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5. American Society of Colon and Rectal Surgeons 95th Annual Convention Podium and Poster Abstracts June 9–14, 1996 Seattle, Washington

Author

Obrand, D., Gordon, P. H., Rowley, S., Grace, R. H., Rai, S., Moran, M. R., Rai, A. M., Farouk, R., Lee, P. W. R., Edwards, J., Thorne, M., MacDonald, A. W., Duthie, G. S., Monson, J. R. T., Shabahang, M., Brenner, R., Wright, A., Montgomery, E., Trock, B., Buras, R., Schumaker, L., Nolla, J., Buffan, A., Uskokovic, M., Nauta, R., Evans, S., Velázquez, O. C., Zhou, D., Seto, R. W., Choi, J., Jabbar, A., Breen, F., Rombeau, J. L., Casillas, S., Dietz, D. W., Brand, M. I., Vladisavljevic, A., Jones, S. C., Milsom, J. W., Stuntz, M., Wilmoth, G., Ong, J., Stabile, B., Stamos, M. J., Kahn, H., Alexander, A., Rakinic, J., Nagle, D., Fry, R., Simons, A. J., Kerr, R., Toms, C., Groshen, S., Ross, R., Morris, M., Beart, R., Ortega, A., Anthone, G., Lucha, P., Rosen, L., Stasik, J., Olenwine, J., Riether, R., Khubchandani, I., Ogunbivi, O., Birnbaum, E., Fleshman, J., Kodner, I., McLeod, R. S., Geerts, W., Sniderman, K., Greenwood, C., Gregoire, R., Taylor, B., Silverman, R., Atkinson, K., Burnstein, M., Marshall, J., Burul, C., Anderson, D., Ross, T., Wilson, S., Barton, P., Maetani, S., Onodera, H., Morimoto, H., Imamura, M., Hyams, D. M., Mamounas, E., Petrelli, N., Rockette, H., Jones, J., Wolmark, N., Sofo, L., Ratto, C., Valentini, V., Ippoliti, M., Nucera, P., Merico, M., Bellantone, R., Doglietto, G. B., Crucitti, F., Goes, R., Simons, A., Gunderson, L., Grado, G., Streeter, O., Sun, J. H., Decanini-Garza, P., Kim, D. G., Wong, W. D., Rothenberger, D. A., Madoff, R. D., Madlensky, L., Berk, T., Bapat, B., Redston, M., Gallinger, S., Cohen, Z., Winde, G., Schmid, K. W., Brandt, B., Müller, R., Osswald, H., Jang, Y., Steinhagen, R., Heimann, T., Schnitzler, M., Blackstein, M., McLeod, R., Devesa, J. M., Madrid, J. M. Fernandez, Enriquez, J. M., Geerdes, B. P., Heineman, E., Konsten, J., Baeten, C. G. M., Michot, F., Lehur, P. A., Denis, P., Grise, P. H., Leborgne, J., Teniere, P., Buzelin, J. M., Stebbing, J. F., Brading, A. F., Mortensen, N. J. McC, Gunn, J., Gardiner, A., Abdullah, N., Nyam, D. C. N. K., Pemberton, J. H., Ilstrup, D., Lund, J. N., Scholefield, J. H., Stamm, L., Matzel, K. E., Stadelmaier, U., Dünne, A., Hohenberger, W., Sala, C., Garcia-Granero, E., Molina, M. J., Garcia, J. V., Lledo, S., Ternent, C. A., Shashidharan, M., Blatchford, G. J., Christensen, M. A., Thorson, A. G., Sentovich, S. M., Jensen, L. L., Lowry, A. C., Zaheer, S., Reilly, W. T., Tsang, C., Singer, D., Richard, C. S., Stern, H. S., Oliveira, L., Daniel, N., Bernstein, M., DeMarta, D., Weiss, E. G., Nogueras, J. J., Wexner, S. D., Keighley, M. R. B., Korsgen, S., Agachan, F., Kim, D. -S., Goldberg, S. M., Durham, R. M., Pruitt, G., Longo, W. E., Marchesa, P., Oliart, S., Goldblum, J., Fazio, V. W., Rantis, P. C., Daniel, G. L., Vernava, III, A. M., Becker, J. M., Marie, G. St., Ferzoco, S., Franklin, M., Rosenthal, D., Goldstein, E. T., Bass, E. M., DelPino, A., Tan, A., Pearl, R., Orsay, C., Sher, M. E., Sands, L. R., Påhlman, Lars, Hewett, P. J., Thomas, W. M., King, G., Eaton, M., Allendorf, U. D. F., Bessler, M., Whelan, R. L., Trokel, M., Laird, D., Nowygrod, R., Treat, M. R., Vukasin, P., Steele, G., Weston, L., Allendorf, J. D. F., Sellers, G., Joo, J. S., Bruce, C. J., Coller, J. A., Murray, J. J., Schoetz, Jr., D. J., Roberts, P. L., Schoetz, D., Bockler, M., Rosenblatt, M., Malhorta, S., Roberts, P., Murray, J., Coller, J., Rusin, L., Liu, C. D., Newton, T. R., Zinner, M. J., Ashley, S. W., McFadden, D. W., Tusek, D. L., Church, J. M., Strong, S. A., Grass, J., Steinhart, A. H., Greenberg, G. R., Siminovich, K., Blair, J. E., Cruz, C., Prabhakar, L. P., Laramee, C., Nelson, H., Dozois, R. R., Ozuner, G., Hull, T., Fazio, V., Navaro, G., Bauer, J. J., Gorfine, S. R., Gelemt, I. M., Harris, M. T., Kreel, I., Marcello, P. W., Rusin, L. C., Veidenheimer, M. C., Ogunbiyi, O. A., Thibault, C., Sagar, P., Wolff, B. G., Lee, F., Lee, E. C., Pennoyer, W. P., Vignati, P. V., Cohen, J., MacRae, H. M., O'Connor, B., Ton, E., Hain, J. M., Perez-Ramirez, J. J., Spencer, M. P., Gemlo, B. T., Neto, J. A. Reis, Quilici, F. A., Cordeiro, F., Reis, Jr., J. A., Neto, C. I. Reis, Gottesman, L., Tjandra, J., Takano, M., Kuromizu, J., Tsuji, Y., Lee, C. S., Ferrara, A., Levy, J. R., Larach, S. W., Krecker, M., Williamson, P. R., Wong, D. W., Sarmiento, J. M., Burgart, L. J., Frizelle, F. A., Ilstrup, D. M., Salem, R., Smith, L. E., Rooney, P. S., Chapman, M. A. S., Steele, R. J. C., Koren, R., Gal, R., Kyzer, S., Chaimoff, CH., Rodríguez-Bigas, M. A., Mahoney, M. C., Weber, T. K., Petrelli, N. J., Ault, G., Ceron, O., Conti, P., Hadfield, M. B., Turnbull, L. W., Nicholson, A. A., Horsman, A., Shibata, D., Sentovich, S., Hyland, W., Busse, P., Bleday, R., Allendorf, J., Whelan, R., Horvath, K., Treat, M., Wronski, M., Arbit, E., Bilsky, M., Galicich, J. H., Miller, A. S., Lewis, W. G., Williamson, M. E. R., Sagar, P. M., Holdsworth, P. J., Johnston, D., Smith, A. H., Marchetti, F., Thompson-Fawcett, M. W., Warren, B. F., Mortensen, N. J. M., Bouchard, S., Belliveau, P., Trudel, J., Zinsmeister, A. R., Schleck, C. D., McIntyre, P. B., Hanson, R. B., Read, T. E., Dominguez, J. M., Hyman, N. H., Beck, D. E., Dayton, M. T., Stryker, S. J., Wolf, B. G., Young-Fadok, T. M., Meagher, A., Benn, P. L., Takao, Y., Chen, F. C., Wu, J., Milsom, J., Stein, B. L., Vasilevsky, C. A., Hartley, J. E., Cureshi, A., Sellers, G. J., Van, D., Ludwig, K. A., Garcia-Ruiz, A., Espat, N. J., Rao, G. N., Drew, P. J., Pfeifer, J., Park, U. C., Gonzalez, A., Okamoto, T., Konishi, F., Tsukamoto, T., Senba, S., Kashiwagi, H., Kojima, M., Togashi, T., Kanazawa, K., Yoon, W. H., Kang, Y. N., Hong, K. H., Park, H. D., Koo, S. H., Song, K. S., Kim, J. C., Roh, S. A., Park, K. C., Jessup, J. M., Changchien, C. R., Wang, J. Y., Hsu, K. C., Chen, J. S., Tang, R., You, Y. T., Ho, Y. S., Guttman, R., Nelson, R., Sardinha, T. G. S., Gilliland, J., Kroll, M., Lee, E., Wexler, J., Hudzinski, D., Glass, D., Wolff, B. D., King, D. W., Talley, N., Chen, W. S., Lin, W. C., Hsu, H., Wrightson, W. R., Galandiuk, S., LaRocca, R., Myers, S. R., Tada, M., Inoue, H., Tsubaki, M., Endo, M., Sobzcak, S., Welch, J. P., Cohen, J. L., Allen, L. W., Morrow, J. S., Behen, S. L., Smith, K. W., Cali, J. R., Bailey, H. R., Fucini, C., Elbetti, C., Messerini, L., Law, W. L., Butts, D. R., Max, E., Memon, M. A., Devine, J., Feeney, J., Talley, N. J., Stephenson, E. R., Ilahi, O., Koltun, W. A., Spellman, M., Rantis, R. C., Vernava, A. M., Parra, R. O., Breen, E., Hayes, P., Quinn, D., Whitlow, C. B., Opelka, F. G., Gathright, J. B., Golub, R. W., Maccabee, P. J., Combs, A. J., Grose, E. A., Taylor, B. M., Kozell, K., McGannon, E., Krogh, K., Nielsen, J., Djurhuus, J. C., Mosdal, C., Sabroe, S., Laurberg, S., Chen, M. F., Kerner, B. A., Khanduja, K. S., Wise, Jr., W. E., Padmanabhan, A., Meesig, D. M., Yasin, M. T., Aguilar, P. S., Ho, Y. H., Tan, M., Seow-Choen, F., Rustin, R. B., and Harmon, J. M.

Published
1996
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6. Podium presentations

Author

Foley, E. F., Marcello, P. W., Roberts, P. L., Murray, J. J., Coller, J. A., Veidenheimer, M. C., Schoetz, D. J., McIntyre, P. B., Pemberton, J. H., Wolff, B. G., Beart, Jr., R. W., Kelly, K. A., Dozois, R. R., Sugita, A., Fukushima, T., Harada, H., Yamamoto, M., Shimada, H., Tjandra, J. J., Fazio, V. W., Milson, J. W., Lavery, I. C., Oakley, J. R., Fabre, J. M., Karch, L. A., Bauer, J. J., Gorfine, S. R., Gelernt, I. M., Metcalf, A. M., Varilek, G., Keck, J. O., Hoffmann, D. C., Sgambati, S. A., Sardella, W. V., Marts, B. C., Longo, W. E., Vernava, III, A. M., Kennedy, D. J., Daniel, G. L., Jones, I., Venkatesh, K. S., Diamond, L. W., Larson, D. M., Ramanujam, P. J., Hicks, J. R., Ellis, C. N., Blakemore, W. S., Nathanson, S. D., Linden, M. D., Tender, P., Zarbo, R. J., Nelson, L., Bannon, J., Marks, G., Zhou, J., Mohiuddin, M., Marks, J., Pollard, C. W., Nivatvongs, S., Rojanasakul, A., Ilstrup, D. M., Speziale, N. J., Saclarides, T. J., Rubin, D. B., Szeluga, D. J., Morgado, P. J., Gomez, L. G., Morgado, Jr., P. J., Neto, J. A. Reis, Quilici, F. A., Cordeiro, F., Reis, Jr., J. A., Nitecki, S., Benn, P., Sarr, M. G., Weiland, L. H., Elhadad, A., Rouffet, F., Baillet, P., Akasu, T., Moriya, Y., Hojo, K., Sugihara, K., Oshima, H., Liu, S. K., Church, J. M., Kirkpatrick, J. R., Danielson, C. L., Dominguez, J. M., Jakate, S. M., Savin, M. H., Altringer, W. J., Lee, C. S., Spencer, M. P., Madoff, R. D., Barrett, R. C., Oster, M. A., Durdey, P., Stein, B. L., Staniunas, R. J., Grewal, H., Guillem, J. G., Quan, S., Enker, W. E., Cohen, A. M., van Tets, W. F., Kuijpers, H. C., Kerner, B. A., Wise, Jr., W. E., Golub, R. W., Arnold, M. W., Aguilar, P. S., Pernikoff, B. J., Eisenstat, T. E., Rubin, R. J., Oliver, G. C., Salvati, E. P., Lunniss, P. J., Sultan, A. H., Barker, P. G., Armstrong, P., Bartram, C. I., Phillips, R. K. S., Schouten, W. R., Briel, J. W., Auwerda, J. J. A., Harnsberger, J. R., Robbins, P. L., Brabbee, G. W., Ryhammer, A. M., Bek, K. M., Hanberg-Sørensen, F., Laurberg, S., Hoff, S. D., Bailey, H. R., Butts, D. R., Max, E., Smith, K. W., Zamora, L. F., Skakun, G. B., Khanduja, K. S., Lee, H., Beart, R. W., Spencer, R., Wiseman, J. S., Senagore, A. J., Bain, I. M., Oliff, J., Min, L., Neoptolomos, J., Keighley, M. R. B., O'Kelly, T. J., Davies, J., Brading, A. F., Mortensen, N. J. McC, Park, J. -G., Han, H. J., Kang, M. S., Nakamura, Y., Goldberg, G. S., Orkin, B. A., Smith, L. E., Fleshner, P. R., Freilich, M. I., Meagher, A. P., Adams, W. J., Lubowski, D. Z., King, D. W., Moran, M., Opelka, F., Timmcke, A., Hicks, T., Gathright, Jr., J. B., Leu, S. Y., Hsu, H., Dean, P. A., Ramsey, P. S., Nelson, H., Philpott, G., Siegel, B., Schwarz, S., Fleshman, J., Welch, M., Connett, J., Buie, W. D., Johnson, D. R., Heine, J. A., Wong, W. D., Rothenberger, D. A., Goldberg, S. M., Shafik, A., MacDonald, A., Craig, J. W., Finlay, I. G., Baxter, J. N., Muir, T. C., Parikh, S., Gold, R. P., Gottesman, L., Annibali, R., Öresland, T., Hallgren, T., Fasth, S., Hultén, L., Farouk, R., Duthie, G. S., MacGregor, A. B., Bartolo, D. C. C., Williamson, M. E. R., Lewis, W. G., Holdsworth, P. J., Hall, N., Finan, P. J., Johnston, D., Seow-Choen, F., Goh, H. S., Motson, R. W., Walsh, C. J., Mooney, E., Yamashita, H. J., Wise, W. E., Hartmann, R. F., Seccia, M., Menconi, C., Ghiselli, G., Cavina, E., Salomon, M. C., Ferrara, A., Larach, S. W., Williamson, P. R., Bass, E. M., Orsay, C. P., Firfer, B., Ramakrishnan, V., Abcarian, H., Bufo, A. J., Feldman, S., Daniels, G. A., Lieberman, R. C., Loder, P. B., Kamm, M. A., Nicholls, R. J., Kum, C. K., Ngoi, S. S., Goh, P. M. Y., Tekant, Y., Isaac, J. R., Gerstle, J. T., Kauffman, G. L., and Koltun, W. A.

Published
1993
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7. Goal-directed Fluid Therapy Does Not Reduce Primary Postoperative Ileus after Elective Laparoscopic Colorectal Surgery: A Randomized Controlled Trial

Author

Gomez-Izquierdo J. C., Trainito A., Mirzakandov D., Stein B. L., Liberman S., Charlebois P., Pecorelli N., Feldman L. S., Carli F., Baldini G., Gomez-Izquierdo, J. C., Trainito, A., Mirzakandov, D., Stein, B. L., Liberman, S., Charlebois, P., Pecorelli, N., Feldman, L. S., Carli, F., and Baldini, G.

Subjects
Male, Canada, Ileus, Postoperative Complications, Treatment Outcome, Elective Surgical Procedures, Fluid Therapy, Humans, Female, Laparoscopy, Intestine, Large, Middle Aged, Goals
Abstract

Background: Inadequate perioperative fluid therapy impairs gastrointestinal function. Studies primarily evaluating the impact of goal-directed fluid therapy on primary postoperative ileus are missing. The objective of this study was to determine whether goal-directed fluid therapy reduces the incidence of primary postoperative ileus after laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Methods: Randomized patient and assessor-blind controlled trial conducted in adult patients undergoing laparoscopic colorectal surgery within an Enhanced Recovery After Surgery program. Patients were assigned randomly to receive intraoperative goal-directed fluid therapy (goal-directed fluid therapy group) or fluid therapy based on traditional principles (control group). Primary postoperative ileus was the primary outcome. Results: One hundred twenty-eight patients were included and analyzed (goal-directed fluid therapy group: N = 64; control group: N = 64). The incidence of primary postoperative ileus was 22% in the goal-directed fluid therapy and 22% in the control group (relative risk, 1; 95% CI, 0.5 to 1.9; P = 1.00). Intraoperatively, patients in the goal-directed fluid therapy group received less intravenous fluids (mainly less crystalloids) but a greater volume of colloids. The increase of stroke volume and cardiac output was more pronounced and sustained in the goal-directed fluid therapy group. Length of hospital stay, 30-day postoperative morbidity, and mortality were not different. Conclusions: Intraoperative goal-directed fluid therapy compared with fluid therapy based on traditional principles does not reduce primary postoperative ileus in patients undergoing laparoscopic colorectal surgery in the context of an Enhanced Recovery After Surgery program. Its previously demonstrated benefits might have been offset by advancements in perioperative care.

Published
2017

9. Electronic properties of Si/Si1–x–yGexCy heterojunctions

Author

Stein, B. L., Yu, E. T., Croke, E. T., Hunter, A. T., Laursen, T., Mayer, J. W., and Ahn, C. C.

Subjects
Caltech Library Services
Abstract

We have used admittance spectroscopy and deep-level transient spectroscopy to characterize electronic properties of Si/Si1–x–yGexCy heterostructures. Band offsets measured by admittance spectroscopy for compressively strained Si/Si1–x–yGexCy heterojunctions indicate that incorporation of C into Si1–x–yGexCy lowers both the valence- and conduction-band edges compared to those in Si1–xGex by an average of 107 ± 6 meV/% C and 75 ± 6 meV/% C, respectively. Combining these measurements indicates that the band alignment is type I for the compositions we have studied, and that these results are consistent with previously reported results on the energy band gap of Si1–x–yGexCy and with measurements of conduction band offsets in Si/Si1–yCy heterojunctions. Several electron traps were observed using deep-level transient spectroscopy on two n-type heterostructures. Despite the presence of a significant amount of nonsubstitutional C (0.29–1.6 at. %), none of the peaks appear attributable to previously reported interstitial C levels. Possible sources for these levels are discussed.

Published
1998

10. Measurement of band offsets in Si/Si1–xGex and Si/Si1–x–yGexCy heterojunctions

Author

Stein, B. L., Yu, E. T., Croke, E. T., Hunter, A. T., Laursen, T., Bair, A. E., Mayer, J. W., and Ahn, C. C.

Subjects
Caltech Library Services
Abstract

Realization of group IV heterostructure devices requires the accurate measurement of the energy band offsets in Si/Si1–xGex and Si/Si1–x–yGexCy heterojunctions. Using admittance spectroscopy, we have measured valence-band offsets in Si/Si1–xGex heterostructures and conduction-band and valence-band offsets in Si/Si1–x–yGexCy heterostructures grown by solid-source molecular-beam epitaxy. Measured Si/Si1–xGex valence-band offsets were in excellent agreement with previously reported values. For Si/Si1–x–yGexCy our measurements yielded a conduction-band offset of 100 ± 11 meV for a n-type Si/Si0.82Ge0.169C0.011 heterojunction and valence-band offsets of 118 ± 12 meV for a p-type Si/Si0.79Ge0.206C0.004 heterojunction and 223 ± 20 meV for a p-type Si/Si0.595Ge0.394C0.011 heterojunction. Comparison of our measured band offsets with previously reported measurements of energy band gaps in Si1–x–yGexCy and Si1–yCy alloy layers indicates that the band alignment is type I for the compositions we have studied and that our measured band offsets are in quantitative agreement with these previously reported results.

Published
1997

11. Disruption of the ASXL1 gene is frequent in primary, post-essential thrombocytosis and post-polycythemia vera myelofibrosis, but not essential thrombocytosis or polycythemia vera: analysis of molecular genetics and clinical phenotypes

Author

Stein, B. L., primary, Williams, D. M., additional, O'Keefe, C., additional, Rogers, O., additional, Ingersoll, R. G., additional, Spivak, J. L., additional, Verma, A., additional, Maciejewski, J. P., additional, McDevitt, M. A., additional, and Moliterno, A. R., additional

Published
2011
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13. Deep-level transient spectroscopy of Si/Si1–x–yGexCy heterostructures

Author

Stein, B. L., Yu, E. T., Croke, E. T., Hunter, A. T., Laursen, T., Mayer, J. W., Ahn, C. C., Stein, B. L., Yu, E. T., Croke, E. T., Hunter, A. T., Laursen, T., Mayer, J. W., and Ahn, C. C.

Abstract

Deep-level transient spectroscopy was used to measure the activation energies of deep levels in n-type Si/Si1–x–yGexCy heterostructures grown by solid-source molecular-beam epitaxy. Four deep levels have been observed at various activation energies ranging from 231 to 405 meV below the conduction band. The largest deep-level concentration observed was in the deepest level and was found to be approximately 2 × 10^15 cm^–3. Although a large amount of nonsubstitutional C was present in the alloy layers (1–2 at. %), no deep levels were observed at any energy levels that, to the best of our knowledge, have been previously attributed to interstitial C.

Published
1998

14. Band offsets in Si/Si1–x–yGexCy heterojunctions measured by admittance spectroscopy

Author

Stein, B. L., Yu, E. T., Croke, E. T., Hunter, A. T., Laursen, T., Bair, A. E., Mayer, J. W., Ahn, C. C., Stein, B. L., Yu, E. T., Croke, E. T., Hunter, A. T., Laursen, T., Bair, A. E., Mayer, J. W., and Ahn, C. C.

Abstract

We have used admittance spectroscopy to measure conduction-band and valence-band offsets in Si/Si1–xGex and Si/Si1–x–yGexCy heterostructures grown by solid-source molecular-beam epitaxy. Valence-band offsets measured for Si/Si1–xGex heterojunctions were in excellent agreement with previously reported values. Incorporation of C into Si1–x–yGexCy lowers the valence- and conduction-band-edge energies compared to those in Si1–xGex with the same Ge concentration. Comparison of our measured band offsets with previously reported measurements of energy band gaps in Si1–x–yGexCy and Si1–yCy alloy layers indicate that the band alignment is Type I for the compositions we have studied and that our measured band offsets are in quantitative agreement with these previously reported results.

Published
1997

22. Deep-level transient spectroscopy of Si/Si[sub 1-x-y]Ge[sub x]C[sub y] heterostructures.

Author

Stein, B. L., Yu, E. T., Croke, E. T., Hunter, A. T., Laursen, T., Mayer, J. W., and Ahn, C. C.

Subjects
*DEEP level transient spectroscopy, *HETEROSTRUCTURES, *ELECTRON mobility
Abstract

Deep-level transient spectroscopy was used to measure the activation energies of deep levels in n-type Si/Si[sub 1-x-y]Ge[sub x]C[sub y] heterostructures grown by solid-source molecular-beam epitaxy. Four deep levels have been observed at various activation energies ranging from 231 to 405 meV below the conduction band. The largest deep-level concentration observed was in the deepest level and was found to be approximately 2×10[sup 15] cm[sup -3]. Although a large amount of nonsubstitutional C was present in the alloy layers (1–2 at. %), no deep levels were observed at any energy levels that, to the best of our knowledge, have been previously attributed to interstitial C. © 1998 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Published
1998
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23. An app for patient education and self-audit within an enhanced recovery program for bowel surgery: a pilot study assessing validity and usability

Author

Julio F. Fiore, Barry Stein, Nicolò Pecorelli, Liane S. Feldman, Abarna Somasundram, Patrick Charlebois, Franco Carli, A. Sender Liberman, Pepa Kaneva, Pecorelli, N., Fiore, J. F., Kaneva, P., Somasundram, A., Charlebois, P., Liberman, A. S., Stein, B. L., Carli, F., and Feldman, L. S.

Subjects
Adult, Male, Clinical audit, medicine.medical_specialty, Intraclass correlation, Pilot Projects, Audit, 030230 surgery, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, Cohen's kappa, Physical medicine and rehabilitation, Patient Education as Topic, Colorectal surgery, Outcome Assessment, Health Care, Humans, Medicine, Prospective Studies, Outcome and process assessment (health care), Enhanced recovery, Digestive System Surgical Procedures, Aged, Aged, 80 and over, Clinical Audit, business.industry, System usability scale, Reproducibility of Results, Usability, Middle Aged, Mobile Applications, Health education, Patient Satisfaction, 030220 oncology & carcinogenesis, Physical therapy, Patient Compliance, Female, Surgery, Self Report, business, Patient education
Abstract

Introduction: While patient engagement and clinical audit are key components of successful enhanced recovery programs (ERPs), they require substantial resource allocation. The objective of this study was to assess the validity and usability of a novel mobile device application for education and self-reporting of adherence for patients undergoing bowel surgery within an established ERP. Methods: Prospectively recruited patients undergoing bowel surgery within an ERP used a novel app specifically designed to provide daily recovery milestones and record adherence to 15 different ERP processes and six patient-reported outcomes (PROs). Validity was measured by the agreement index (Cohen’s kappa coefficient for categorical, and interclass correlation coefficient (ICC) for continuous variables) between patient-reported data through the app and data recorded by a clinical auditor. Acceptability and usability of the app were measured by the System Usability Scale (SUS). Results: Forty-five patients participated in the study (mean age 61, 64% male). Overall, patients completed 159 of 179 (89%) of the available questionnaires through the app. Median time to complete a questionnaire was 2min 49s (i.q.r. 2′32″–4′36″). Substantial (kappa > 0.6) or almost perfect agreement (kappa > 0.8) and strong correlation (ICC > 0.7) between data collected through the app and by the clinical auditor was found for 14 ERP processes and four PROs. Patient-reported usability was high; mean SUS score was 87 (95% CI 83–91). Only 6 (13%) patients needed technical support to use the app. Forty (89%) patients found the app was helpful to achieve their daily goals, and 34 (76%) thought it increased their motivation to recover after surgery. Conclusions: This novel application provides a tool to record patient adherence to care processes and PROs, with high agreement with traditional clinical audit, high usability, and patient satisfaction. Future studies should investigate the use of mobile device apps as strategies to increase adherence to perioperative interventions.

Published
2017
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24. Predictors of adherence to enhanced recovery pathway elements after laparoscopic colorectal surgery

Author

Juan Mata, Barry Stein, Julio F. Fiore, Nicolò Pecorelli, Liane S. Feldman, Sender Liberman, Patrick Charlebois, Mata, J., Fiore, J. F., Pecorelli, N., Stein, B. L., Liberman, S., Charlebois, P., and Feldman, L. S.

Subjects
Male, medicine.medical_specialty, Nausea, 030230 surgery, Perioperative Care, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, Colorectal surgery, Internal medicine, medicine, Humans, Prospective Studies, Patient participation, Laparoscopy, Enhanced recovery, medicine.diagnostic_test, Postoperative recovery, business.industry, Middle Aged, Hepatology, Surgery, Adherence, 030220 oncology & carcinogenesis, Vomiting, Female, Guideline Adherence, medicine.symptom, business, Colorectal Surgery, Postoperative nausea and vomiting, Abdominal surgery
Abstract

Introduction: Enhanced recovery pathways (ERP) include a bundle of evidence-based preoperative, intraoperative, and postoperative interventions that together reduce morbidity and length of stay after colorectal surgery. Increased adherence with the bundle is associated with better postoperative outcomes, but adherence is lowest in the postoperative period. Identifying risk factors for lower adherence may help design quality improvement strategies. The aim of this study was to estimate the extent to which patient, procedural, and organizational factors predict adherence to postoperative ERP elements in laparoscopic colorectal surgery. Methods: Patients in an institutional ERP registry undergoing elective laparoscopic colorectal surgery between 2012 and 2014 were analyzed. The ERP included 10 postoperative ERP elements classified into 2 groups: those requiring patient participation (PP, 5 elements, including nutritional intake and mobilization) and those provided by the clinical team (CT, 5 elements, including removal of catheters and type of analgesia). The impact of baseline and intraoperative factors on adherence was estimated using stepwise linear regression. Results: A total of 223 patients were included (mean age 60, 48% male). Mean adherence was 79% to the PP bundle (range 65–93% for individual elements), and 82% for the CT bundle (range 68–98% for individual elements). The occurrence of nausea/vomiting in the first 24h was associated with lower adherence to both bundles. In the PP bundle, patients who arrived at the ward after 6p.m. had lower adherence. In the CT bundle, patients who had rectal resection had lower adherence while thoracic epidural was associated with higher adherence. Conclusions: With the exception of postoperative nausea and vomiting, predictors of adherence to ERP elements after colorectal surgery differed for elements requiring patient participation and those provided by the clinical team. Strategies to improve ERP adherence should target staff education and engagement of patients at risk for lower adherence.

Published
2017
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25. In Reply

Author

Juan C. Gómez-Izquierdo, Alessandro Trainito, David Mirzakandov, Barry L. Stein, A. Sender Liberman, Patrick Charlebois, Nicolò Pecorelli, Liane S. Feldman, Franco Carli, Gabriele Baldini, Gomez-Izquierdo, J. C., Trainito, A., Mirzakandov, D., Stein, B. L., Liberman, A. S., Charlebois, P., Pecorelli, N., Feldman, L. S., Carli, F., and Baldini, G.

Subjects
Ileus, Anesthesiology and Pain Medicine, Fluid Therapy, Humans, Laparoscopy, Colorectal Surgery, Goals
Published
2018
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26. Incidence and predictors of prolonged postoperative ileus after colorectal surgery in the context of an enhanced recovery pathway

Author

Barry Stein, Patrick Charlebois, Nadia Safa, Juan Mata, Mohsen Alhashemi, Nicolò Pecorelli, Nandini Dendukuri, Julio F. Fiore, Liane S. Feldman, Franco Carli, Gabriele Baldini, A. Sender Liberman, Mohammed Al Mahroos, Alhashemi, M., Fiore, J. F., Safa, N., Al Mahroos, M., Mata, J., Pecorelli, N., Baldini, G., Dendukuri, N., Stein, B. L., Liberman, A. S., Charlebois, P., Carli, F., and Feldman, L. S.

Subjects
Male, medicine.medical_specialty, Postoperative ileus, Blood Loss, Surgical, Context (language use), 030230 surgery, 03 medical and health sciences, Colonic Diseases, 0302 clinical medicine, Ileus, Postoperative Complications, Enhanced recovery, Risk Factors, Internal medicine, medicine, Humans, Colorectal, Digestive System Surgical Procedures, Aged, Retrospective Studies, business.industry, Incidence (epidemiology), Incidence, Bayes Theorem, Hepatology, Middle Aged, Colorectal surgery, Analgesia, Epidural, Analgesics, Opioid, Rectal Diseases, Critical Pathways, Defecation, Fluid Therapy, 030211 gastroenterology & hepatology, Surgery, Female, Laparoscopy, business, Abdominal surgery
Abstract

Background: Prolonged postoperative ileus (PPOI) is common after colorectal surgery but has not been widely studied in the context of enhanced recovery pathways (ERPs) that include interventions aimed to accelerate gastrointestinal recovery. The aim of this study is to estimate the incidence and predictors of PPOI in the context of an ERP for colorectal surgery. Methods: We analyzed data from an institutional colorectal surgery ERP registry. Incidence of PPOI was estimated according to a definition adapted from Vather (intolerance of solid food and absence of flatus or bowel movement for ≥ 4days) and compared to other definitions in the literature. Potential risk factors for PPOI were identified from previous studies, and their predictive ability was evaluated using Bayesian model averaging (BMA). Results are presented as posterior effect probability (PEP). Evidence of association was categorized as: no evidence (PEP < 50%), weak evidence (50–75%), positive evidence (75–95%), strong evidence (95–99%), and very strong evidence (> 99%). Results: There were 323 patients analyzed (mean age 63.5years, 51% males, 74% laparoscopic, 33% rectal resection). The incidence of PPOI was 19% according to the primary definition, but varied between 11 and 59% when using other definitions. On BMA analysis, intraoperative blood loss (PEP 99%; very strong evidence), administration of any intravenous opioids in the first 48h (PEP 94%; strong evidence), postoperative epidural analgesia (PEP 56%; weak evidence), and non-compliance with intra-operative fluid management protocols (3ml/kg/h for laparoscopic and 5ml/kg/h for open; PEP 55%, weak evidence) were predictors of PPOI. Conclusions: The incidence of PPOI after colorectal surgery is high even within an established ERP and varied considerably by diagnostic criteria, highlighting the need for a consensus definition. The use of intravenous opioids is a modifiable strong predictor of PPOI within an ERP, while the role of epidural analgesia and intraoperative fluid management should be further evaluated.

Published
2019

27. A mobile device application (app) to improve adherence to an enhanced recovery program for colorectal surgery: a randomized controlled trial

Author

Dan Moldoveanu, Patrick Charlebois, Lawrence Lee, Barry Stein, Juan Mata, Julio F. Fiore, Liane S. Feldman, Nicolò Pecorelli, Alexandre Gosselin-Tardiff, Saba Balvardi, Mohsen Alhashemi, Sender Liberman, Stephan Robitaille, Pepa Kaneva, Mata, J., Pecorelli, N., Kaneva, P., Moldoveanu, D., Gosselin-Tardiff, A., Alhashemi, M., Robitaille, S., Balvardi, S., Lee, L., Stein, B. L., Liberman, S., Charlebois, P., Fiore, J. F., and Feldman, L. S.

Subjects
Technology, medicine.medical_specialty, Mobile application, 030230 surgery, Recovery pathways, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Patient Education as Topic, law, Surveys and Questionnaires, Outcome Assessment, Health Care, medicine, Humans, Patient participation, Colorectal, business.industry, Behavior change, Behavior change methods, Mobile Applications, Colorectal surgery, Telemedicine, Physical therapy, Patient Compliance, 030211 gastroenterology & hepatology, Surgery, Health education, business, Enhanced Recovery After Surgery, Colorectal Surgery, Abdominal surgery, Patient education
Abstract

Background: Increased adherence with enhanced recovery pathways (ERP) is associated with improved outcomes. However, adherence to postoperative elements that rely on patient participation remains suboptimal. Mobile device apps may improve delivery of health education material and have the potential to foster behavior change and improve patient compliance. The objective of this study was to estimate the extent to which a novel mobile device app affects adherence to an ERP for colorectal surgery in comparison to standard written education. Methods: This was a superiority, parallel-group, assessor-blind, sham-controlled randomized trial involving 97 patients undergoing colorectal resection. Participants were randomly assigned with a 1:1 ratio into one of two groups: (1) iPad including a novel mobile device app for postoperative education and self-assessment of recovery, or (2) iPad without the app. The primary outcome measure was mean adherence (%) to a bundle of five postoperative ERP elements requiring patient participation: mobilization, gastrointestinal motility stimulation, breathing exercises, and consumption of oral liquids and nutritional drinks. Results: In the intervention group, app usage was high (94% completed surveys on POD0, 82% on POD1, 72% on POD2). Mean overall adherence to the bundle on the two first postoperative days was similar between groups: 59% (95% CI 52–66%) in the intervention group and 62% (95% CI 56–68%) in the control group [Adjusted mean difference 2.4% (95% CI − 5 to 10%) p = 0.53]. Conclusions: In this randomized trial, access to a mobile health application did not improve adherence to a well-established enhanced recovery pathway in colorectal surgery patients, when compared to standard written patient education. Future research should evaluate the impact of applications integrating novel behavioral change techniques, particularly in contexts where adherence is low.

Published
2018

28. Glutaraldehyde-induced colitis.

Author

Stein BL, Lamoureux E, Miller M, Vasilevsky CA, Julien L, and Gordon PH

Subjects
Acute Disease, Adult, Aged, Biopsy, Colitis diagnosis, Colorectal Neoplasms diagnosis, Disinfection methods, Female, Humans, Male, Mass Screening, Middle Aged, Risk Factors, Colitis chemically induced, Colonoscopy methods, Disinfectants adverse effects, Glutaral adverse effects, Sigmoidoscopy methods
Abstract

Objective: To describe the etiology and clinical course of acute colitis occurring after flexible endoscopy., Design: Chart review., Setting: A university teaching hospital., Patients: Eight patients who sought assessment of potential colonic disease., Intervention: Colonoscopy in 5 patients and flexible sigmoidoscopy in 3 patients. The indication for endoscopy was screening in 5 patients, cancer surveillance in 2 patients and preoperative evaluation of colon carcinoma in 1 patient., Outcome Measures: The relation of presenting symptoms to glutaraldehyde exposure, the response to therapy and the need for further therapy., Results: All patients had abdominal pain, mucus diarrhea and rectal bleeding within 48 hours after endoscopy. Most patients reported that the symptoms started within 12 hours of the procedure. All patients were confirmed by sigmoidoscopy to have colitis within 72 hours of the first endoscopic procedure. One patient required hospitalization. In the first 7 patients several stool cultures were negative for Clostridium difficile using the cytotoxin assay by the cell culture method. Four patients had negative cultures for Yersinia, Salmonella and Shigella spp. Three patients were treated with metronidazole initially. Two patients underwent endoscopic biopsy and examination of the biopsy specimen showed fibrinoleukocytic exudate and ischemic type injury. One patient underwent the scheduled sigmoid resection within 48 hours of endoscopy for a Dukes' stage B adenocarcinoma. Concomitant acute ischemic colitis limited to the mucosa and submucosa was noted in the resected specimen. Symptoms resolved in all patients and follow-up endoscopy revealed normal mucosa., Conclusion: The entity of glutaraldehyde-induced colitis should be recognized and special attention should be given during instrument cleansing to minimize the risk of its development.

Published
2001

29. Management of malignant colorectal polyps.

Author

Stein BL and Coller JA

Subjects
Carcinoma surgery, Colonic Polyps surgery, Colorectal Neoplasms pathology, Humans, Intestinal Polyps pathology, Neoplasm Invasiveness, Treatment Outcome, Colorectal Neoplasms surgery, Intestinal Polyps surgery
Abstract

The optimal management of patients with adenomatous polyps that contain invasive adenocarcinoma remains controversial. The independent factors of margins of resection, level of invasion, differentiation, grade, and vascular invasion are examined as prognostic indicators for outcome. The literature is reviewed with regard to the management of patients with polyp-containing invasive adenocarcinoma with standard operative resection versus endoscopic treatment alone.

Published
1993
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30. Perianal inflammatory conditions in inflammatory bowel disease.

Author

Stein BL and Gordon PH

Subjects
Abscess pathology, Adult, Colitis, Ulcerative complications, Colitis, Ulcerative pathology, Combined Modality Therapy, Crohn Disease complications, Crohn Disease pathology, Female, Humans, Male, Mercaptopurine administration & dosage, Metronidazole administration & dosage, Proctitis pathology, Rectal Fistula pathology, Rectovaginal Fistula pathology, Abscess surgery, Colitis, Ulcerative surgery, Crohn Disease surgery, Proctitis surgery, Rectal Fistula surgery, Rectovaginal Fistula surgery
Abstract

Perianal complications of Crohn's disease are fairly common in the adult and pediatric populations. Transrectal ultrasonography is effective for the diagnosis and follow-up of patients with anorectal abscesses and fistulas in Crohn's disease. Metronidazole and 6-mercaptopurine therapy have been used effectively to treat perianal complications of Crohn's disease in the pediatric population. Asymptomatic perianal fistulas in a patient with Crohn's disease do not require treatment. If a fistula is symptomatic and involves only a small portion of the sphincter mechanism, conventional fistulotomy may be performed with good results. Complex fistulas that involve larger areas of the sphincter are best treated by optimizing medical management and seton placement. The management of rectovaginal fistulas in the presence of Crohn's disease is controversial. Conventional fistulotomy and transvaginal mucosal advancement flap with diverting ileostomy have been advocated as primary treatment modalities. Rectovaginal fistulas secondary to ulcerative colitis may be treated by ileoanal pouch anastomosis and primary repair.

Published
1993

31. Preoperative parathyroid localization: a prospective evaluation of ultrasonography and thallium-technetium scintigraphy in hyperparathyroidism.

Author

Stein BL and Wexler MJ

Subjects
Adolescent, Adult, Aged, Female, Humans, Hyperparathyroidism pathology, Male, Middle Aged, Parathyroid Glands diagnostic imaging, Predictive Value of Tests, Prospective Studies, Radionuclide Imaging, Sensitivity and Specificity, Sodium Pertechnetate Tc 99m, Subtraction Technique, Thallium Radioisotopes, Hyperparathyroidism diagnosis, Parathyroid Glands pathology, Ultrasonography
Abstract

To assess the ability of ultrasonography (US) and dual tracer thallium-technetium subtraction scanning (NS) to localize abnormal parathyroid glands, these two investigations were carried out preoperatively in 27 consecutive patients who underwent surgery for hyperparathyroidism. Nineteen patients had adenomas and 8 hyperplasia. Of 23 US procedures 2 were inadequate, and of 26 NS procedures 1 was inadequate. Ultrasonography was found to be superior to NS for preoperative localization of abnormal parathyroid glands (sensitivity per gland 53% versus 36%); detection rates for hyperplasia were poor for both techniques (sensitivity per gland 36% and 25%). However, when positive, both techniques were extremely accurate (positive predictive value of 100% for both). There was no correlation between the weight of the gland or degree of physiological hyperfunction (parathyroid hormone level) and detection rates for the two techniques. False-positive results were rare for both, so a positive result was highly predictive of an abnormality at that location. Ultrasonography had sufficient accuracy to suggest its routine use when adenoma is suspected, particularly to detect the side of the lesion (sensitivity 78% and positive predictive value 100%). The addition of subtraction scintigraphy does not appear to be warranted.

Published
1990

32. Nonshunting operations for variceal hemorrhage.

Author

Wexler MJ and Stein BL

Subjects
Esophageal and Gastric Varices complications, Gastrointestinal Hemorrhage etiology, Humans, Meta-Analysis as Topic, Methods, Esophageal and Gastric Varices surgery, Gastrointestinal Hemorrhage surgery
Abstract

To evaluate the various nonshunting treatment modalities currently being used, it is difficult to make comparative assessments by reviewing the literature. There is varied composition in the groups studied; numerous major modifications, but more often subtle but poorly described differences in surgical techniques; and lack of uniform definitions and methods of reporting even the most basic of results, be it recurrent hemorrhage, encephalopathy, or survival. Series often lump together patients with cirrhosis, both alcoholic and nonalcoholic, noncirrhotic intrahepatic block, and extrahepatic block, each of which has a different natural history, prognosis, and physiologic and hemodynamic response to interventions. Classification of severity of cirrhosis, although commonly referred to as Child's class A, B, or C, may be based on time of assessment, worst criteria present, or a point scoring system. The operations are described as "emergency," "urgent," "emergent," or "elective," and the definition of each varies with investigator. Clearly, the ability of the patient to stop bleeding and survive the hazards and high mortality of the early hours of the acute event places him in a better risk group irrespective of whether the surgical intervention is performed "urgently" within 24 hours or electively in 24 days. Expressions of long-term survival frequently do not always take into account the operative deaths or the mean follow-up time. However, some general remarks can be made. The Sugiura procedure can be performed with an extremely low mortality in selected elective patients, particularly the nonalcoholic, with virtually no postoperative encephalopathy and negligible variceal rebleeding. Postoperative major hepatic decompensation does not appear to occur with time, and long-term survival would appear superior to DSR shunt. In the class A or B alcoholic cirrhotic, results are certainly as good as and perhaps better than DSR shunt, and it is a reasonable alternative, particularly when technical and other considerations make the performance of such a shunt difficult. Surgeons who routinely perform the Warren shunt should have this operation available in their repertoire as an alternative. Attempts to compromise and reduce the extent of devascularization utilizing only a thoracic or abdominal venue or to violate Sugiura's principle of leaving intact the coronary-periesophageal-azygos venous pathway generally result in a progressively higher incidence of recurrent hemorrhage with time. The early success reported by Perecchia, Abouna, and Franco, with a transabdominal approach and lesser thoracic devascularization, which avoids "entry" into the chest, is noted with interest for the future and suggests such an approach for the more critically bleeding patients rather than the initial thoracic approach of others.(ABSTRACT TRUNCATED AT 400 WORDS)

Published
1990
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33. Hemoglobin E in a refugee family.

Author

Owens MR, Andolina JR, and Stein BL

Subjects
Adult, Blood Cell Count, Female, Humans, Laos ethnology, Anemia, Hypochromic drug therapy, Hemoglobin E genetics, Hemoglobins, Abnormal genetics, Hemoglobinuria genetics
Published
1981

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