types of fixation utilized. A Bankart lesion is a tear in the anteroinferior capsulolabral complex within the shoulder, occurring in association with an anterior shoulder dislocation. These injuries can result in glenoid bone loss, decreased range of motion, and recurrent shoulder instability. Successful repair of these lesions has been reported in the literature with repair constructs that have three points of fixation. However, the definition of "one point of fixation" is yet to be fully elucidated. MATERIALS AND METHODS A consecutive series of arthroscopically repaired Bankart lesions were evaluated pertaining to the points of fixation required to achieve shoulder stability. This included the number, position, and types of anchors used. Patients consented to complete a series of surveys at a minimum of two years postoperatively. The primary outcome was to determine recurrent instability via the UCLA Shoulder Score, the ROWE Shoulder Instability Score, and the Oxford Shoulder Score. A secondary outcome included pain on a Visual Analog Scale (VAS). RESULTS There were 116 patients reviewed, 46 patients achieved three points of fixation in their surgical repair via two anchors and 70 patients achieved a similar fixation with three or more anchors. There was no significant difference in the mean age, gender, or body mass index (BMI). Patients receiving two anchors demonstrated recurrent instability 8.7% of the time (4 of 46 patients). Patients who received three or more anchors demonstrated recurrent instability 8.6% of the time (6 of 70 patients). Overall, there was no statistical significance between the number/types of anchors used. Between the two cohorts, there was no statistically significant difference found between VAS, ROWE, UCLA, and Oxford Scores. There was a significant difference in pain reported on the VAS scale with an average VAS score of 0.43 versus 2.5 in those without and with recurrent instability respectively. CONCLUSION Contention still exists surrounding the exact definition of "a point of fixation" in arthroscopic Bankart repairs. Three-point constructs can be created through a variety of combinations including anchors and sutures, ultimately achieving the goal of a stable shoulder.
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Affiliation(s)
- Sean Mc Millan
- Department of Orthopedics, Virtual Health Systems, Burlington, New Jersey
| | - Brian Fliegel
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Michael Stark
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Elizabeth Ford
- Department of Orthopedics, Inspira Health Network, Vineland, New Jersey
| | - Manuel Pontes
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Michael Markowitz
- Department of Orthopedics, Rowan School of Osteopathic Medicine, Stratford, New Jersey
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Roberts CT, Manley BJ, O'Shea JE, Stark M, Andersen C, Davis PG, Buckmaster A. Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review. Arch Dis Child Fetal Neonatal Ed 2021; 106:336-341. [PMID: 32989046 DOI: 10.1136/archdischild-2020-319804] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 11/03/2022]
Abstract
Surfactant is an effective treatment for respiratory distress syndrome, being particularly important for infants in whom continuous positive airway pressure (CPAP) provides insufficient support. Supraglottic airway devices present an attractive option for surfactant delivery, particularly as an alternative to methods dependent on direct laryngoscopy, a procedural skill that is both difficult to learn and in which to maintain competence. Published studies provide encouraging data that surfactant administration by supraglottic airway device can be performed with a high rate of success and may reduce the need for subsequent intubation compared with either continued CPAP or surfactant administration via endotracheal tube. However, existing randomised controlled trials (RCTs) are heterogeneous in design and include just over 350 infants in total. To date, all RCT evidence has been generated in tertiary units, whereas the greatest potential for benefit from the use of these devices is likely to be in non-tertiary settings. Future research should investigate choice and utility of device in addition to safety and effectiveness of procedure. Importantly, studies conducted in non-tertiary settings should evaluate feasibility, meaningful clinical outcomes and the impact that this approach might have on infants and their families. Supraglottic airway devices may represent a simple and effective mode of surfactant administration that can be widely used by a variety of clinicians. However, further well-designed RCTs are required to determine their role, safety and effectiveness in both tertiary and non-tertiary settings before introduction into routine clinical practice.
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Affiliation(s)
- Calum T Roberts
- Department of Paediatrics, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia .,Monash Newborn, Monash Children's Hospital, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Brett James Manley
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Joyce E O'Shea
- Department of Paediatrics, Royal Hospital for Sick Children, Glasgow, Scotland, United Kingdom
| | - Michael Stark
- The Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hsopital, Adelaide, South Australia, Australia
| | - Chad Andersen
- The Robinson Institute, University of Adelaide, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hsopital, Adelaide, South Australia, Australia
| | - Peter G Davis
- Newborn Research Centre and Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Adam Buckmaster
- Women, Children and Families, Central Coast Local Health District, Gosford, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Medeiros PDB, Stark M, Long M, Allen E, Grace E, Andersen C. Feasibility and accuracy of cord blood sampling for admission laboratory investigations: A pilot trial. J Paediatr Child Health 2021; 57:611-617. [PMID: 33171536 DOI: 10.1111/jpc.15273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/16/2020] [Accepted: 10/27/2020] [Indexed: 11/29/2022]
Abstract
AIM Phlebotomy losses greatly contribute to anaemia following preterm birth. Therefore, the possibility of drawing initial tests from the placenta seems attractive. There is a lack of literature regarding the feasibility and accuracy of pathology tests taken from umbilical arterial and venous (UAB/UVB) compared to blood collected from the newborn. METHODS UAB and UVB complete blood pictures were compared with the initial neonatal blood test. The relationship between UAB, UVB and neonatal complete blood picture values was determined by Spearman's Rho correlation with absolute values compared by Kruskal-Wallis. P < 0.05 was considered significant. RESULTS Neonatal haemoglobin, white cell count, immature/total ratio and platelets were significantly correlated to the corresponding values in the UAB and UVB (all P < 0.001). While UAB and UVB haemoglobin and white cell count were similar, both were significantly lower than the neonatal values (P < 0.001 and P = 0.014, respectively). No difference was seen for immature/total ratio and platelet concentrations. UVB blood culture (BC) was feasible (90%), even with delayed cord clamping, and the UVB BC volume was significantly higher (P < 0.001), with a low rate of BC contamination (1.5%). CONCLUSIONS Our findings support the feasibility and accuracy of umbilical blood in place of blood collected from the newborn. This reduces the phlebotomy losses and allows higher blood volume collection which may increase the sensitivity of BC collection.
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Affiliation(s)
- Poliana De B Medeiros
- The Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Michael Stark
- The Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia.,The Robinson Research Institute, The School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Miriam Long
- The Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Elizabeth Allen
- The Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Erin Grace
- The Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
| | - Chad Andersen
- The Department of Neonatal Medicine, The Women's and Children's Hospital Adelaide, Adelaide, South Australia, Australia
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Hague WM, Callaway L, Chambers J, Chappell L, Coat S, de Haan-Jebbink J, Dekker M, Dixon P, Dodd J, Fuller M, Gordijn S, Graham D, Heikinheimo O, Hennessy A, Kaaja R, Khong TY, Lampio L, Louise J, Makris A, Markus C, Marschall HU, Middleton P, Mol BW, Morris J, Newnham JP, Ovadia C, Peek M, Shand A, Stark M, Thornton J, Timonen S, Walker S, Warrilow D, Williamson C. A multi-centre, open label, randomised, parallel-group, superiority Trial to compare the efficacy of URsodeoxycholic acid with RIFampicin in the management of women with severe early onset Intrahepatic Cholestasis of pregnancy: the TURRIFIC randomised trial. BMC Pregnancy Childbirth 2021; 21:51. [PMID: 33435904 PMCID: PMC7802989 DOI: 10.1186/s12884-020-03481-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe early onset (less than 34 weeks gestation) intrahepatic cholestasis of pregnancy (ICP) affects 0.1% of pregnant women in Australia and is associated with a 3-fold increased risk of stillbirth, fetal hypoxia and compromise, spontaneous preterm birth, as well as increased frequencies of pre-eclampsia and gestational diabetes. ICP is often familial and overlaps with other cholestatic disorders. Treatment options for ICP are not well established, although there are limited data to support the use of ursodeoxycholic acid (UDCA) to relieve pruritus, the main symptom. Rifampicin, a widely used antibiotic including in pregnant women, is effective in reducing pruritus in non-pregnancy cholestasis and has been used as a supplement to UDCA in severe ICP. Many women with ICP are electively delivered preterm, although there are no randomised data to support this approach. METHODS We have initiated an international multicentre randomised clinical trial to compare the clinical efficacy of rifampicin tablets (300 mg bd) with that of UDCA tablets (up to 2000 mg daily) in reducing pruritus in women with ICP, using visual pruritus scores as a measuring tool. DISCUSSION Our study will be the first to examine the outcomes of treatment specifically in the severe early onset form of ICP, comparing "standard" UDCA therapy with rifampicin, and so be able to provide for the first-time high-quality evidence for use of rifampicin in severe ICP. It will also allow an assessment of feasibility of a future trial to test whether elective early delivery in severe ICP is beneficial. TRIAL IDENTIFIERS Australian New Zealand Clinical Trials Registration Number (ANZCTR): 12618000332224p (29/08/2018). HREC No: HREC/18/WCHN/36. EudraCT number: 2018-004011-44. IRAS: 272398. NHMRC registration: APP1152418 and APP117853.
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Affiliation(s)
- William M Hague
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia.
- Obstetric Medicine, Women's and Babies' Division, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia.
| | - Leonie Callaway
- Gynaecology, Oncology & Obstetric Medicine, Royal Brisbane and Women's Hospital, Herston, 4029, Queensland, Australia
- The University of Queensland, Brisbane, 4072, Queensland, Australia
| | - Jennifer Chambers
- Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Lucy Chappell
- Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Suzette Coat
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia
| | - Jiska de Haan-Jebbink
- Dutch Consortium for Healthcare Evaluation in Obstetrics and Gynaecology (NVOG Consortium), Postbus 20075, Utrecht, 3502 LB, The Netherlands
| | - Marloes Dekker
- The University of Queensland, Brisbane, 4072, Queensland, Australia
| | - Peter Dixon
- Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jodie Dodd
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia
| | - Maria Fuller
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia
- SA Pathology, Women's and Children's Hospital, 72 King William Road, North Adelaide, 5006, South Australia, Australia
| | - Sanne Gordijn
- Dutch Consortium for Healthcare Evaluation in Obstetrics and Gynaecology (NVOG Consortium), Postbus 20075, Utrecht, 3502 LB, The Netherlands
| | - Dorothy Graham
- University of Western Australia Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, PO Box 134, Subiaco, Perth, 6904, Western Australia, Australia
| | - Oskari Heikinheimo
- Women's Hospital, University of Helsinki and Helsinki University Hospital, P.O. Box 140, Haartmaninkatu 2, Helsinki, HUS 00029, Finland
| | - Annemarie Hennessy
- School of Medicine, Campbelltown Campus, University of Western Sydney, Narellan Rd, Campbelltown, 2560, NSW, Australia
| | - Risto Kaaja
- Department of Obstetrics and Gynaecology, Turku University Hospital (TYKS), PO Box 52, Turku, 20521, Finland
| | - Teck Yee Khong
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia
- SA Pathology, Women's and Children's Hospital, 72 King William Road, North Adelaide, 5006, South Australia, Australia
| | - Laura Lampio
- School of Medicine, Campbelltown Campus, University of Western Sydney, Narellan Rd, Campbelltown, 2560, NSW, Australia
| | - Jennie Louise
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia
| | - Angela Makris
- Women's Hospital, University of Helsinki and Helsinki University Hospital, P.O. Box 140, Haartmaninkatu 2, Helsinki, HUS 00029, Finland
| | - Corey Markus
- SA Pathology, Women's and Children's Hospital, 72 King William Road, North Adelaide, 5006, South Australia, Australia
- Flinders University International Centre for Point-of-Care Testing, College of Medicine & Public Health, GPO Box 2100, Sturt Road, Bedford Park, South Australia, 5042, Australia
| | | | - Philippa Middleton
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia
- SAHMRI Women and Kids, South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, 5001, South Australia, Australia
| | - Ben W Mol
- Obstetrics & Gynaecology Monash Health, Monash University, Clayton, 3800, Victoria, Australia
| | - Jonathan Morris
- Paediatrics and Reproductive Medicine, The University of Sydney, Sydney, 2006, New South Wales, Australia
| | - John P Newnham
- University of Western Australia Division of Obstetrics and Gynaecology, King Edward Memorial Hospital, PO Box 134, Subiaco, Perth, 6904, Western Australia, Australia
| | - Caroline Ovadia
- Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Michael Peek
- Obstetrics and Gynaecology, Australian National University Medical School, The Canberra Hospital, PO Box 11, Woden, 2606, Australian Capital Territory, Australia
| | - Antonia Shand
- Paediatrics and Reproductive Medicine, The University of Sydney, Sydney, 2006, New South Wales, Australia
| | - Michael Stark
- Robinson Research Institute, The University of Adelaide, 55 King William Road, North Adelaide, 5006, South Australia, Australia
- Obstetric Medicine, Women's and Babies' Division, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006, Australia
| | - Jim Thornton
- Obstetrics and Gynaecology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Rd, Nottingham, NG7 2UH, UK
| | - Susanna Timonen
- Department of Obstetrics and Gynaecology, Turku University Hospital (TYKS), PO Box 52, Turku, 20521, Finland
| | - Susan Walker
- Department of Obstetrics and Gynaecology, University of Melbourne, Mercy Hospital for Women, 163 Studley Road, Heidelberg, 3084, Victoria, Australia
| | - David Warrilow
- Public Health Virology Laboratory, Public and Environmental Health, Forensic and Scientific Services, Health Support Queensland, Department of Health, 39 Kessels Road, Coopers Plains, 4108, Queensland, Australia
| | - Catherine Williamson
- Women and Children's Health, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Barnea ER, Nicholson W, Theron G, Ramasauskaite D, Stark M, Albini SM, Nassar AH, Visser GHA, Escobar MF, Kim YH, Pacagnella R, Wright A. From fragmented levels of care to integrated health care: Framework toward improved maternal and newborn health. Int J Gynaecol Obstet 2021; 152:155-164. [DOI: 10.1002/ijgo.13551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/25/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Eytan R. Barnea
- The Society for the Investigation of Early Pregnancy New York NY USA
| | - Wanda Nicholson
- Department of Obstetrics and Gynecology University of North Carolina Chapel Hill NC USA
| | - Gerhard Theron
- Department of Obstetrics and Gynecology Stellenbosch University Stellenbosch South Africa
| | - Diana Ramasauskaite
- Center of Obstetrics and Gynecology Vilnius University Medical Faculty Vilnius Lithuania
| | - Michael Stark
- The New European Surgical Academy The Charite University Hospital Berlin Germany
| | - S. Mark Albini
- Department of Obstetrics and Gynecology St Mary Hospital Waterbury CT USA
| | - Anwar H. Nassar
- Department of Obstetrics and Gynecology American University of Beirut Medical Center Beirut Lebanon
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40
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Unter den Linden 21, 10117 Berlin, Germany
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41
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
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Mynbaev OA, Sparic R, Stark M, Malvasi A, Marinelli E, Zaami S, Tinelli A. The Medical Device Applied to Uterine Fibroids Morcellation: Analysis of Critical Biological Issues and Drawbacks from A Medical-Legal Prospective. Curr Pharm Des 2020; 26:318-325. [PMID: 32013843 DOI: 10.2174/1381612826666200204093737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/27/2020] [Indexed: 12/23/2022]
Abstract
Following the FDA safety communication of 2014 increasing attention has been to the treatment of uterine fibroids, due to the suspicion of a potential leiomyosarcoma (ULM). FDA banned the use of power morcellation in the US, since this technique is likely to spread malignant cells from an unsuspected ULM. We criticized the medical legal consequences of this banning among gynecologists and patients, focusing on the drawbacks of biology and surgery. The authors analyzed literature data on one side, on the incidence, diagnosis and treatment of leiomyoma and ULM, and the other side, on the power morcellations and related critical issues, trying to highlight their main controversial aspects and to outline the possible impact on patients and on medical responsibility. The alternative methods to power morcellation are more invasive surgical solutions (as mini laparotomy or culdotomy), which inevitably involve associated risks with the surgical procedure as such and always request the containing bags. Although the in-bag morcellation is a promising technique, currently the used devices are largely off-label. This highlights the surgical risk, in case of complications, of suffering for malpractice claims both for not having used a containment system, favoring the spread of the neoplasm, and for its off-label use. Since the diagnosis of ULM is by histology after surgery, the fear of legal consequences or medical malpractice for unknown ULM power morcellation, should be targeted to analyze, in terms of cost/benefit ratio, the surgical priority. It should focus on the prevention of the risk of having a rare and statistically limited ULM or on the surgical-related complications, often linked to a slowdown minimally invasive surgery, or on the use of the authorized in-bag morcellations.
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Affiliation(s)
- Ospan A Mynbaev
- Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russian Federation
| | | | - Michael Stark
- Department of Obstetrics and Gynecology, GVM Care & Research Santa Maria Hospital, Bari, Italy. Laboratory of Human Physiology, Phystech BioMed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russian Federation
| | - Antonio Malvasi
- Clinical Centre of Serbia, Clinic for Gynecology and Obstetrics, and University of Belgrade, School of Medicine, Belgrade, Serbia
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, "Veris delli Ponti" Hospital, Scorrano, Lecce, Italy
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Duffy J, Cairns AE, Richards-Doran D, van 't Hooft J, Gale C, Brown M, Chappell LC, Grobman WA, Fitzpatrick R, Karumanchi SA, Khalil A, Lucas DN, Magee LA, Mol BW, Stark M, Thangaratinam S, Wilson MJ, von Dadelszen P, Williamson PR, Ziebland S, McManus RJ. A core outcome set for pre-eclampsia research: an international consensus development study. BJOG 2020; 127:1516-1526. [PMID: 32416644 DOI: 10.1111/1471-0528.16319] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To develop a core outcome set for pre-eclampsia. DESIGN Consensus development study. SETTING International. POPULATION Two hundred and eight-one healthcare professionals, 41 researchers and 110 patients, representing 56 countries, participated. METHODS Modified Delphi method and Modified Nominal Group Technique. RESULTS A long-list of 116 potential core outcomes was developed by combining the outcomes reported in 79 pre-eclampsia trials with those derived from thematic analysis of 30 in-depth interviews of women with lived experience of pre-eclampsia. Forty-seven consensus outcomes were identified from the Delphi process following which 14 maternal and eight offspring core outcomes were agreed at the consensus development meeting. Maternal core outcomes: death, eclampsia, stroke, cortical blindness, retinal detachment, pulmonary oedema, acute kidney injury, liver haematoma or rupture, abruption, postpartum haemorrhage, raised liver enzymes, low platelets, admission to intensive care required, and intubation and ventilation. Offspring core outcomes: stillbirth, gestational age at delivery, birthweight, small-for-gestational-age, neonatal mortality, seizures, admission to neonatal unit required and respiratory support. CONCLUSIONS The core outcome set for pre-eclampsia should underpin future randomised trials and systematic reviews. Such implementation should ensure that future research holds the necessary reach and relevance to inform clinical practice, enhance women's care and improve the outcomes of pregnant women and their babies. TWEETABLE ABSTRACT 281 healthcare professionals, 41 researchers and 110 women have developed #preeclampsia core outcomes @HOPEoutcomes @jamesmnduffy. [Correction added on 29 June 2020, after first online publication: the order has been corrected.].
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Affiliation(s)
- Jmn Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Institute for Women's Health, University College London, London, UK
| | - A E Cairns
- Institute for Women's Health, University College London, London, UK
| | - D Richards-Doran
- Institute for Women's Health, University College London, London, UK
| | - J van 't Hooft
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands
| | - C Gale
- Academic Neonatal Medicine, Imperial College London, London, UK
| | - M Brown
- Department of Renal Medicine, St George Hospital and University of New South Wales, Kogarah, NSW, Australia
| | - L C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - W A Grobman
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - R Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - D N Lucas
- London North West University Healthcare NHS Trust, Harrow, UK
| | - L A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Vic., Australia
| | - M Stark
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, SA, Australia
| | - S Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
| | - M J Wilson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - P von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - P R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - S Ziebland
- Institute for Women's Health, University College London, London, UK
| | - R J McManus
- Institute for Women's Health, University College London, London, UK
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Khokhar H, Craver R, Stark M. Malignant Extrarenal Rhabdoid Tumor in a 5-Month-Old Male With Mediastinal and Heart/Great Vessel Involvement. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction/Objective
Extrarenal rhabdoid tumor is a high-grade soft-tissue predominately pediatric malignancy with a frequency of 0.15 per million children less than 15 years. It is associated with del(22) (q11.2) with SMARCB1 loss, recognized by loss of INI-1 staining. It has distinct perinuclear hyaline inclusions; however, this feature can be present in other tumors. We describe a malignant extrarenal rhabdoid tumor involving the heart and great vessels to highlight the multiple modalities required for the diagnosis of this tumor in this unusual location.
Methods
We utilized routine histology, immunohistochemistry, and electron microscopy.
Results
This 5 -month -old male presented with respiratory distress due to a mass that invaded the heart, surrounding the great vessels. The tumor was composed of sheets of polygonal large cells with light pink to clear cytoplasm, eccentric nuclei with mild anisonucleosis, peripherally marginating chromatin, prominent nucleoli, with 2 mitoses per 10 high power field. Hyaline perinuclear inclusions were inapparent. There were frequent clusters of lymphocytes and eosinophils, with 10 percent necrosis and moderately increased vascularity. The tumor was positive for vimentin, SMA, EMA, MSA, S-100, keratin, and WT1, and negative for INI-1, CD34, ALK, AFP, PLAP, CD30, myogenin, NeuN1, synaptophysin, chromogranin, and NSE. Electron microscopy demonstrated occasional cells with perinuclear collections of intermediate filaments, some with whorls. The strong positivity for vimentin, keratin, SMA, MSA, S-100, negative staining for INA-1 and CD34, and visualization of perinuclear intermediate filament whorls by electron microscopy helped make the diagnosis of extrarenal rhabdoid tumor.
Conclusion
Malignant extrarenal rhabdomyosarcomas may occur in the middle mediastinum, invade the heart, occur in the first 6 months of life, and not have the typical rhabdoid cells. Diagnoses depend on multiple modalities
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Affiliation(s)
- H Khokhar
- Pathology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, UNITED STATES
| | - R Craver
- Pathology, Children’s Hospital, New Orleans, Louisiana, UNITED STATES
| | - M Stark
- Pathology, Children’s Hospital, New Orleans, Louisiana, UNITED STATES
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Stark M, DeBernardis D, McDowell C, Ford E, McMillan S. Percutaneous Skeletal Fixation of Painful Subchondral Bone Marrow Edema Utilizing an Injectable, Synthetic, Biocompatible Hyaluronic Acid-Based Bone Graft Substitute. Arthrosc Tech 2020; 9:e1645-e1650. [PMID: 33294321 PMCID: PMC7695546 DOI: 10.1016/j.eats.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/09/2020] [Indexed: 02/03/2023] Open
Abstract
Subchondral bone marrow edema (SBME) represents a pathologic alteration of subchondral bone. A strong correlation exists between its presence and the progression of osteoarthritis. Very few treatment options exist between the spectrum of conservative management and the definitive treatment of total knee arthroplasty (TKA). Tactoset® is an injectable synthetic, biocompatible hyaluronic acid-based bone graft substitute that allows for a minimally invasive treatment for painful SBME via percutaneous skeletal fixation (PSF). We present the technique of PSF using Tactoset.
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Affiliation(s)
- Michael Stark
- Rowan School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
- Address correspondence to Michael Stark, D.O., 1 Medical Center Dr, Stratford, NJ 08084, U.S.A.
| | | | - Chris McDowell
- Rowan School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
| | | | - Sean McMillan
- Rowan School of Osteopathic Medicine, Stratford, New Jersey, U.S.A
- Department of Sports Medicine and Arthroscopy, Virtua Willingboro Hospital, Burlington, New Jersey, U.S.A
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Duffy JMN, Cairns AE, Magee LA, von Dadelszen P, van 't Hooft J, Gale C, Brown M, Chappell LC, Grobman WA, Fitzpatrick R, Karumanchi SA, Lucas DN, Mol B, Stark M, Thangaratinam S, Wilson MJ, Williamson PR, Ziebland S, McManus RJ. Standardising definitions for the pre-eclampsia core outcome set: A consensus development study. Pregnancy Hypertens 2020; 21:208-217. [PMID: 32674052 DOI: 10.1016/j.preghy.2020.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To develop consensus definitions for the core outcome set for pre-eclampsia. STUDY DESIGN Potential definitions for individual core outcomes were identified across four formal definition development initiatives, nine national and international guidelines, 12 Cochrane systematic reviews, and 79 randomised trials. Eighty-six definitions were entered into the consensus development meeting. Ten healthcare professionals and three researchers, including six participants who had experience of conducting research in low- and middle-income countries, participated in the consensus development process. The final core outcome set was approved by an international steering group. RESULTS Consensus definitions were developed for all core outcomes. When considering stroke, pulmonary oedema, acute kidney injury, raised liver enzymes, low platelets, birth weight, and neonatal seizures, consensus definitions were developed specifically for low- and middle-income countries because of the limited availability of diagnostic interventions including computerised tomography, chest x-ray, laboratory tests, equipment, and electroencephalogram monitoring. CONCLUSIONS Consensus on measurements for the pre-eclampsia core outcome set will help to ensure consistency across future randomised trials and systematic reviews. Such standardization should make research evidence more accessible and facilitate the translation of research into clinical practice. Video abstract can be available at: www.dropbox.com/s/ftrgvrfu0u9glqd/6.%20Standardising%20definitions%20in%20teh%20pre-eclampsia%20core%20outcome%20set%3A%20a%20consensus%20development%20study.mp4?dl=0.
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Affiliation(s)
- James M N Duffy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom; Institute for Women's Health, University College London, London, United Kingdom.
| | - Alexandra E Cairns
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - Janneke van 't Hooft
- Department of Obstetrics and Gynecology, Amsterdam UMC, Academic Medical Center, Amsterdam, Netherlands
| | - Chris Gale
- Academic Neonatal Medicine, Imperial College London, London, United Kingdom
| | - Mark Brown
- Department of Renal Medicine, St George Hospital and University of New South Wales, Kogarah, Australia
| | - Lucy C Chappell
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom
| | - William A Grobman
- Department of Obstetrics and Gynaecology, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - D Nuala Lucas
- London North West University Healthcare NHS Trust, Harrow, United Kingdom
| | - Ben Mol
- Women's Health Care Research Group, Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - Michael Stark
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Mathew J Wilson
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Abstract
The present study aimed to analyze the litigation trends and ensuing compensatory damages brought about by the use of episiotomy, in order to outline a set of cautionary rules meant to limit the scope of legreal aftermath for both doctors and health care facilities. The authors have set out to gain an insight into the controversial practice of episiotomy, in light of available research data and official positions of various scientific and medical associations, with a close focus on the legal and medical viability of the procedure itself. Court data and trial records have been taken into account as well, via searches into legal databases and search engines (Justia, Lexis, Jurist.org, Venice Courthouse, etc.). This review showed that most episiotomy-related lawsuits stemmed from a routine use of that procedure, which is almost universally advised against, and without valid informed consent having been gained. Ultimately, authors have seen fit to underscore the need for patients potentially eligible for an episiotomy (selective episiotomy) to receive thorough and understandable information in a timely fashion including the necessity and the effectiveness of the procedure as well as the risks involved, so that a well-informed decision can be made based on factual data.
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Affiliation(s)
- Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy -
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany.,ELSAN Group Hospitals, Paris, France
| | - Antonio Malvasi
- Department of Applied Mathematics, Institute of Physics and Technology, State University, Moscow, Russia.,Department of Obstetrics and Gynecology, GVM Care and Research, Santa Maria Hospital, Bari, Italy
| | - Fabrizio Signore
- Department of Obstetrics and Gynecology, Misericordia Hospital, Grosseto, Italy
| | - Enrico Marinelli
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, Rome, Italy
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Benhidjeb T, Stark M, Schulte Am Esch J. Re: "Comparative Study Between Endoscopic Thyroid Surgery via the Oral Vestibular Approach and the Areola Approach" by Guo et al. J Laparoendosc Adv Surg Tech A 2020; 30:866-867. [PMID: 32364829 DOI: 10.1089/lap.2020.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tahar Benhidjeb
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany.,The New European Surgical Academy (NESA), Berlin, Germany
| | - M Stark
- The New European Surgical Academy (NESA), Berlin, Germany
| | - Jan Schulte Am Esch
- Department of General and Visceral Surgery, Evangelisches Klinikum Bethel, Bielefeld, Germany
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Leggett C, Lwin EMP, Ritchie U, Song Y, Gerber JP, Turner S, Hague WM, Stark M, Upton R, Garg S. Perindopril in Breast Milk and Determination of Breastfed Infant Exposure: A Prospective Observational Study. Drug Des Devel Ther 2020; 14:961-967. [PMID: 32184565 PMCID: PMC7060030 DOI: 10.2147/dddt.s239704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/10/2020] [Indexed: 11/23/2022]
Abstract
Objective This study aimed to quantify the amount of perindopril and its active metabolite perindoprilat present in breast milk and corresponding maternal and infant plasma concentrations. Design Prospective, longitudinal, observational. Setting Tertiary specialist paediatric and obstetric hospital in Adelaide, South Australia. Population Breastfeeding women actively treated with perindopril for hypertensive disorders postpartum. Methods Eight breast milk samples and a single plasma sample were collected from each participant over a 24 hrs period, and plasma samples were taken from eligible breastfed infants. Breast milk and plasma concentrations of perindopril and perindoprilat were analysed using a validated Liquid Chromatography tandem-Mass Spectrometry (LC-MS/MS) method. Main Outcome Measures Mean breast milk concentrations of perindopril and perindoprilat, Relative Infant Dose (RID) <10%, and Theoretical Infant Dose (TID). Results Ten women and three infants participated in the study. The mean concentration of perindopril in breast milk for each participant ranged from 0.003 to 1.2 ng/mL and perindoprilat 0.2–36 ng/mL. RID for perindopril was 0.0005–0.2% and perindoprilat 0.03–4.6%. TID for perindopril was 0.00045–0.18 µg/kg/day and perindoprilat 0.032–5.4 µg/kg/day. Infant plasma levels for perindopril ranged from 0.44 to 1.12 ng/mL and perindoprilat undetectable – 10.14 ng/mL. Maternal reports described normal infant growth and development. Conclusion Infant exposure to perindopril and perindoprilat through breast milk is low. However, some infants were found to have plasma perindoprilat concentrations consistent with pharmacodynamic effects. Perindopril may be used in mothers of healthy term infants, provided the infant is carefully monitored.
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Affiliation(s)
- Catherine Leggett
- SA Pharmacy, Women's and Children's Hospital, North Adelaide, SA 5006, Australia
| | - Ei Mon Phyo Lwin
- School of Pharmacy and Medical Sciences, Reid Building, City East Campus, University of South Australia, Adelaide, SA 5000, Australia
| | - Usha Ritchie
- SA Pharmacy, Women's and Children's Hospital, North Adelaide, SA 5006, Australia
| | - Yunmei Song
- School of Pharmacy and Medical Sciences, Reid Building, City East Campus, University of South Australia, Adelaide, SA 5000, Australia
| | - Jacobus P Gerber
- School of Pharmacy and Medical Sciences, Reid Building, City East Campus, University of South Australia, Adelaide, SA 5000, Australia
| | - Sean Turner
- SA Pharmacy, Women's and Children's Hospital, North Adelaide, SA 5006, Australia
| | - William M Hague
- Robinson Research Institute, University of Adelaide, North Adelaide, SA 5006, Australia.,Obstetric Medicine, Women's and Children's Hospital, North Adelaide, SA 5006, Australia
| | - Michael Stark
- Robinson Research Institute, University of Adelaide, North Adelaide, SA 5006, Australia.,Neonatal Medicine, Women's and Children's Hospital, North Adelaide, SA 5006, Australia
| | - Richard Upton
- School of Pharmacy and Medical Sciences, Reid Building, City East Campus, University of South Australia, Adelaide, SA 5000, Australia
| | - Sanjay Garg
- School of Pharmacy and Medical Sciences, Reid Building, City East Campus, University of South Australia, Adelaide, SA 5000, Australia
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