1367 Five Years of Robotic Surgery in Colorectal Service: James Cook University Hospital Experience

Aim

This paper gives an account of our institutional experience with safe adoption of robotic surgery in colorectal service.

Method

Analysis of our prospectively maintained database of all patients who underwent robotic colorectal surgery in our institute between February 2015 and February 2020. Overall surgical and oncological outcomes were interrogated.

Results

A total of 255 patients underwent robotic surgery between 2015 and 2020. 148 were males, and 107 were females. Median age was 68 years (range: 35–89). 198 patients had bowel cancer and 57 had benign conditions. Operative procedures performed were anterior resection (n = 125), right colectomy (n = 77), abdominoperineal resection (n = 40), subtotal colectomy (n = 5), completion proctocolectomy (n = 2) and reversal of Hartmann’s procedure (n = 6). Mean operative time was 164 (SD ± 47.5) for right colectomy and 267 (SD ± 77.8) for anterior resection. Median length of hospital stay was 6 days (IQR: 4 – 9). There was no 30 days mortality or intraoperative complications. Conversion to open or laparoscopy surgery rate was 5.1% (n = 13). Anastomotic leakage occurred in 3 patients (1.2%). Median lymph nodes harvested were 21 (range 4 – 79) and the R0 resection rate was 96.5%.

Conclusions

Our results demonstrate that colorectal robotic surgery is feasible and can be adopted safely for both benign and neoplastic conditions without undermining clinical or oncological outcomes.

Sudden sensorineural hearing loss in COVID-19: A case series from the Wrightington, Wigan and Leigh Teaching Hospitals, United Kingdom

Sudden sensory neural hearing Loss (SSNHL) needs to be identified and managed correctly in a secondary or tertiary centre. Whilst 45% of presentations are said to be idiopathic in nature, several viruses have been linked to its aetiology. It was noted, anecdotally, that more patients were presenting with SSNHL during the COVID-19 pandemic to our ENT service at Wrightington Wigan and Leigh teaching hospitals, UK (WWL). We identified 4 COVID-19 positive patients who presented to our ENT service with SSNHL. Despite normal findings on external ear examination, three of the patients showed bilateral hearing loss, whilst one had a predominantly unilateral loss. Given our findings we would like to present these four cases, as well as providing hypotheses on possible aetiology of this association. This may aid in research, diagnosis and treatment of future COVID positive patients with SSNHL.

Classification and retrieval of thoracic diseases using patch-based visual words: a study on chest x-rays

This research work explores the Content-Based Medical Image Retrieval system (CBMIR) to categorization and retrieval of different types of common thoracic diseases such as Atelectasis, cardiomegaly, Effusion, Infiltration etc, based on local patch representation of 'Bag of Visual Words' approach, when performing patch-based image representation, the selected patch size has significant impact on image categorization and retrieval process. It is a challenging task in selecting the appropriate patch size to the current experimental dataset. Chest Xray8 medical image database is used, to analyze the impact of different patch size to categorize and retrieval of eight common thorax diseases. 1000 frontal view x-ray images is obtained (100 images from each category and 200 images combination of more than one disease) from the database. Different sizes of image patches (16 × 16 and 32 × 32) and different codebook sizes (500, 1000, 1500, 2000) created to identify best precision and recall values. From the excremental result, 32 × 32 patch size and 1500 codebook size gives the good precision and recall value using Radial Basis Function SVM kernel.

Using functional behavioral assessment to treat sleep problems in two children with autism and vocal stereotypy

Objectives: Sleep problems are prevalent among children with autism spectrum disorder (ASD) and are often accompanied by stereotypies, the function of which may be difficult to determine. Functional behavioral assessment (FBA) is an evidence-based approach to assessing and treating challenging behaviors, however, it has scarcely been used with sleep problems. This study investigates the effectiveness of FBA-based treatments for sleep disturbance (SD) in children with ASD, the short- and long-term maintenance of these effects, and parents' perspectives on the assessment and treatment process. Method: Two case studies used FBA to inform treatments for SD in two children with ASD and stereotypic behavior. The sleep-competing behaviors appeared to be multi-functional and included sleep interfering vocal stereotypy. The parents of each child implemented individualized, multi-component treatment packages. Results: Results demonstrate a reduction in SD for each participant, though delayed sleep onset latency remained for one participant. These results were maintained at short- and long-term follow-up. The interventions had high social validity. Conclusion: The implications of these findings for future research, and the assessment and treatment of SD in children with ASD and vocal stereotypy are discussed.

Using Functional Behavioral Assessment to Develop a Multicomponent Treatment for Sleep Problems in a 3-Year-Old Boy With Autism

A large number of children with autism spectrum disorder (ASD) and their families are affected by sleep disturbance. Given the concomitant negative effects of sleep problems, it is essential to identify effective treatments. This case study exemplifies the use of Functional Behavioral Assessment (FBA) to develop treatments for sleep problems in a 3-year old boy with ASD. A function-based, multicomponent intervention resulted in the elimination of nighttime breastfeeding, a reduction in the frequency of curtain calls, and the frequency and duration of nighttime awakenings, although not all gains were maintained at follow-up. This case study highlights the importance of FBA in the assessment of sleep problems for each individual, and the need to develop treatments that address the unique function of sleep disturbance for each individual. Further research into the assessment and treatment of sleep problems in children with ASD is required.

Empirical research evaluating non-traditional approaches to managing sleep problems in children with autism

OBJECTIVE

This paper examines the efficacy of non-behavioural and non-pharmacological approaches to the treatment of sleep disturbance in individuals with autism spectrum disorder.

METHODS

A systematic search of electronic databases and reference lists identified eight studies that met inclusion criteria. Studies were evaluated according to (a) treatment used, (b) participants, (c) experimental design, (d) baseline measures, (e) dependent variables, (f) follow-up measures, (g) reliability and treatment integrity, (h) results and certainty of evidence and (i) implications for treatment.

RESULTS

Positive outcomes were reported for the use of massage therapy and vitamin supplements. Aromatherapy was reported to have no effect on sleep. No studies were found that examined other non-traditional treatment approaches, nor did any of the studies provide conclusive evidence.

CONCLUSIONS

The limited corpus of evidence and the methodological limitations suggests that the efficacy of non-traditional approaches to treatment of sleep problems in individuals with autism is yet to be demonstrated.

Exercise HIMALAYAN SERPENT: feedback article

Exercise HIMALAYAN SERPENT was open to junior doctors from the United Kingdom (UK) Armed Forces and aimed to educate potential expedition doctors on aspects of high altitude and wilderness medicine as well as conducting adventurous training (AT) and medical research. This was the first time such an exercise had been undertaken and this article explores the views of those junior doctors taking part to assess whether the exercise met the aims and objectives it set out.

Behavioural treatments for sleep problems in children and adolescents with physical illness, psychological problems or intellectual disabilities

Young people with physical, psychological or intellectual disabilities or disorders are reported to have more frequent and persistent problems with sleep than their peers without <<<<special needs>>>>. Sleep disorders affecting the quantity or quality of sleep have effects on a child's daytime functioning and the functioning of their families. Many children with special needs have learning and behaviour problems and their parents (particularly mothers) have increased levels of stress and poorer mental health. This relationship between sleep disorders and learning, and behaviour and family functioning makes it particularly important that children with special needs receive appropriate intervention for their sleep disorders. This may be one way of mitigating these other problems. This review considers the case reports and experimental trials which have used behavioural treatments for sleep problems in children and adolescents with special needs. Behavioural treatments for sleep-wake cycle disorders, sleeplessness, parasomnias and excessive sleepiness are reported. These preliminary reports do suggest that behavioural approaches can be rapidly successful for treating sleep problems, even where the sleep problems are long-standing, severe and associated with physical, psychological or intellectual problems. The parent and the clinician should not be deterred from treating the sleep problem in isolation using behavioural treatments. Methodological issues, however, highlight the importance of further and better research. Not all children responded to the behavioural interventions and some needed re-implementation of therapy to maintain improvements; the use of heterogeneous groups make the findings and choice of treatment for individuals difficult to interpret. Finally, there are few studies overall, and the majority are case studies rather than controlled studies using multiple baseline designs or randomization and a control group. Careful studies are required in order to establish the relative efficacy of the behavioural techniques and their suitability with homogeneous subgroups of children with special needs.

In vitro activity of ciprofloxacin, levofloxacin, and trovafloxacin, alone and in combination with beta-lactams, against clinical isolates of Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Burkholderia cepacia

We tested three fluoroquinolones (ciprofloxacin, levofloxacin, and trovafloxacin), each combined with each of four beta-lactams (cefoperazone, ceftriaxone, imipenem, and meropenem) for synergy against clinical isolates of nosocomial strains of Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Burkholderia cepacia. The ciprofloxacin-beta-lactam combinations showed synergy against none or only a small fraction (7 to 10%) of the P. aeruginosa and B. cepacia isolates. Ciprofloxacin-cefoperazone, -ceftriaxone, and -meropenem were synergic against 50%, 25%, and 30% of the S. maltophilia isolates, respectively. Among the levofloxacin combinations, only those with cefoperazone and imipenem showed significant synergy, and this only against B. cepacia (50% and 30%, respectively). Trovafloxacin-cefoperazone and -imipenem showed modest synergy against P. aeruginosa (23% and 27%, respectively), as did trovafloxacin-cefoperazone and -ceftriaxone against B. cepacia (30%). The trovafloxacin-imipenem combination was synergic against all isolates of B. cepacia. Because of their synergy, the following combinations may be useful in the nosocomial setting: trovafloxacin-cefoperazone or -imipenem against P. aeruginosa; ciprofloxacin-cefoperazone, -ceftriaxone, or -meropenem against S. maltophilia; levofloxacin-cefoperazone and trovafloxacin-imipenem against B. cepacia.

In vitro susceptibility of recent gram-positive isolates to ciprofloxacin, levofloxacin, and trovafloxacin

Gram-positive isolates (n = 290) were tested for their susceptibility to three fluoroquinolone antibiotics by standard disk-diffusion technology. Overall, 59%, 72%, and 85% were susceptible and 29%, 25%, and 11% were resistant to ciprofloxacin, levofloxacin, and trovafloxacin, respectively. Of Staphylococcus aureus isolates (n = 84), 55%, 57%, and 88% were susceptible to the three antibiotics, respectively. Staphylococcus epidermidis (n = 45), too, was more susceptible to trovafloxacin, although the differences were smaller (60%, 62%, and 78%). Of 35 Enterococcus faecalis isolates, 66% and 74% were susceptible to levofloxacin and trovafloxacin, respectively, but only 9% were susceptible to ciprofloxacin.

Response of enteric gram-negative bacteria to disks containing 20 micrograms each of ampicillin and sulbactam

Ampicillin-sulbactam disks containing either 10 microg of each drug or 20 microg of each drug were tested against 138 recently, sequentially isolated members of the family Enterobacteriaceae. Results obtained with the higher-content disks corresponded more closely to the impressions of clinicians.

Patterns and correlates of hormone replacement therapy use among middle-aged Australian women

In this study, we examine the patterns of use of hormone replacement therapy (HRT) among women age 51 to 60 years and describe the characteristics of women who currently use HRT, previously used HRT, and have never used HRT. A brief postal survey of 800 women in this age range was used to determine HRT status. Telephone interviews were then conducted with 258 women (111 currently using HRT, 47 who previously used HRT, and 100 who had never used HRT) to determine characteristics of women who currently or previously used HRT or never used HRT, type of HRT used, duration of use, and reasons for use and nonuse. Nearly 40% of women were currently using HRT, 14% had previously used HRT, and 47% had never used HRT. Women currently using HRT were more likely than those not using HRT to have had a hysterectomy, attribute a greater number of symptoms to the climacteric, be in paid employment, and report a greater number of visits to the doctor over the past 12 months. HRT use among Australian women in their 50s is high and rising. Hysterectomy status, the attribution of symptoms to menopause, paid employment, and health care use were the most important correlates of HRT use. Few women specified long-term prevention of osteoporosis or heart disease as a reason for taking HRT.

Hormone replacement therapy: knowledge, attitudes, and weil-being among middle-aged australian women

Use of hormone replacement therapy (HRT) is increasing, yet little is known of women's perceptions of HRT. A telephone survey examined relevant knowledge and attitudes, and psychological well-being, in 258 women aged 51 to 60 (111 HRT users, 47 previous users, and 100 never-users). Although HRT users were better informed than nonusers, knowledge was generally low. Half the HRT users could not name any hormone used in HRT, and one third could not give any reason for using HRT. Current users, however, had more positive attitudes to HRT. Groups defined by HRT usage did not differ on well-being or current symptomatology, although current and previous HRT users reported having previously experienced a higher level of symptomatology than never-users, suggesting that HRT may have provided symptom relief for those women who chose to use it. In contrast to previous research, women with a history of hysterectomy did not show more emotional distress than others. Results suggest that Australian women frequently make choices concerning HRT without adequate knowledge, and that HRT may reduce symptoms but may have little impact on psychological well-being. Optimal usage of HRT by middle-aged women will rely on a clearer understanding, both of its effects and of women's attitudes toward its use.

Susceptibility testing of Propionibacterium acnes comparing agar dilution with E test

Propionibacterium acnes has been identified as a significant agent of nosocomial infections, including endophthalmitis. Data concerning susceptibility of P. acnes to newer beta-lactam antibiotics and fluoroquinolones are limited. Recent reports suggest that quinolones have activity against these organisms sufficient to warrant further study. We undertook a study to select appropriate antimicrobial agents for use in a rabbit model of P. acnes endophthalmitis. We compared the antibiotic susceptibilities of P. acnes by using the National Committee for Clinical Laboratory Standards method of agar dilution with the E test. Thirteen clinical isolates obtained from eye specimens and three American Type Culture Collection control strains were tested against 14 antibiotics. All the clinical isolates were susceptible by both methods to piperacillin, piperacillin-tazobactam, ampicillin-sulbactam, ticarcillin-clavulanate, cefotaxime, cefotetan, ceftriaxone, cefoxitin, and imipenem in addition to clindamycin but were resistant to metronidazole. The clinical P. acnes isolates also displayed high-level susceptibility to ciprofloxacin, sparfloxacin, and ofloxacin. Almost all the P. acnes strains demonstrated E-test MICs within 2 dilutions of the MICs observed by the agar dilution method. Those few strains for which discrepancies were noted exhibited E-test susceptibilities three- to fivefold dilutions lower than the agar dilution method susceptibilities but only with ampicillin-sulbactam, ticarcillin-clavulanate, and/or clindamycin. On the basis of our study, all of clinical eye isolates were susceptible to these newer antimicrobial agents and the two methods demonstrated similar susceptibility patterns.

Microbial adherence to and disinfection of laryngoscopes used in office practice

This study reports the appropriate disinfection methods for flexible and rigid laryngoscopes when used in an outpatient setting. This investigation presents evidence that an appreciable number of laryngoscopes are contaminated during use. A brief tap water rinse serves to eliminate gross soil of host origin known to interfere with disinfectant efficacy. Disinfection with 3.2% glutaraldehyde (Cidexplus) for 10 minutes effectively eliminated microbial contaminants. Since potentially harmful microorganisms were included among the more than 100 isolates during our baseline experiments, the need to eliminate bacteria, viruses, fungi, and protozoa from laryngoscopes is obvious and can be attained readily.

A case of bacteremia due to resistant Streptococcus pneumoniae

Streptococcus pneumoniae isolates with varying degrees of resistance to penicillin have been described. Strains that are highly resistant to penicillin (MIC, greater than 1 microgram/mL) and that are resistant to multiple antibiotics have been reported primarily in South Africa and Spain. We report a case of an adult patient with bacteremia due to S. pneumoniae that was highly resistant to penicillin (MIC, 4 micrograms/mL) and resistant to erythromycin, clindamycin, chloramphenicol, and co-trimoxazole who was successfully treated with vancomycin.

Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis

OBJECTIVE

To assess whether daily ingestion of yogurt containing Lactobacillus acidophilus prevents vulvovaginal candidal infections.

DESIGN

Crossover trial for at least 1 year during which patients were examined for candidal infections and colonizations while receiving either a yogurt-free or a yogurt-containing diet. Patients served as their own controls.

SETTING

Ambulatory infectious disease center in a teaching hospital providing tertiary care.

PATIENTS

Thirty-three women with recurrent candidal vaginitis were eligible after recruitment from community practices and clinics and through advertising. Twelve patients were eliminated for protocol violations. Of the remaining 21 patients, 8 who were assigned to the yogurt arm initially refused to enter the control phase 6 months later. Thus, 13 patients completed the protocol.

INTERVENTIONS

Women ate yogurt for 6 months of the study period.

MEASUREMENTS

Colonization of lactobacilli and candida in the vagina and rectum; candidal infections of the vagina.

MAIN RESULTS

Thirty-three eligible patients were studied. A threefold decrease in infections was seen when patients consumed yogurt containing Lactobacillus acidophilus. The mean (+/- SD) number of infections per 6 months was 2.54 +/- 1.66 in the control arm and 0.38 +/- 0.51 per 6 months in the yogurt arm (P = 0.001). Candidal colonization decreased from a mean of 3.23 +/- 2.17 per 6 months in the control arm to 0.84 +/- 0.90 per 6 months in the yogurt arm (P = 0.001).

CONCLUSION

Daily ingestion of 8 ounces of yogurt containing Lactobacillus acidophilus decreased both candidal colonization and infection.

Evaluation of three disinfectants after in-use stress

Solutions of 2.0% and 3.4% glutaraldehyde, and of 0.5% phenate with 0.18% glutaraldehyde were stressed with a microbial and organic soil load for the periods advocated by the respective manufacturers. The disinfecting efficacy of the stressed solutions was challenged with Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, Mycobacterium bovis (BCG), a water Mycobacterium sp. and Candida albicans. The three disinfectants were active against the fast-growing bacteria in appropriate dilutions; lesser dilutions of the glutaraldehyde solutions killed the mycobacteria and the yeast, while stressed phenate with glutaraldehyde did not. One hour exposure of the stressed disinfectants failed to kill the spore preparations while reducing the number of survivors.

Collaborative clinical laboratory evaluation of an individual MIC strip system

Susceptibility results obtained with individualized MIC strips (MICRO-MIC) agreed with the standard microdilution broth method at a level of 96% or greater for each of the 10 antimicrobial agents tested.