|
This issue of MB's Articles of Interest may be incomplete. It will also be the last. Michael died before he was finished with them. In memory of Michael
John Bookallil |
ARTICLE TITLE: Multiorgan failure induced by atorvastatin.
ARTICLE SOURCE: Am J Med (United States), Sep 2002, 113(4) p348-9
AUTHOR(S): Sreenarasimhaiah J; Shiels P; Lisker-Melman M
PUBLICATION TYPE: Letter
ARTICLE TITLE: Heart failure after myocardial infarction: a
review.
COMMENTS: Comment In: Comment In: RefSource:Am J Med. 2002 Sep;
113(4):341-3/PMID:12361824
ARTICLE SOURCE: Am J Med (United States), Sep 2002, 113(4)
p324-30
AUTHOR(S): Hellermann JP; Jacobsen SJ; Gersh BJ; Rodeheffer RJ;
Reeder GS; Roger VL
AUTHOR'S ADDRESS: Division of Cardiovascular Diseases and Internal
Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
PUBLICATION TYPE: Journal Article; Meta-Analysis
ARTICLE TITLE: Cost-effectiveness of newer treatment strategies
for influenza.
ARTICLE SOURCE: Am J Med (United States), Sep 2002, 113(4) p300-7
AUTHOR(S): Smith KJ; Roberts MS
AUTHOR'S ADDRESS: Section of Decision Sciences and Clinical Systems
Modeling, Division of General Internal Medicine, and the Center for
Research on Health Care, University of Pittsburgh School of Medicine,
Pittsburgh, Pennsylvania 15213, USA. smithkj2@msx.upmc.edu.
PUBLICATION TYPE: Journal Article
RESULTS: In the baseline analysis, testing strategies are more
expensive and less effective than treatment strategies. Amantadine
costs $9.06 per illness day avoided or $11.60 per quality-adjusted
day gained. Compared with amantadine, zanamivir costs $198 per
illness day avoided or $185 per quality-adjusted day gained, whereas
oseltamivir costs $252 per illness day avoided or $235 per
quality-adjusted day gained<snip> CONCLUSIONS: Antiviral
treatment of influenza without rapid testing is reasonable
economically in febrile patients with typical symptoms during
influenza season. The choice of antiviral agent depends on age, the
likelihood of influenza A, and the willingness to pay per
quality-adjusted day gained.
MB: I wonder how much is saved & even death averted by avoiding
pneumonia &/or cardiac failure - although that might cost
more.
ARTICLE TITLE: Visual spatial perception and surgical
competence.
ARTICLE SOURCE: Am J Surg (United States), Sep 2002, 184(3)
p291-5
AUTHOR(S): Risucci DA
AUTHOR'S ADDRESS: Department of Surgery, New York Medical College,
Munger Pavilion, Valhalla, NY 10595, USA.
Donald_Risucci@nymc.edu.
PUBLICATION TYPE: Status: Completed
Evaluation Studies; Journal Article
CONCLUSIONS: Surgeons tend to outperform the general population on
tests of high-level visual spatial perception (VSP) abilities (ie,
envisioning depth and mentally manipulating two-dimensional
representations of three-dimensional structures) identified
previously as correlates of surgical skill acquisition. VSP
proficiency is a valid component of surgical competence that should
perhaps be included in career selection discussions with medical
students and in assessment of the competence of surgeons.
MB: I don't think they have shown the validity. It would seem logical
but it might develop after acquiring surgical skills. They start off
with only a tendency.
ARTICLE TITLE: Financing graduate medical education and limiting
resident work hours: a political assessment(1).
ARTICLE SOURCE: Am J Surg (United States), Sep 2002, 184(3)
p187-95
AUTHOR(S): Knapp R
AUTHOR'S ADDRESS: Association of American Medical Colleges, 2450 N
Street, NW, Washington DC 20037-1127, USA.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: A preliminary measurement of the surgical
personality.
ARTICLE SOURCE: Am J Surg (United States), Aug 2002, 184(2)
p121-5
AUTHOR(S): McGreevy J; Wiebe D
AUTHOR'S ADDRESS: Department of Surgery, University of Utah, Salt
Lake City, UT 84132, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: We used the Revised NEO Personality Inventory
(Psychological Resources, Inc.) to test for a distinct surgical
personality. METHODS: The NEO-PI-R is a compilation of 240
statements. Subjects agree or disagree with the statements,
generating a score in five personality traits according to the five
factor theory: neuroticism (N), extraversion (E), openness (O),
agreeableness (A), and conscientiousness (C). Each score is compared
with that for the general population. RESULTS: Twenty-four male and
15 female surgical residents voluntarily took the inventory. Compared
to the general population, males scored lower in N (p <0.05),
higher in E (P <0.001), O (P <0.05) and C (p <0.001), and
average in A (no significant difference). Females scored average in N
and A (no significant difference), and higher in E (p <0.001), O
(P <0.05), and C (P <0.001). CONCLUSIONS: The similarity of
trait variance from the general population in both male and female
surgical residents supports the concept of a surgical
personality.
MB: I'm sure anaesthetists have different personalities to surgeons.
I wonder how our males differ from females
ARTICLE TITLE: Survey conducted of regional anesthesia
complications in France.
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 2002 Nov;
97(5):1274-80
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p7A
AUTHOR(S): Henkel G
PUBLICATION TYPE: Comment; Journal Article
ARTICLE TITLE: Three reports explore influence of hypovolemia on
propofol phamacokinetics.
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 2002 Nov;
97(5):1156-61; Comment On: Comment On: RefSource:Anesthesiology. 2002
Nov; 97(5):1218-26; Comment On: Comment On: RefSource:Anesthesiology.
2002 Nov; 97(5):1303-5
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p6A
AUTHOR(S): Henkel G
PUBLICATION TYPE: Comment; Journal Article
ARTICLE TITLE: Safety in numbers: how do we study toxicity of
spinal analgesics?
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 2002 Nov;
97(5):1250-3
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1047-9
AUTHOR(S): Eisenach JC; Yaksh TL
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Fact and fantasy about sleep and
anesthesiology.
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 2002 Nov;
97(5):1281-94
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1050-1
AUTHOR(S): Lydic R
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Comparative efficacy of acustimulation (ReliefBand)
versus ondansetron (Zofran) in combination with droperidol for
preventing nausea and vomiting.
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1075-81
AUTHOR(S): White PF; Issioui T; Hu J; Jones SB; Coleman JE; Waddle
JP; Markowitz SD; Coloma M; Macaluso AR; Ing CH
AUTHOR'S ADDRESS: Department of Anesthesiology and Pain Management,
University of Texas Southwestern Medical Center, Dallas 75390-9068,
USA. paul.white@utsouthwestern.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
There were no significant differences between the ReliefBand and
ondansetron when administered as adjuvants to droperidol for
antiemetic prophylaxis. CONCLUSIONS: The transcutaneous electrical
acupoint stimulation using a ReliefBand compared favorably to
ondansetron (4 mg intravenously) when used for prophylaxis against
postoperative nausea and vomiting. Furthermore, the acustimulation
device enhanced the antiemetic efficacy of ondansetron after plastic
surgery.
MB: They all had droperidol.
ARTICLE TITLE: Concentration-effect relation of succinylcholine
chloride during propofol anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1082-92
AUTHOR(S): Roy JJ; Donati F; Boismenu D; Varin F
AUTHOR'S ADDRESS: Faculte de Pharmacie, Departement
d'Anesthesiologie, Universite de Montreal, Quebec, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSION: Succinylcholine is a low-potency drug with a very fast
clearance that equilibrates relatively slowly with the effect
compartment. Its disappearance is greatly accountable by a rapid
hydrolysis in plasma.
MB: A lot of trouble to obtain the expected result. The term
'concentration effect' already has a meaning.
ARTICLE TITLE: Renal responses to desflurane and isoflurane in
patients with renal insufficiency.
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1133-6
AUTHOR(S): Litz RJ; Hubler M; Lorenz W; Meier VK; Albrecht DM
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care
Medicine, Carl-Gustav-Carus University Hospital, Dresden,
Germany.
PUBLICATION TYPE: Journal Article
CONCLUSION: General anesthesia with desflurane or isoflurane did not
aggravate renal impairment in patients with preexisting renal
insufficiency.
MB: What a relief.
ARTICLE TITLE: Transmission through the dorsal spinocerebellar and
spinoreticular tracts: wakefulness versus thiopental anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1178-88
AUTHOR(S): Soja PJ; Taepavarapruk N; Pang W; Cairns BE; McErlane SA;
Fragoso MC
AUTHOR'S ADDRESS: Division of Pharmacology and Toxicology, Faculty of
Pharmaceutical Sciences, The University of British Columbia,
Vancouver, Canada. soja@exchange.ubc.ca.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: These results demonstrate that thiopental administration
is associated with a prolonged blockade of motoneuron output and
sensory transmission through the dorsal spinocerebellar and
spinoreticular tracts that exceeds the duration of general
anesthesia. Further, the blockade of glutamate-evoked neuronal
responses indicates that these effects are due, in part, to a local
action of the drug in the spinal cord. The authors suggest that this
combination of lumbar sensory and motoneuron inhibition underlies the
prolonged impairment of reflex coordination observed when thiopental
is used clinically.
ARTICLE TITLE: Influence of hemorrhage on propofol pseudo-steady
state concentration.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Nov;
97(5):6A
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1156-61
AUTHOR(S): Kazama T; Kurita T; Morita K; Nakata J; Sato S
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care,
Hamamatsu University School of Medicine, Japan.
tkazama@hama-med.ac.jp.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: A small induction dose has been recommended in
cases of hemorrhagic shock. However, the influence of hemorrhage on
the amplitude of plasma propofol concentration has not yet been fully
investigated during continuous propofol infusion. The authors
hypothesized that the effect of hemorrhage on plasma propofol
concentration is variously influenced by the different stages of
shock. METHODS: After 120 min of steady state infusion of propofol at
a rate of 2 mg x kg(-1) x h(-1), nine instrumented immature swine
were studied using a stepwise increasing hemorrhagic model (200 ml of
blood every 30 min until 1 h, then additional stepwise bleeding of
100 ml every 30 min thereafter, to the point of circulatory
collapse). Hemodynamic parameters and plasma propofol concentration
were recorded at every step. RESULTS: Before total circulatory
collapse, it was possible to drain 976 +/- 166 ml (mean +/- SD) of
blood. Hemorrhage of less than 600 ml (19 ml/kg) was not accompanied
by a significant change in plasma propofol concentration. At
individual peak systemic vascular resistance, when cardiac output and
mean arterial pressure decreased by 31% and 14%, respectively, plasma
propofol concentration increased by 19% of its prehemorrhagic value.
At maximum heart rate, when cardiac output and mean arterial pressure
decreased by 46% and 28%, respectively, plasma propofol concentration
increased by 38%. In uncompensated shock, it increased to 3.75 times
its prehemorrhagic value. CONCLUSIONS: During continuous propofol
infusion, plasma propofol concentration increased by less than 20%
during compensated shock. However, it increased 3.75 times its
prehemorrhagic concentration during uncompensated shock.
ARTICLE TITLE: Long-term pain and activity during recovery from
major thoracotomy using thoracic epidural analgesia.
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1234-44
AUTHOR(S): Ochroch EA; Gottschalk A; Augostides J; Carson KA; Kent L;
Malayaman N; Kaiser LR; Aukburg SJ
AUTHOR'S ADDRESS: Department of Anesthesia, University of
Pennsylvania Medical Center, Philadelphia, USA.
ABSTRACT: BACKGROUND: Pain following thoracotomy can persist for
years with an undetermined impact on quality of life. Factors
hypothesized to modulate this painful experience include analgesic
regimen, gender, and type of incision. METHODS: A total of 157
generally healthy patients of both genders scheduled for
segmentectomy, lobectomy, or bilobectomy through a posterolateral or
muscle-sparing incision were randomly assigned to receive thoracic
epidural analgesia initiated prior to incision or at the time of rib
approximation. Pain and activity scores were obtained 4, 8, 12, 24,
36, and 48 weeks after surgery. RESULTS: Overall, there were no
differences in pain scores between the control and intervention
groups during hospitalization (P >or= 0.165) or after discharge
(P>or= 0.098). The number of patients reporting pain 1 yr
following surgery (18 of 85; 21.2%) was not significantly different
(P = 0.122) from the number reporting preoperative pain (15 of 120;
12.5%). During hospitalization, women reported greater pain than men
(worst pain, P= 0.007; average pain, P= 0.016). Women experienced
fewer supraventricular tachydysrhythmias (P = 0.013) and were thus
discharged earlier (P = 0.002). After discharge women continued to
report greater discomfort than men (P <or= 0.016), but did not
differ from men in their level of physical activity (P = 0.241).
CONCLUSIONS: Initiation of thoracic epidural analgesia prior to
incision or the use of a muscle-sparing incision did not
significantly impact pain or physical activity. Although women
reported significantly greater pain during hospitalization and after
discharge, they experienced fewer complications, were more likely to
be discharged from the hospital sooner, and were just as active after
discharge as men.
ARTICLE TITLE: Major complications of regional anesthesia in
France: The SOS Regional Anesthesia Hotline Service.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Nov;
97(5):7A
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1274-80
AUTHOR(S): Auroy Y; Benhamou D; Bargues L; Ecoffey C; Falissard B;
Mercier F; Bouaziz H; Samii K
AUTHOR'S ADDRESS: Departement d' Anesthesie-Reanimation, Hopital d'
Instruction des Armees Percy, Clamart, France.
Yves.Auroy@wanadoo.fr.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Several previous surveys have estimated the
rate of major complications that occur after regional anesthesia.
However, because of the increase in the use of regional anesthesia in
recent years and because of the introduction of new techniques,
reappraisal of the incidence and the characteristics of major
complications is useful. METHODS: All French anesthesiologists were
invited to participate in this 10-month prospective survey based on
(1) voluntary reporting of major complications related to regional
anesthesia occurring during the study period using a telephone
hotline service available 24 h a day and managed by three experts,
and (2) voluntary reporting of the number and type of regional
anesthesia procedures performed using pocket booklets. The service
was free of charge for participants. RESULTS: The participants (n =
487) reported 56 major complications in 158,083 regional anesthesia
procedures performed (3.5/10,000). Four deaths were reported. Cardiac
arrest occurred after spinal anesthesia (n = 10; 2.7/10,000) and
posterior lumbar plexus block (n = 1; 80/10,000). Systemic local
anesthetic toxicity consisted of seizures only, without cardiac
toxicity. Lidocaine spinal anesthesia was associated with more
neurologic complications than bupivacaine spinal anesthesia
(14.4/10,000 vs. 2.2/10,000). Most neurologic complications were
transient. Among 12 that occurred after peripheral nerve blocks, 9
occurred in patients in whom a nerve stimulator had been used.
CONCLUSION: This prospective survey based on a free hotline permanent
telephone service allowed us to estimate the incidence of major
complications related to regional anesthesia and to provide a
detailed analysis of these complications.
ARTICLE TITLE: Decrease in bispectral index preceding
intraoperative hemodynamic crisis: evidence of acute alteration of
propofol pharmacokinetics.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Nov;
97(5):6A
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1303-5
AUTHOR(S): Honan DM; Breen PJ; Boylan JF; McDonald NJ; Egan TD
AUTHOR'S ADDRESS: Department of Anaesthesia, Intensive Care and Pain
Medicine, St. Vincent's University Hospital, Dublin, Ireland.
honan@iol.ie.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Fatigue in anesthesia: implications and strategies
for patient and provider safety.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Nov;
97(5):1050-1
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1281-94
AUTHOR(S): Howard SK; Rosekind MR; Katz JD; Berry AJ
AUTHOR'S ADDRESS: Patient Safety Center of Inquiry, Anesthesia
Service, VA Palo Alto Health Care System, Department of Anesthesia,
Stanford University School of Medicine, California 94304, USA.
showard@stanford.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: Oral to nasal endotracheal tube exchange in a
difficult airway: a novel method.
ARTICLE SOURCE: Anesthesiology (United States), Nov 2002, 97(5)
p1324-5
AUTHOR(S): Dutta A; Chari P; Mohan RA; Manhas Y
PUBLICATION TYPE: Letter
ARTICLE TITLE: Effectiveness of acute normovolemic hemodilution to
minimize allogeneic blood transfusion in major liver resections.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Oct;
97(4):773-5
ARTICLE SOURCE: Anesthesiology (United States), Oct 2002, 97(4)
p794-800
AUTHOR(S): Matot I; Scheinin O; Jurim O; Eid A
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care
Medicine, Hadassah University Medical Center, The Hebrew University
of Jerusalem, Israel. matoth@cc.huji.ac.il.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
RESULTS: During the perioperative period, 14 control patients (36%)
received at least one unit of allogeneic blood compared with 4
patients (10%) in the acute normovolemic hemodilution (ANH) group (
< 0.05). The hemodilution process was not associated with
significant changes in patients' hemodynamics. Morbidity was similar
between the control and the ANH groups. Postoperative hematocrit
levels and biochemical liver, renal, and standard coagulation test
results were similar in both groups. CONCLUSIONS: Acute normovolemic
hemodilution in patients with American Society of Anesthesiologists
status I-II undergoing major liver resection may allow a significant
number of patients to avoid exposure to allogeneic blood.
ARTICLE TITLE: Positive experimental demonstration of the negative
brain "protective" effects of anesthetics following cardiac
arrest.
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 1974 Sep;
41(3):231-6
ARTICLE SOURCE: Anesthesiology (United States), Oct 2002, 97(4)
p1005-6
AUTHOR(S): Michenfelder JD
AUTHOR'S ADDRESS: Department of Anesthesiia, Mayo Clinic, Rochester,
Minnesota, USA. am31@pitel.net.
PUBLICATION TYPE: Comment; Journal Article
It is concluded that there was no alteration in normal cerebral
metabolic pathways, that cerebral metabolic effects of thiopental are
secondary to functional effects, that thiopental would provide no
cerebral protection during hypoxia sufficient to abolish cerebral
function, and that thiopental does not uncouple oxidative
phosphorylation.
MB: It did not help the dogs.
ARTICLE TITLE: Duration of anesthesia before muscle relaxant
injection influences level of paralysis.
ARTICLE SOURCE: Anesthesiology (United States), Sep 2002, 97(3)
p616-21
AUTHOR(S): Plaud B; Debaene B; Donati F
AUTHOR'S ADDRESS: Department of Anesthesiology, Hotel-Dieu du
Centre-Hospitalier de l' Universite de Montreal (CHUM) and University
of Montreal, Quebec, Canada.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
METHODS: Patients were randomly allocated into three groups.
Anesthesia was induced with alfentanil and propofol. Group A (n = 10)
received mivacurium (0.1 mg/kg) immediately after loss of
consciousness. Groups B (n = 10) and C (n = 10) received mivacurium
after 15 min of anesthesia with propofol alone (B) or propofol with N
O (C). The evoked response to train-of-four stimulation was measured
by acceleromyography at the AP and the CS. RESULTS: Maximum
neuromuscular blockade (%T1, median [range]) was
significantly less in group A than in groups B and C ( < 0.001) at
both the AP (81 [47-90]; 90 [35-100]; 100
[93-100], respectively) and the CS (19 [5-63]; 68
[61-100]; 89 [72-100], respectively). Maximum
neuromuscular blockade was less in group B than in group C ( <
0.001) at the AP. Onset time of maximum neuromuscular blockade was
not different between groups but was shorter at the corrugator
supercilii (CS) than at the adductor pollicis (AP). CONCLUSIONS:
Duration of nitrous oxide (N O)-opioid anesthesia before mivacurium
injection affect intensity of neuromuscular blockade but not onset
time. Neuromuscular blockade obtained at the adductor pollicis (AP)
after several minutes of stable anesthesia with N O is greater than
immediately after induction. This explains in part the discrepancy
between the measured ED and the intubating dose.
MB: They were measuring ED95s. They might have been relating twitch
& intubating condition. Apnoea can occur long before peripheral
twitches go away.
ARTICLE TITLE: Epidural analgesia enhances functional exercise
capacity and health-related quality of life after colonic surgery:
results of a randomized trial.
COMMENTS: Comment In: Comment In: RefSource:Anesthesiology. 2002 Sep;
97(3):533-4
ARTICLE SOURCE: Anesthesiology (United States), Sep 2002, 97(3)
p540-9
AUTHOR(S): Carli F; Mayo N; Klubien K; Schricker T; Trudel J;
Belliveau P
AUTHOR'S ADDRESS: Department of Anesthesia, McGill University Health
Centre, Royal Victoria Hospital, Montreal, Quebec, Canada HA1.
franco.carli@muhc.mcgill.ca.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
Length of hospital stay and incidence of complications were similar
in both groups, although patients in the epidural group were ready to
be discharged earlier. CONCLUSIONS: The superior quality of pain
relief provided by epidural analgesia had a positive impact on
out-of-bed mobilization, bowel function, and intake of food, with
long-lasting effects on exercise capacity and health-related quality
of life.
MB: Outcome was no different although there were some trivial
surrogate measurements
ARTICLE TITLE: Optimizing postoperative analgesia: the use of
global outcome measures.
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 2002 Sep;
97(3):540-9
ARTICLE SOURCE: Anesthesiology (United States), Sep 2002, 97(3)
p533-4
AUTHOR(S): Wu CL; Raja SN
PUBLICATION TYPE Comment; Editorial
MB: They are enthusiastic. Evidence does not seem to correspond.
ARTICLE TITLE: Frontiers in translational research: the etiology
of incisional and postoperative pain.
COMMENTS: Comment On: Comment On: RefSource:Anesthesiology. 2002 Sep;
97(3):550-9
ARTICLE SOURCE: Anesthesiology (United States), Sep 2002, 97(3)
p535-7
AUTHOR(S): Brennan TJ
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Robot-assisted surgical systems: a new era in
laparoscopic surgery.
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Jul 2002, 84(4)
p223-6
AUTHOR(S): Ruurda JP; van Vroonhoven TJ; Broeders IA
AUTHOR'S ADDRESS: Department of Surgery, University Medical Centre,
Utrecht, The Netherlands.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: Maybe we can get rid of human surgeons.
ARTICLE TITLE: Lessons learned from the evacuation of an urban
teaching hospital.
ARTICLE SOURCE: Arch Surg (United States), Oct 2002, 137(10)
p1141-5
AUTHOR(S): Cocanour CS; Allen SJ; Mazabob J; Sparks JW; Fischer CP;
Romans J; Lally KP
AUTHOR'S ADDRESS: Department of Surgery, University of Texas Health
Sciences Center at Houston, 6431 Fannin, MSB 4.284, Houston, TX
77030, USA. Christine.S.Cocanour@uth.tmc.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The lessons learned from this experience included the
following: (1) flooding will occur in a flood plain; (2) electrical
power outages are not necessarily temporary-begin evacuation; (3)
appoint a triage officer from those available; (4) have a reliable
in-house communication system not dependent on telephone lines or
electricity; (5) have a reliable telephone system for contacting
outside facilities; (6) have flashlights available on all units; (7)
have battery-operated exit signs and stairway lights; (8) maximize
use of volunteers when they are available and fresh; (9) maintain a
paper record of all patient transfers; (10) coordinate loading of
ambulances and helicopters for patient transfer; and (11) reassign
staff as necessary to care for transferred patients. Emergent
evacuation of a large, tertiary hospital requires extensive effort
from both the hospital staff and the community.
MB: Sounds like a big mess.
ARTICLE TITLE: The time has come to change the algorithm for the
surgical management of early breast cancer.
ARTICLE SOURCE: Arch Surg (United States), Oct 2002, 137(10)
p1131-5
AUTHOR(S): Hansen NM; Grube BJ; Giuliano AE
AUTHOR'S ADDRESS: Joyce Eisenberg Keefer Breast Center, John Wayne
Cancer Institute at St John's Health Center, Santa Monica, CA 90404,
USA. HansenN@jwci.org.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Sentinel lymph node dissection is a safe and efficacious
treatment option for patients with early breast cancer. It provides
excellent regional control and is associated with excellent survival.
A multicenter trial such as the American College of Surgeons Oncology
Group Z0010 is needed to corroborate findings of this
single-institution study.
MB: Aren't they going to wait for that trial? The rest of the
literature on breast cancer is not terribly optimistic.
ARTICLE TITLE: Fish consumption, fish oil, omega-3 fatty acids,
and cardiovascular disease.
ARTICLE SOURCE: Circulation (United States), Nov 19 2002, 106(21)
p2747-57
AUTHOR(S): Kris-Etherton PM; Harris WS; Appel LJ
AUTHOR'S ADDRESS: Collective Name: American Heart Association.
Nutrition Committee.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Medication errors in acute cardiac care: An
American Heart Association scientific statement from the Council on
Clinical Cardiology Subcommittee on Acute Cardiac Care, Council on
Cardiopulmonary and Critical Care, Council on Cardiovascular Nursing,
and Council on Stroke.
ARTICLE SOURCE: Circulation (United States), Nov 12 2002, 106(20)
p2623-9
AUTHOR(S): Freedman JE; Becker RC; Adams JE; Borzak S; Jesse RL;
Newby LK; O'Gara P; Pezzullo JC; Kerber R; Coleman B; Broderick J;
Yasuda S; Cannon C
AUTHOR'S ADDRESS: Collective Name: American Heart Association.
Council on Clinical Cardiology Subcommittee on Acute Cardiac Care,
Council on Cardiopulmonary and Critical Care, Council on
Cardiovascular Nursing, and Council on Stroke.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: Not only about dispensing errors. There are lots of other
problems with drug therapy both omission & commission.
ARTICLE TITLE: Sympathetic nervous system in heart failure.
COMMENTS: Comment On: Comment On: RefSource:Circulation. 2002 Nov 5;
106(19):2491-6
ARTICLE SOURCE: Circulation (United States), Nov 5 2002, 106(19)
p2417-8
AUTHOR(S): Cohn JN
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Need for emergency CABG decreases, but morbidity
and mortality remain high.
COMMENTS: Comment On: Comment On: RefSource:Circulation. 2002 Oct 29;
106(18):2346-50; Comment On: Comment On: RefSource:Circulation. 2002
Oct 29; 106(18):2366-71
ARTICLE SOURCE: Circulation (United States), Oct 29 2002, 106(18)
pe9045-6
AUTHOR(S): So Relle R
PUBLICATION TYPE: Comment; News
ARTICLE TITLE: Emergency coronary artery bypass surgery in the
contemporary percutaneous coronary intervention era.
COMMENTS: Comment In: Comment In: RefSource:Circulation. 2002 Oct 29;
106(18):e9045-6
ARTICLE SOURCE: Circulation (United States), Oct 29 2002, 106(18)
p2346-50
AUTHOR(S): Seshadri N; Whitlow PL; Acharya N; Houghtaling P;
Blackstone EH; Ellis SG
AUTHOR'S ADDRESS: Department of Cardiology, Cleveland Clinic
Foundation, Cleveland, Ohio 44195, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The need for emergency CABG has considerably decreased
over time. Risk factors include female sex and a higher ACC/AHA score
of the intervened lesion. However, morbidity and mortality of
emergency CABG remain high even in the new millennium.
ARTICLE TITLE: The electrocardiogram 100 years later: electrical
insights into molecular messages.
ARTICLE SOURCE: Circulation (United States), Oct 22 2002, 106(17)
p2173-9
AUTHOR(S): Rosen MR
AUTHOR'S ADDRESS: Department of Pharmacology, College of Physicians
and Surgeons of Columbia University, New York, NY 10032, USA.
mrr1@columbia.edu.
PUBLICATION TYPE: Historical Article; Lectures
ARTICLE TITLE: Effect of carvedilol on the morbidity of patients
with severe chronic heart failure: results of the carvedilol
prospective randomized cumulative survival (COPERNICUS) study.
COMMENTS: Comment In: Comment In: RefSource:Circulation. 2002 Oct 22;
106(17):2164-6
ARTICLE SOURCE: Circulation (United States), Oct 22 2002, 106(17)
p2194-9
AUTHOR(S): Packer M; Fowler MB; Roecker EB; Coats AJ; Katus HA; Krum
H; Mohacsi P; Rouleau JL; Tendera M; Staiger C; Holcslaw TL;
Amann-Zalan I; De Mets DL
AUTHOR'S ADDRESS: College of Physicians and Surgeons, Columbia
University, New York, NY 10032, USA. mp65@columbia.edu; Collective
Name: Carvedilol Prospective Randomized Cumulative Survival
(COPERNICUS) Study Group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study;
Randomized Controlled Trial
CONCLUSION: In euvolemic patients with symptoms at rest or on minimal
exertion, the addition of carvedilol to conventional therapy
ameliorates the severity of heart failure and reduces the risk of
clinical deterioration, hospitalization, and other serious adverse
clinical events.
MB: It is strange that there were enough not having beta-blockers
already. The rest of the 'conventional' therapy was quite variable.
Beta-blockers are really the conventional therapy now.
ARTICLE TITLE: Comparative survival of dialysis patients in the
United States after coronary angioplasty, coronary artery stenting,
and coronary artery bypass surgery and impact of diabetes.
ARTICLE SOURCE: Circulation (United States), Oct 22 2002, 106(17)
p2207-11
AUTHOR(S): Herzog CA; Ma JZ; Collins AJ
AUTHOR'S ADDRESS: Cardiovascular Special Studies Center, United
States Renal Data System, Minneapolis, Minn., USA.
cherzog@usrds.org.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In this retrospective study, dialysis patients in the
United States had better long-term survival after CABG surgery than
after percutaneous coronary intervention. Stent outcomes were
relatively worse in diabetic patients. Our data support the need for
large clinical registries and prospective trials of surgical and
percutaneous coronary revascularization procedures in dialysis
patients.
ARTICLE TITLE: ARBITER: Arterial Biology for the Investigation of
the Treatment Effects of Reducing Cholesterol: a randomized trial
comparing the effects of atorvastatin and pravastatin on carotid
intima medial thickness.
COMMENTS: Comment In: Comment In: RefSource:Circulation. 2002 Oct 15;
106(16):2039-40Comment In: Comment In: RefSource:Circulation. 2002
Oct 15; 106(16):e9041-2
ARTICLE SOURCE: Circulation (United States), Oct 15 2002, 106(16)
p2055-60
AUTHOR(S): Taylor AJ; Kent SM; Flaherty PJ; Coyle LC; Markwood TT;
Vernalis MN
AUTHOR'S ADDRESS: Cardiology Service, Walter Reed Army Medical
Center, Washington, DC 20307-5001, and USA.
allen.taylor@na.amedd.army.mil.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
ABSTRACT: BACKGROUND: Whether marked LDL reduction to levels well
below 100 mg/dL would further reduce the burden of cardiovascular
disease is controversial. We compared the effects of 2 statins with
widely differing potencies for LDL reduction (pravastatin 40 mg/d and
atorvastatin 80 mg/d) on carotid intima-media thickness (CIMT).
METHODS AND RESULTS: This was a single-center, randomized, clinical
trial of 161 patients (mean age, 60 years; 71.4% male; 46% with known
cardiovascular disease) that met National Cholesterol Education
Program (NCEP) II criteria for lipid-lowering therapy. The effects of
atorvastatin (80 mg/d; n=79) and pravastatin (40 mg/d; n=82) on CIMT
were compared using blinded, serial assessments of the far wall of
the distal common carotid artery. Baseline CIMT and other
characteristics were similar between study groups. As anticipated,
atorvastatin was substantially more potent for LDL reduction after 12
months: in the atorvastatin group, LDL cholesterol was 76+/-23 mg/dL
after 12 months (-48.5%); LDL cholesterol was 110+/-30 mg/dL in the
pravastatin group (-27.2%; P<0.001). Atorvastatin induced
progressive CIMT regression over 12 months (change in CIMT,
-0.034+/-0.021 mm), whereas CIMT was stable in the pravastatin group
(change of 0.025+/- 0.017 mm; P=0.03). CONCLUSIONS: Marked LDL
reduction (<100 mg/dL) with a high-potency statin provides
superior efficacy for atherosclerosis regression at 1 year. This
early effect on CIMT, a surrogate for clinical benefit, suggests that
marked LDL reduction with synthetic statins may provide enhanced
reduction in clinical coronary event rates.
ARTICLE TITLE: Angina pectoris without chest pain: clinical
implications of silent ischemia.
ARTICLE SOURCE: Circulation (United States), Oct 8 2002, 106(15)
p1906-8
AUTHOR(S): Stern S
AUTHOR'S ADDRESS: Bikur Cholim Hospital, Jerusalem, Israel.
sh_stern@netvision.net.il.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: ACC/AHA guideline update for the management of
patients with unstable angina and non-ST-segment elevation myocardial
infarction--2002: summary article: a report of the American College
of Cardiology/American Heart Association Task Force on Practice
Guidelines (Committee on the Management of Patients With Unstable
Angina).
ARTICLE SOURCE: Circulation (United States), Oct 1 2002, 106(14)
p1893-900
AUTHOR(S): Braunwald E; Antman EM; Beasley JW; Califf RM; Cheitlin
MD; Hochman JS; Jones RH; Kereiakes D; Kupersmith J; Levin TN; Pepine
CJ; Schaeffer JW; Smith EE; Steward DE; Theroux P; Gibbons RJ; Alpert
JS; Faxon DP; Fuster V; Gregoratos G; Hiratzka LF; Jacobs AK; Smith
SC
AUTHOR'S ADDRESS: Collective Name: American College of
Cardiology/American Heart Association Task Force on Practice
Guidelines (Committee on the Management of Patients With Unstable
Angina).
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline
ARTICLE TITLE: ACC/AHA 2002 guideline update for exercise testing:
summary article: a report of the American College of
Cardiology/American Heart Association Task Force on Practice
Guidelines (Committee to Update the 1997 Exercise Testing
Guidelines).
ARTICLE SOURCE: Circulation (United States), Oct 1 2002, 106(14)
p1883-92
AUTHOR(S): Gibbons RJ; Balady GJ; Bricker JT; Chaitman BR; Fletcher
GF; Froelicher VF; Mark DB; McCallister BD; Mooss AN; O'Reilly MG;
Winters WL; Gibbons RJ; Antman EM; Alpert JS; Faxon DP; Fuster V;
Gregoratos G; Hiratzka LF; Jacobs AK; Russell RO; Smith SC
AUTHOR'S ADDRESS: Collective Name: American College of
Cardiology/American Heart Association Task Force on Practice
Guidelines (Committee to Update the 1997 Exercise Testing
Guidelines).
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline
ARTICLE TITLE: Safety of aprotinin use and re-use in pediatric
cardiothoracic surgery.
ARTICLE SOURCE: Circulation (United States), Sep 24 2002, 106(12
Suppl 1) pI90-4
AUTHOR(S): Jaquiss RD; Ghanayem NS; Zacharisen MC; Mussatto KA;
Tweddell JS; Litwin SB
AUTHOR'S ADDRESS: Medical College of Wisconsin, and the Children's
Hospital of Wisconsin, Milwaukee, Wisc, USA. rjaquiss@chw.org.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The risk of hypersensitivity reactions to aprotinin is
low in children undergoing cardiothoracic surgery, even with multiple
exposures to the medication. Reactions are more likely with
re-exposure, and risk increases with multiple exposures. Neither skin
testing nor assays for IgE identified reactors.
ARTICLE TITLE: Preoperative use of enoxaparin compared with
unfractionated heparin increases the incidence of re-exploration for
postoperative bleeding after open-heart surgery in patients who
present with an acute coronary syndrome: clinical investigation and
reports.
ARTICLE SOURCE: Circulation (United States), Sep 24 2002, 106(12
Suppl 1) pI19-22
AUTHOR(S): Jones HU; Muhlestein JB; Jones KW; Bair TL; Lavasani F;
Sohrevardi M; Horne BD; Doty D; Lappe DL
AUTHOR'S ADDRESS: Cardiovascular Department, LDS Hospital, Salt Lake
City, Utah 84143, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: The preoperative use of enoxaparin compared with
unfractionated heparin (UFH) in patients presenting with an acute
coronary syndrome (ACS) who undergo open-heart surgery during the
same hospitalization is associated with a significantly increased
incidence of re-exploration for postoperative bleeding. Further study
is needed to understand the mechanism of this phenomenon and to
develop appropriate guidelines to address this potentially important
issue.
ARTICLE TITLE: Effects of pH management during deep hypothermic
bypass on cerebral microcirculation: alpha-stat versus pH-stat.
ARTICLE SOURCE: Circulation (United States), Sep 24 2002, 106(12
Suppl 1) pI103-8
AUTHOR(S): Duebener LF; Hagino I; Sakamoto T; Mime LB; Stamm C;
Zurakowski D; Schafers HJ; Jonas RA
AUTHOR'S ADDRESS: Department of Cardiac Surgery, Children's Hospital
Boston, and Harvard Medical School, Boston, Mass 02115, USA.
PUBLICATION TYPE: Journal Article
METHODS: Two groups of 5 <snip> CONCLUSIONS: pH-stat management
increases tissue oxygenation during deep hypothermic bypass and after
circulatory arrest. Leukocyte/endothelial cell interactions during
hypothermic bypass are mild with both alpha-stat and pH-stat.
ARTICLE TITLE: Myocardial infarction in parents who lost a child:
a nationwide prospective cohort study in Denmark.
ARTICLE SOURCE: Circulation (United States), Sep 24 2002, 106(13)
p1634-9
AUTHOR(S): Li J; Hansen D; Mortensen PB; Olsen J
AUTHOR'S ADDRESS: Danish Epidemiology Science Centre, Department of
Epidemiology and Social Science, University of Aarhus, Denmark.
jl@soci.au.dk.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The death of a child was associated with an increased
risk of myocardial infarction (MI) in bereaved parents.
ARTICLE TITLE: Wine drinking and risks of cardiovascular
complications after recent acute myocardial infarction.
COMMENTS: Comment In: Comment In: RefSource:Circulation. 2002 Sep 17;
106(12):e9029-32
ARTICLE SOURCE: Circulation (United States), Sep 17 2002, 106(12)
p1465-9
AUTHOR(S): de Lorgeril M; Salen P; Martin JL; Boucher F; Paillard F;
de Leiris J
AUTHOR'S ADDRESS: Laboratoire du Stress Cardiovasculaire et
Pathologies Associees, Universite Joseph Fourier de Grenoble, France.
michel.delorgeril@ujf-grenoble.fr.
PUBLICATION TYPE: Journal Article
In comparison with abstainers, the adjusted risk of complications was
reduced by 59% (95% confidence interval: 17 to 80) in patients whose
average ethanol intake was 7.7% of the total energy intake (about 2
drinks/day), and by 52% (95% confidence interval: 4 to 76) in those
whose average ethanol intake was of 16% of energy (about 4
drinks/day). CONCLUSION: Whereas moderate wine drinking was
associated with a significant reduction in the risk of complications
in this homogenous population of coronary heart disease patients,
further studies are required to confirm the data, define the clinical
and biological profile of the patients who would most benefit from
wine drinking after recent myocardial infarction (AMI), and examine
whether the relations found are due to ethanol or other wine
ingredients.
ARTICLE TITLE: A randomized, controlled trial of medical therapy
versus endoscopic ligation for the prevention of variceal rebleeding
in patients with cirrhosis.
COMMENTS: Comment In: Comment In: RefSource:Gastroenterology. 2002
Oct; 123(4):1388-91
ARTICLE SOURCE: Gastroenterology (United States), Oct 2002, 123(4)
p1013-9
AUTHOR(S): Patch D; Sabin CA; Goulis J; Gerunda G; Greenslade L;
Merkel C; Burroughs AK
AUTHOR'S ADDRESS: Department of Liver Transplantation and
Hepatobiliary Medicine, University Department of Surgery, Royal Free
Hospital Hampstead NHS Trust, London, UK.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
CONCLUSIONS: In the prevention of variceal rebleeding, beta-blockers
+/- nitrates are as effective as endoscopic banding.
MB: There is quite a long discussion but that seems to be the
evidence result.
ARTICLE TITLE: Non-variceal upper gastrointestinal haemorrhage:
guidelines.
ARTICLE SOURCE: Gut (England), Oct 2002, 51 Suppl 4 piv1-6
AUTHOR'S ADDRESS: Collective Name: British Society of
Gastroenterology Endoscopy Committee.
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline
ARTICLE TITLE: Primary biliary cirrhosis: past, present, and
future.
COMMENTS: Comment On: Comment On: RefSource:Gastroenterology. 2002
Oct; 123(4):1044-51
ARTICLE SOURCE: Gastroenterology (United States), Oct 2002, 123(4)
p1392-4
AUTHOR(S): Kaplan MM
PUBLICATION TYPE: Comment; Editorial; Review; Review Literature
ARTICLE TITLE: American Gastroenterological Association medical
position statement: evaluation of liver chemistry tests.
ARTICLE SOURCE: Gastroenterology (United States), Oct 2002, 123(4)
p1364-6
AUTHOR'S ADDRESS: Collective Name: American Gastroenterological
Association.
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline
ARTICLE TITLE: Trends in causes of death among persons with
acquired immunodeficiency syndrome in the era of highly active
antiretroviral therapy, San Francisco, 1994-1998.
ARTICLE SOURCE: J Infect Dis (United States), Oct 1 2002, 186(7)
p1023-7
AUTHOR(S): Louie JK; Hsu LC; Osmond DH; Katz MH; Schwarcz SK
AUTHOR'S ADDRESS: Center for AIDS Prevention Studies, University of
California, San Francisco, CA 94105, USA. JLouie@psg.ucsf.edu.
PUBLICATION TYPE: Journal Article
With increasing acquired immunodeficiency syndrome (AIDS) survival,
prevention of chronic diseases, assessment of long-term toxicity from
highly active antiretroviral therapy (HAART), and surveillance for
additional causes of mortality will become increasingly
important.
ARTICLE TITLE: Bioethics and history.
COMMENTS: Comment In: Comment In: RefSource:J Med Philos. 2002 Aug;
27(4):493-508
ARTICLE SOURCE: J Med Philos (Netherlands), Aug 2002, 27(4)
p447-74
AUTHOR(S): Baker R
AUTHOR'S ADDRESS: Center for Bioethics and Clinical Leadership, Union
College Schenectady, New York 12308, USA. bakerr@union.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: Standard bioethics textbooks present the field to students
and non-experts as a form of "applied ethics." This ahistoric and
rationalistic presentation is similar to that used in philosophy of
science textbooks until three decades ago. Thomas Kuhn famously
critiqued this self-conception of the philosophy of science,
persuading the field that it would become deeper, richer, and more
philosophical, if it integrated the history of science, especially
the history of scientific change, into its self-conception. This
essay urges a similar reconceptualization for bioethics, arguing that
the analysis of moral change ought to be integral to bioethics (and
to ethics generally). It proceeds by suggesting the sterility of the
ahistoric, rationalist applied ethics model of bioethics embraced by
standard bioethics textbooks. It also suggests the fecundity of
alternative conceptions of the bioethics that focus on the history of
successful and failed attempts to negotiate moral change, and the
history of multifaceted relations between moral philosophy and
practical ethics.
MB: The whole text should be read. The argument from Kuhn is by
analogy to his concept of scientific revolutions when a new theory
comes along.
ARTICLE TITLE: The meanings of professional life: teaching across
the health professions.
COMMENTS: Comment In: Comment In: RefSource:J Med Philos. 2002 Aug;
27(4):493-508
ARTICLE SOURCE: J Med Philos (Netherlands), Aug 2002, 27(4)
p475-91
AUTHOR(S): Kelley M
AUTHOR'S ADDRESS: Center for Medical Ethics and Health Policy, Baylor
College of Medicine, Houston, TX 77030, USA. mkelley@bcm.tmc.edu.
PUBLICATION TYPE: Journal Article
MB: This is pretty wishy-washy.
ARTICLE TITLE: Two concepts of medical ethics and their
implications for medical ethics education.
COMMENTS: Comment On: Comment On: RefSource:J Med Philos. 2002 Aug;
27(4):447-74Comment On: Comment On: RefSource:J Med Philos. 2002 Aug;
27(4):475-91
ARTICLE SOURCE: J Med Philos (Netherlands), Aug 2002, 27(4)
p493-508
AUTHOR(S): Rhodes R
AUTHOR'S ADDRESS: Department of Medical Education, Mount Sinai School
of Medicine, New York, NY 10029-6574, USA.
rhodes@smtplink.mssm.edu.
PUBLICATION TYPE: Comment; Journal Article
ABSTRACT: People who discuss medical ethics or bioethics come to very
different conclusions about the levels of agreement in the field and
the implications of consensus among health care professionals. In
this paper I argue that these disagreements turn on a confusion of
two distinct senses of medical ethics. I differentiate (1) medical
ethics as a subject in applied ethics from (2) medical ethics as the
professional moral commitments of health care professions. I then use
the distinction to explain its significant implications for medical
ethics education. Drawing on the recent work of John Rawls, I also
show the centrality of philosophy in medical ethics by illustrating
how contemporary philosophy can be used to construct an ethical
framework for the medical professions.
MB: They want to disagree with the above 2 which state that if you
start as philosophers do with an idea you end up with a stalemate.
This article wants to start with an ethical clean slate. I don't
think that is realistic. There is always a 'cultural' inter-human
behaviour norm.
ARTICLE TITLE: What conception of moral truth works in
bioethics?
COMMENTS: Comment In: Comment In: RefSource:J Med Philos. 2002 Aug;
27(4):433-45
ARTICLE SOURCE: J Med Philos (Netherlands), Aug 2002, 27(4)
p403-16
AUTHOR(S): Momeyer RW
AUTHOR'S ADDRESS: Department of Philosophy, University Honors
Program, Miami University, Oxford, OH 45056, USA.
momeyerw@muohio.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: For the most part, philosophers have regarded moral truth
as propositional and as what follows from the application of moral
theory to particular problematic cases. Here I maintain that this is
not a useful way of conceiving moral truth in bioethics. Rather, we
are better off conceiving of moral truth as what emerges from a
process of inquiry conducted in a certain manner. There are four
elements to this process: (1) careful exploration of the embedded
norms of medical practice, research, and delivery; (2) recognition of
the irreducible plurality of ultimate moral values within and between
these practices; (3) the cultivation and exercise of moral
imagination; and (4) the attainment, however temporarily, of wide
reflective equilibrium. This process, I argue, is reflected in the
way bioethics is most fruitfully practiced, and it is further to be
recommended by being true to the character of moral conscientiousness
generally. This analysis suggests that moral truth is "unstable," but
that this is not a bad thing. Further, the implication is drawn that
moral theory would be better informed if formulated on the basis of
paying more attention to lived moral practices. .
ARTICLE TITLE: Can hospital transfusion committees change
transfusion practice?
ARTICLE SOURCE: J R Soc Med (England), Sep 2002, 95(9) p450-2
AUTHOR(S): Torella F; Haynes SL; Bennett J; Sewell D; McCollum CN
AUTHOR'S ADDRESS: Academic Surgery Unit, Education and Research
Centre, South Manchester University Hospital, Southmoor Road,
Manchester M23 9LT, UK. FCMTDR@aol.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: Blood and blood products are commonly over-used in hospital
practice. We investigated whether the introduction of a red-cell
transfusion trigger (haemoglobin <8 g dL(-1)) influenced
transfusion practice in surgery. Coronary artery bypass grafts
(CABGs, n=400), total hip replacements (n=107), colectomies (n=85)
and transurethral prostatectomies (TURPs, n=158) were reviewed over
two periods of six months, before and after the introduction of the
policy by the local hospital transfusion committee. After
introduction of the policy, the proportion of patients transfused
fell from 57% to 45% with CABGs (P=0.02) and from 52% to 26% with hip
replacements (P=0.006); for colectomies and TURPs there was no
change. Hospital stay did not increase in any of the groups. In the
second period, haemoglobin concentration on discharge was lower after
total hip replacement, by a mean (95% CI) of 0.7 (0.3-1.2) g dL(-1)
(P=0.002) and after colectomy, by a mean of 0.6 (0.1-1.1) g dL(-1)
(P=0.03). Although other factors cannot be excluded, we suggest that
the reductions in red-cell transfusion were in large part
attributable to the new transfusion policy.
ARTICLE TITLE: Quality of life: a deconstruction for
clinicians.
ARTICLE SOURCE: J R Soc Med (England), Oct 2002, 95(10) p481-8
AUTHOR(S): Koller M; Lorenz W
AUTHOR'S ADDRESS: Institute of Theoretical Surgery,
Philipps-University Marburg, Baldingerstrasse, D-35033 Marburg,
Germany. koller@mailer.uni-marburg.de.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: Absolutely hopeless. They want to invent a scale or measurement
for 'quality of life'. They start by criticising as cynical a comment
that pain can be estimated by scoring systems but the quality of life
cannot. Pain, of course, cannot be measured either.
ARTICLE TITLE: Michelangelo and medicine.
ARTICLE SOURCE: J R Soc Med (England), Oct 2002, 95(10) p514-5
AUTHOR(S): Strauss RM; Marzo-Ortega H
AUTHOR'S ADDRESS: Department of Dermatology, Leeds General Infirmary,
Great George Street, Leeds LS1 3EX, UK.
roland@strauss.karoo.co.uk.
PUBLICATION TYPE: Biography; Historical Article; Journal Article
ARTICLE TITLE: Does the use of artificial turf contribute to head
injuries?
ARTICLE SOURCE: J Trauma (United States), Oct 2002, 53(4) p691-4
AUTHOR(S): Naunheim R; McGurren M; Standeven J; Fucetola R; Lauryssen
C; Deibert E
AUTHOR'S ADDRESS: Department of Emergency Medicine, Washington
University School of Medicine, St. Louis, Missouri 63110, USA.
naunheir@msnotes.wustl.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: A number of high-profile professional football
players have suffered career-ending concussions. The purpose of this
article is to test the surfaces used by a professional team to
determine their impact-attenuating properties. METHODS: An
accelerometer was dropped from a height of 48 inches onto three
different playing fields in the St. Louis area: an indoor artificial
turf practice field, a grass outdoor practice field, and the
artificial turf field at a domed stadium. The accelerometer was
dropped 20 times from a height of 48 inches onto each surface.
<snip> CONCLUSION: The surface used to play league games has
the least impact attenuation of any field tested and may contribute
to the high incidence of concussion in football players.
MB: How about giving up all froms of football except maybe soccer but
I think that we had an article a few months ago showing that heading
a soccer ball knocks out neurones.
ARTICLE TITLE: An analysis of head injuries among skiers and
snowboarders.
ARTICLE SOURCE: J Trauma (United States), Oct 2002, 53(4)
p695-704
AUTHOR(S): Levy AS; Hawkes AP; Hemminger LM; Knight S
AUTHOR'S ADDRESS: Intermountain Neurosurgery and Neuroscience, Saint
Anthony Central Hospital, Denver, Colorado 80204, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Head injury is the leading cause of death and
critical injury in skiing and snowboarding accidents. METHODS: Data
relating to head injuries occurring on the ski slopes were collected
from the trauma registry of a Level I trauma center located near a
number of ski resorts. RESULTS: From 1982 to 1998, 350 skiers and
snowboarders with head injuries were admitted to our Level I trauma
center. Most of the injuries were mild, with Glasgow Coma Scale (GCS)
scores of 13 to 15 in 81% and simple concussion in 69%. However, 14%
of patients had severe brain injuries, with GCS scores of 3 to 8, and
the overall mortality rate was 4%. Collision with a tree or other
stationary object (skier-tree) was the mechanism of injury in 47% of
patients; simple falls in 37%; collision with another skier
(skier-skier) in 13%; and major falls in 3%. Skier-tree collision and
major falls resulted in a higher percentage of severe injuries, with
GCS scores of 3 to 8 in 24% and 20%, respectively, and mean Injury
Severity Scores of 14 and 17, respectively. Mortality from skier-tree
collision was 7.2%, compared with 1.6% in simple falls and no deaths
from skier-skier collision or major falls. The risk of sustaining a
head injury was 2.23 times greater for male subjects compared with
female subjects, 2.81 times higher for skiers/boarders < or = 35
years of age compared with those > 35 years, and 3.04 times higher
for snowboarders compared with skiers. CONCLUSION: Skier-tree
collision was the most common mechanism for head injuries in patients
admitted to our Level I trauma center, and resulted in the most
severe injuries and the highest mortality rate. Because most
traumatic brain injuries treated at our facility resulted from a
direct impact mechanism, we believe that the use of helmets can
reduce the incidence and severity of head injuries occurring on the
ski slopes.
MB: I think we could give this up too. I was being driven for a drink
by a liver transplant anaesthetist in Innsbruch. When I suggested
that they must have got a lot of nice donors from the twisty roads he
said that they got them from the ski slopes.
ARTICLE TITLE: Deer stand-related trauma in West Virginia: 1994
through 1999.
ARTICLE SOURCE: J Trauma (United States), Oct 2002, 53(4) p705-8
AUTHOR(S): Gates RL; Helmkamp JC; Wilson SL; Denning DA; Beaver
BL
AUTHOR'S ADDRESS: Department of Surgery, Marshall University School
of Medicine, Huntington, West Virginia 25701, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: Injuries from deer stand falls are a significant cause of
morbidity and mortality in this state. This is the largest series of
hunting-related deer stand injuries reported in the current
literature. Other states have successfully implemented prevention
programs that have resulted in a reduction of these types of
injuries. Our data emphasize the need to establish and promote
preventative education programs for hunters using tree stands.
MB: It's a platform 30ft up the tree. They watch for the deer and
often fall off. Alcohol& drugs are factors. We shoot kangaroos
from 4 wheel drives.
ARTICLE TITLE: Physical and psychological outcomes 8 months after
serious gunshot injury.
ARTICLE SOURCE: J Trauma (United States), Oct 2002, 53(4) p709-16
AUTHOR(S): Greenspan AI; Kellermann AL
AUTHOR'S ADDRESS: Department of Rehabilitation Medicine, Emory
University, Atlanta, Georgia 30322, USA. agreens@emory.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: Many hospitalized survivors of gunshot injuries report
significant long-term declines in physical and/or mental health.
Injury severity at hospital admission may not be predictive of
long-term health status.
ARTICLE TITLE: Knowing patients' preferences about organ donation:
does it make a difference?
ARTICLE SOURCE: J Trauma (United States), Oct 2002, 53(4) p754-60
AUTHOR(S): Siminoff LA; Lawrence RH
AUTHOR'S ADDRESS: School of Medicine, Center for Bioethics, Case
Western Reserve University, Cleveland, Ohio 44106, USA.
las5@po.cwru.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: Having knowledge of a patient's preference to donate
increased the likelihood of donating by 6.90 times, and having enough
information about the patient's wishes increased satisfaction with
the decision by 3.32 times. Families only infrequently made decisions
counter to patients' own wishes concerning organ donation.
ARTICLE TITLE: Noninvasive ventilation.
ARTICLE SOURCE: J Trauma (United States), Sep 2002, 53(3)
p593-601
AUTHOR(S): Acton RD; Hotchkiss JR; Dries DJ
AUTHOR'S ADDRESS: Department of Surgery, Regions Hospital, St. Paul,
Minnesota 55101, USA.
PUBLICATION TYPE Journal Article; Review; Review, Tutorial
ARTICLE TITLE: Positive end-expiratory pressure alters
intracranial and cerebral perfusion pressure in severe traumatic
brain injury.
ARTICLE SOURCE: J Trauma (United States), Sep 2002, 53(3) p488-92;
discussion 492-3
AUTHOR(S): Huynh T; Messer M; Sing RF; Miles W; Jacobs DG; Thomason
MH
AUTHOR'S ADDRESS: Department of Surgery, Division of Trauma/Surgical
Critical Care, Carolinas Medical Center, Charlotte, North Carolina
28232, USA. toan.huynh@carolinashealthcare.org.
PUBLICATION TYPE: Journal Article
CONCLUSION: In trauma patients with severe traumatic brain injury
(TBI), the strategy of increasing positive end-expiratory pressure
(PEEP) to optimize oxygenation is not associated with reduced
cerebral perfusion or compromised oxygen transport.
MB: What a relief.
ARTICLE TITLE: Hospital cost is reduced by motorcycle helmet
use.
ARTICLE SOURCE: J Trauma (United States), Sep 2002, 53(3) p469-71
AUTHOR(S): Brandt MM; Ahrns KS; Corpron CA; Franklin GA; Wahl WL
AUTHOR'S ADDRESS: Department of Surgery, Division of Trauma, Burn and
Emergency Surgery, University of Michigan Health System, Ann Arbor
48109, USA. mmbrandt@med.umich.edu.
PUBLICATION TYPE: Journal Article
<snip>. Failure to wear a helmet significantly increased
incidence of head injuries (Student's test, p < 0.02), but not
other injuries. Helmet use decreased mean cost of hospitalization by
more than $6,000 per patient. CONCLUSION: Failure to wear a helmet
adds to the financial burden created by motorcycle-related injuries.
Therefore, individuals who do not wear helmets should pay higher
insurance premiums.
MB: I think you'd have to get the money before you started treating
them.
ARTICLE TITLE: A rational framework for decision making by the
National Institute For Clinical Excellence (NICE).
ARTICLE SOURCE: Lancet (England), Aug 31 2002, 360(9334) p711-5
AUTHOR(S): Claxton K; Sculpher M; Drummond M
AUTHOR'S ADDRESS: Department of Economics and Related Studies,
University of York, Heslington, York, UK. kpc1@york.ac.uk.
PUBLICATION TYPE: Journal Article
ABSTRACT: Regulatory and reimbursement authorities face uncertain
choices when considering the adoption of health-care technologies. In
this Viewpoint, we present an analytic framework that separates the
issue of whether a technology should be adopted on the basis of
existing evidence from whether more research should be demanded to
support future decisions. We show the application of this framework
to the assessment of heath-care technologies using a published
analysis of a new drug treatment for Alzheimer's disease. The results
of the analysis show that the amount and type of evidence required to
support the adoption of a health technology will differ substantially
between technologies with different characteristics. Additionally,
the analysis can be used to aid the efficient design of research. We
discuss the implications of adoption of this new framework for
regulatory and reimbursement decisions.
MB: They are never going to reform the British NHS from the top.
ARTICLE TITLE: Epidural anaesthesia and analgesia in major
surgery.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Apr 13;
359(9314):1276-82
ARTICLE SOURCE: Lancet (England), Aug 17 2002, 360(9332) p568-9;
discussion 569
AUTHOR(S): Kehlet H; Holte K
PUBLICATION TYPE: Comment; Letter
MB: These 2 letters are about the MASTER Trial. This one is pushing
the Kehlet barrow.
ARTICLE TITLE: Epidural anaesthesia and analgesia in major
surgery.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Apr 13;
359(9314):1276-82
ARTICLE SOURCE: Lancet (England), Aug 17 2002, 360(9332) p568;
discussion 569
AUTHOR(S): Van Aken H; Gogarten W; Brussel T; Brodner G
PUBLICATION TYPE: Comment; Letter
MB: Critical that in MASTER they only fulfilled their intention to
treat in about 50% of the trial. It would have been lower if it were
not a trial.
ARTICLE TITLE: Fear the pain.
ARTICLE SOURCE: Lancet (England), Aug 10 2002, 360(9331) p426
AUTHOR(S): Sandkuhler J
AUTHOR'S ADDRESS: Brain Research Institute, Vienna University Medical
School, A-1090 Vienna, Austria. juergen.sandkuehler@univie.ac.at.
PUBLICATION TYPE: Journal Article
MB: Its about the fashionable idea of pain perpetuating itself.
ARTICLE TITLE: Don't remove amalgam fillings, urges American
Dental Association.
ARTICLE SOURCE: Lancet (England), Aug 3 2002, 360(9330) p393
AUTHOR(S): Larkin M
PUBLICATION TYPE: News
MB: Countering claims that amalgam might cause MS, Alzheimers &
autism.
ARTICLE TITLE: Surgery or stent? The gap continues to narrow.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Sep 28;
360(9338):965-70
ARTICLE SOURCE: Lancet (England), Sep 28 2002, 360(9338) p961-2
AUTHOR(S): O'Neill WW; Grines CL
AUTHOR'S ADDRESS: Division of Cardiology, Department of Internal
Medicine, William Beaumont Hospital, Royal Oak, MI 48073, USA.
woneill@Beaumont.edu.
PUBLICATION TYPE: Comment; Journal Article
MB: Relative benefits are changing. They must be related to relative
skills & the prostheses as well as the absolute indications.
ARTICLE TITLE: Epidemiology on trial--confessions of an expert
witness.
ARTICLE SOURCE: Lancet (England), Sep 21 2002, 360(9337) p889-90
AUTHOR(S): McPherson K
AUTHOR'S ADDRESS: Department of Social Medicine, University of
Bristol, Canynge Hall, Bristol BS8 2PR, UK.
klim.mcpherson@bristol.ac.uk.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Danish doctors want a new system to report medical
errors.
ARTICLE SOURCE: Lancet (England), Sep 14 2002, 360(9336) p858
AUTHOR(S): Csillag C
PUBLICATION TYPE: News
MB: Yeah, but they can't decide how to do it.
ARTICLE TITLE: EU promises reforms after another food scandal.
ARTICLE SOURCE: Lancet (England), Sep 14 2002, 360(9336) p857
AUTHOR(S): Rogers A
PUBLICATION TYPE: News
MB: Progesterone in the food.
ARTICLE TITLE: Post-trauma debriefing: the road too frequently
travelled.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Sep 7;
360(9335):766-71
ARTICLE SOURCE: Lancet (England), Sep 7 2002, 360(9335) p741-2
AUTHOR(S): Gist R; Devilly GJ
AUTHOR'S ADDRESS: Kansas City, Missouri Fire Department, and
University of Missouri-Kansas City, Kansas City, M0 64106, USA.
Richard.Gist@kcmo.org.
PUBLICATION TYPE: Comment; Journal Article; Review; Review,
Tutorial
MB: It is often counter productive. A proportion develop no problem
but can be induced to have one by the counselling.
ARTICLE TITLE: Thailand court forces reversal of drug firm
antiretroviral patent.
ARTICLE SOURCE: Lancet (England), Oct 19 2002, 360(9341) p1231
AUTHOR(S): Ahmad K
PUBLICATION TYPE: News
MB: They were using an Aussie patent for some particular size tablets
so government has been allowed to make other sizes.
ARTICLE TITLE: Cardiopulmonary mortality and air pollution.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Oct 19;
360(9341):1203-9; Comment On: Comment On: RefSource:Lancet. 2002 Oct
19; 360(9341):1210-4
ARTICLE SOURCE: Lancet (England), Oct 19 2002, 360(9341) p1184-5
AUTHOR(S): Peters A; Pope CA
AUTHOR'S ADDRESS: GSF National Research Centre for Environment and
Health, Institute of Epidemiology, 85758, Neuherberg, Germany.
peters@gsf.de.
PUBLICATION TYPE: Comment; Journal Article
ARTICLE TITLE: WHO Director-General elections--join The Lancet
debate.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Oct 12;
360(9340):1108-10
ARTICLE SOURCE: Lancet (England), Oct 12 2002, 360(9340) p1118
AUTHOR(S): Ramsay S; Ashraf H; Frankish H
AUTHOR'S ADDRESS: The Lancet, NW1 7BY, London, UK.
PUBLICATION TYPE: Comment; Journal Article
ARTICLE TITLE: Celebrating death--the 2002 Nobel prize in
physiology or medicine.
ARTICLE SOURCE: Lancet (England), Oct 12 2002, 360(9340) p1117
AUTHOR(S): Barbour V
AUTHOR'S ADDRESS: The Lancet, NW1 7BY, London, UK.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Iraq: harm reduction through health.
COMMENTS: Comment On: Comment On: RefSource:Lancet. 2002 Oct 5;
360(9339):1083-8Comment In: Comment In: RefSource:Lancet. 2002 Nov 9;
360(9344):1509; Comment In: Comment In: RefSource:Lancet. 2002 Nov 9;
360(9344):1509; Comment In: Comment In: RefSource:Lancet. 2002 Nov 9;
360(9344):1509
ARTICLE SOURCE: Lancet (England), Oct 5 2002, 360(9339) p1031
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Asthma: future directions.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2002, 86(5)
p1131-56
AUTHOR(S): Leonard P; Sur S
AUTHOR'S ADDRESS: Department of Allergy and Immunology, University of
Texas Medical Branch, MRB 8.104, 301 University Boulevard, Galveston,
TX 77555, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: Asthma continues to be a significant health care problem,
as reflected by the increasing rise in disease morbidity and
mortality. Because steroids are relatively safe, clinically
effective, and easy to administer, they remain the gold standard of
treatment. After many decades of use, however, it is apparent that
inhaled corticosteroids have failed to halt the progression of the
asthma epidemic. Newer, more effective drugs are being developed to
combat this disease, and the interest in developing new medications
to treat allergic disease and asthma has increased exponentially. The
financial burden of asthma has also been a significant motivating
factor in the development of new medications. It is estimated that in
1998 the total cost of asthma on society was $11 billion
[175]. This consideration has further intensified the quest
to develop more effective asthma medications. Table 1 reviews the
wide array of drugs currently being investigated. With the
development and approval of novel asthma treatments, millions of
asthma sufferers will undoubtedly have increased therapeutic options
for control of their disease in the near future.
ARTICLE TITLE: The evaluation and management of acute, severe
asthma.
ARTICLE SOURCE: Med Clin North Am (United States), Sep 2002, 86(5)
p1049-71
AUTHOR(S): Siwik JP; Nowak RM; Zoratti EM
AUTHOR'S ADDRESS: Division of Pulmonary, Critical Care, Allergy,
Immunology and Sleep Medicine, Henry Ford Health Systems, 4B One Ford
Place, Detroit, MI 48202, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: This article provides a systematic approach to the patient
with acute, severe asthma. After a brief, focused evaluation prompt
treatment with inhaled beta 2-agonists and systemic corticosteroids
remains the cornerstone of treatment. Ipratropium bromide is now
recognized as a useful addition for both adult and pediatric
populations, whereas consideration of intravenous MgSO4 and
theophylline is warranted for refractory patients. Ongoing evaluation
of antileukotriene agents offers a possibility of these agents as
alternative bronchodilators. Further research with a number of
potential acute asthma agents will further expand treatment options
for rapid symptomatic airway improvement and prevention of
progressing airway obstruction, hospitalization, and potential
respiratory failure.
ARTICLE TITLE: Hospital medicine: organization, quality
improvement, and clinical care.
ARTICLE SOURCE: Med Clin North Am (United States), Jul 2002, 86(4)
pxiii-xiv
AUTHOR(S): Whitcomb WF; Williams MV
AUTHOR'S ADDRESS: University of Massachusetts Medical School,
Inpatient Medicine Service, Mercy Medical Center, 271 Carew Street,
Springfield, MA 01104, USA. wfwhit@rcn.com.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Understanding medical error and improving patient
safety in the inpatient setting.
ARTICLE SOURCE: Med Clin North Am (United States), Jul 2002, 86(4)
p847-67
AUTHOR(S): Shojania KG; Wald H; Gross R
AUTHOR'S ADDRESS: Department of Medicine, University of California
San Francisco, 505 Parnassus Avenue, UCSF Box 0120, San Francisco, CA
94143, USA. shojania@medicine.ucsf.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Improving patient safety incorporates two complementary
approaches. The first, inspired by research in cognitive psychology
and the lessons of accident investigation in other industries,
provides qualitative methods for anticipating errors, documenting
critical incidents, and responding to them in a blame-free and
structured manner. Using such qualitative methods, physicians can
generate meaningful strategies for preventing similar occurrences in
the future. Hospital-based physicians have an important role to play
in promoting a culture of safety by championing incident-reporting
initiatives and participating in multidisciplinary teams that analyze
adverse events and promote change. The second approach involves
applying the results of quantitative clinical research to reduce some
of the common hazards of hospitalization. Hospitalists also have an
important role to play in this arena because many of these safety
targets and the associated clinical practices (e.g., early enteral
nutritional support and fall prevention) are not on the radar screens
of many hospital-based specialists. In both circumstances, physician
participation in collaboration with nurses, pharmacists,
nutritionists, and other health care professionals would likely
produce important improvements in patient care. More important,
physician involvement in these initiatives will undoubtedly
contribute visible leadership in promoting a culture of patient
safety in hospitals and in health care.
ARTICLE TITLE: Pain management in the hospitalized patient.
ARTICLE SOURCE: Med Clin North Am (United States), Jul 2002, 86(4)
p771-95
AUTHOR(S): Li JM
AUTHOR'S ADDRESS: Hospital Medicine Program, Beth Israel Deconess
Medical Center, Harvard Medical School, One Deaconess Road, Palmer
212, Boston, MA 02215, USA. jli2@caregroup.harvard.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Pain is unnecessary. Effective tools are available to help
doctors evaluate pain in their patients. Unrelieved pain should be
treated just like any other vital sign: with aggressive measures.
Effective therapies are available to treat pain. Use guidelines to
develop a rational plan to relieve pain. Side effects are manageable.
Anticipate side effects and treat aggressively. Addiction rarely
occurs. Trust your patient when they report pain. Tolerance and
physical dependence can occur. Plan and you will succeed. Take the
initiative and focus on relieving pain at your hospital. Your
patients depend on it.
ARTICLE TITLE: Perioperative management of the hospitalized
patient.
ARTICLE SOURCE: Med Clin North Am (United States), Jul 2002, 86(4)
p731-48
AUTHOR(S): Michota FA; Frost SD
AUTHOR'S ADDRESS: Ohio State University College of Medicine, 200
Meiling Hall, 370 West 9th Avenue, Columbus, OH 43210-1238, USA.
michotf@ccf.org.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: The hospitalized surgical patient requires a team approach.
Because of increasing patient age and complexity of conditions, a
comprehensive preoperative evaluation and medical optimization is
often necessary to allow the anesthesiologist and surgeon to deliver
the best surgical outcome. Surgical patients at an increased risk for
postoperative complications should be followed carefully by a medical
consultant throughout the hospital stay. This continuity of
perioperative care improves the likelihood that postoperative
problems, such as delirium, early myocardial ischemia, or VTE, are
quickly identified, and appropriate therapeutic interventions are
initiated before more serious adverse events occur. Special surgical
populations, such as those patients who need perioperative
anticoagulation, further benefit from a surgical team that includes a
medical specialist. Expertise and close supervision throughout the
perioperative period will give the hospitalized surgical patient the
greatest chance for a quick and successful recovery.
ARTICLE TITLE: The evolution of the hospitalist model in the
United States.
ARTICLE SOURCE: Med Clin North Am (United States), Jul 2002, 86(4)
p687-706
AUTHOR(S): Wachter RM
AUTHOR'S ADDRESS: Department of Medicine, University of California
Medical Center, Box 0120, Room M-994, 505 Parnassus Avenue, San
Francisco, CA 94143-0120, USA. bobw@medicine.ucsf.edu.
Journal Article; Review; Review, Tutorial
ABSTRACT: Emerging data support the hypothesis that the use of
hospital-based physicians can lead to improved efficiency without
compromising patient [table: see text] outcomes or
satisfaction. Nevertheless, for the foreseeable future, hospital care
in the United States will likely remain a highly pluralistic system
in which the organization of care is determined by efforts to improve
the value of care in the context of local culture, patient
populations, and patient and provider preferences. The method of
hospital care chosen by each institution and group of physicians
should be the one that promotes the best clinical outcomes and
highest patient satisfaction at the lowest costs. With these goals in
mind, it is likely that hospitalists will play an increasingly
important and visible role in many institutions across the
country.
ARTICLE TITLE: Stimulating illusory own-body perceptions.
ARTICLE SOURCE: Nature (England), Sep 19 2002, 419(6904) p269-70
AUTHOR(S): Blanke O; Ortigue S; Landis T; Seeck M
AUTHOR'S ADDRESS: Laboratory of Presurgical Epilepsy Evaluation,
Program of Functional Neurology and Neurosurgery, University Hospital
of Geneva, Geneva 1211, Switzerland. olaf.blanke@hcuge.ch.
PUBLICATION TYPE: Journal Article
ABSTRACT: 'Out-of-body' experiences (OBEs) are curious, usually brief
sensations in which a person's consciousness seems to become detached
from the body and take up a remote viewing position. Here we describe
the repeated induction of this experience by focal electrical
stimulation of the brain's right angular gyrus in a patient who was
undergoing evaluation for epilepsy treatment. Stimulation at this
site also elicited illusory transformations of the patient's arm and
legs (complex somatosensory responses) and whole-body displacements
(vestibular responses), indicating that out-of-body experiences may
reflect a failure by the brain to integrate complex somatosensory and
vestibular information.
ARTICLE TITLE: Physiology: unhealthy surprises.
ARTICLE SOURCE: Nature (England), Sep 19 2002, 419(6904) p263
AUTHOR(S): Chialvo DR
PUBLICATION TYPE: News
ARTICLE TITLE: Planted 'evidence' weakens case for DNA.
COMMENTS: Comment On: Comment On: RefSource:Nature. 2002 Aug 8;
418(6898):585-6
ARTICLE SOURCE: Nature (England), Sep 19 2002, 419(6904) p247
AUTHOR(S): Flint O
PUBLICATION TYPE: Comment; Letter
ARTICLE TITLE: The many dangers of relying on a DNA database.
COMMENTS: Comment On: Comment On: RefSource:Nature. 2002 Aug 8;
418(6898):585-6
ARTICLE SOURCE: Nature (England), Sep 19 2002, 419(6904) p247
AUTHOR(S): Kirby R
PUBLICATION TYPE: Comment; Letter
ARTICLE TITLE: Next-generation space telescope sets course for
2010 launch.
ARTICLE SOURCE: Nature (England), Sep 19 2002, 419(6904) p235-6
AUTHOR(S): Reichhardt T
PUBLICATION TYPE: News
ARTICLE TITLE: Fruitful meeting between the Pope and
Montagnier.
ARTICLE SOURCE: Nature (England), Sep 12 2002, 419(6903) p104
MAJOR SUBJECT HEADING(S): Acquired Immunodeficiency Syndrome
[prevention & control]; Catholicism; Parkinson Disease
[drug therapy]
PUBLICATION TYPE: News
ARTICLE TITLE: Cancer: stuck at first base.
COMMENTS: Comment On: Comment On: RefSource:Nature. 2002 Sep 12;
419(6903):162-7
ARTICLE SOURCE: Nature (England), Sep 12 2002, 419(6903) p127-8
AUTHOR(S): van der Weyden L; Jonkers J; Bradley A
PUBLICATION TYPE: Comment; News
ARTICLE TITLE: Matter all in the mind.
ARTICLE SOURCE: Nature (England), Sep 12 2002, 419(6903) p117
AUTHOR(S): Gottfried K
AUTHOR'S ADDRESS: Laboratory of Nuclear Studies, Cornell University,
Ithaca, New York 14853, USA.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Effect of British hunting ban on fox numbers.
COMMENTS: Comment In: Comment In: RefSource:Nature. 2002 Oct 31;
419(6910):878
ARTICLE SOURCE: Nature (England), Sep 5 2002, 419(6902) p34
AUTHOR(S): Baker PJ; Harris S; Webbon CC
AUTHOR'S ADDRESS: School of Biological Sciences, University of
Bristol, Woodland Road, Bristol BS8 1UG, UK.
s.harris@bristol.ac.uk.
PUBLICATION TYPE: Journal Article
ABSTRACT: Pressure to ban the hunting of foxes with hounds in Britain
has fuelled debate about its contribution to the control of fox
populations. We took advantage of a nationwide one-year ban on
fox-hunting during the outbreak of foot-and-mouth disease (FMD) in
2001 to examine this issue and found that the ban had no measurable
impact on fox numbers in randomly selected areas. Our results argue
against suggestions that fox populations would increase markedly in
the event of a permanent ban on hunting.
ARTICLE TITLE: Show me the evidence.
ARTICLE SOURCE: Obstet Gynecol (United States), Sep 2002, 100(3)
p403
PUBLICATION TYPE: Editorial
ARTICLE TITLE: Preference and compliance in postoperative
thromboembolism prophylaxis among gynecologic oncology patients.
ARTICLE SOURCE: Obstet Gynecol (United States), Sep 2002, 100(3)
p451-5
AUTHOR(S): Maxwell GL; Synan I; Hayes RP; Clarke-Pearson DL
AUTHOR'S ADDRESS: Division of Gynecologic Oncology, Duke University
Medical Center, Durham, North Carolina 27710, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized
Controlled Trial
ABSTRACT: OBJECTIVE: To compare low molecular weight heparin and
external pneumatic compression in terms of patient preference and
compliance to determine if either of these two methods is superior in
postoperative thromboembolism prophylaxis of gynecologic oncology
patients. METHODS: A total of 211 patients undergoing major surgery
for a suspected gynecologic malignancy were randomized to receive
thromboembolism prophylaxis with either external pneumatic
compression or low molecular weight heparin. Surveys regarding
thromboembolism prophylaxis were completed by patients before surgery
and approximately 7 days postoperatively. Patient preferences as well
as reasons for patient dissatisfaction with prophylactic methods were
elicited in the questionnaires. In addition, patient compliance with
prophylaxis was recorded twice a day during hospitalization. Patients
were not considered to be compliant with prophylaxis if the external
pneumatic compression device was not functioning properly or if the
administration of low molecular weight heparin was not given in a
timely manner. RESULTS: The majority of patients were satisfied with
the prophylactic method that they received to the extent that they
would prefer the treatment they received to one they had not
necessarily experienced. The postoperative preferences of 78% of
patients receiving low molecular weight heparin and 74% of those
wearing external pneumatic compression corresponded to what the
patients actually received as a method of thromboembolism prevention.
Patient compliance with prophylaxis was noted to be inadequate in ten
of 104 (9.6%) patients receiving external pneumatic compression and
seven of 103 (6.8%) patients receiving low molecular weight heparin.
CONCLUSION: Pneumatic compression and low molecular weight heparin
are similar both in terms of patient preference and compliance among
gynecologic oncology patients receiving postoperative thromboembolism
prophylaxis.
ARTICLE TITLE: Survey of the injury rate for children in community
sports.
ARTICLE SOURCE: Pediatrics (United States), Sep 2002, 110(3) pe28
AUTHOR(S): Radelet MA; Lephart SM; Rubinstein EN; Myers JB
AUTHOR'S ADDRESS: Neuromuscular Research Laboratory, University of
Pittsburgh, Pittsburgh, Pennsylvania 15203, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To determine the baseline injury rate for
children ages 7 to 13 participating in community organized baseball,
softball, soccer, and football. METHODS: In this observational cohort
study, 1659 children were observed during 2 seasons of sports
participation in an urban area. Data were collected by coaches using
an injury survey tool designed for the study. A reportable injury was
defined as one requiring on-field evaluation by coaching staff, or
causing a player to stop participation for any period of time, or
requiring first aid during an event. Logistic regression analyses
were done within and across sports for injury rates, game versus
practice injury frequencies, and gender differences where
appropriate. RESULTS: The injury rates, calculated per 100 athlete
exposures during total events (games plus practices), were: baseball,
1.7; softball, 1.0; soccer, 2.1; and football, 1.5. The injury rates
for baseball and football were not significantly different. Across
sports, contusions were the most frequent type of injury. Contact
with equipment was the most frequent method of injury, except in
football where contact with another player was the most frequent
method. In baseball, 3% of all injuries reported were considered
serious (fracture, dislocation, concussion); in soccer, 1% were
considered serious; and in football, 14% were considered serious. The
frequency of injury per team per season (FITS), an estimation of
injury risk, was 3 for baseball and soccer, 2 for softball, and 14
for football for total events. For all sports, there were more game
than practice injuries; this difference was significant except for
softball. There were no significant gender differences in soccer for
injury rates during total events. CONCLUSIONS: Given the
classification of football as a collision sport, the high number of
exposures per player, the FITS score, and the percentage of injuries
considered serious, youth football should be a priority for injury
studies. Health professionals should establish uniform medical
coverage policies for football even at this age level.
RECOMMENDATIONS FOR MODIFICATIONS: Injury surveillance for youth
sports is gaining momentum as an important step toward formulating
injury prevention methods. However, establishing patterns of
injuries, taking preventive measures, and evaluating equipment and
coaching modifications may take years. In addition to the objective
findings of this study, our direct observations of community sports
through 2 seasons showed areas where immediate modifications could
reduce injury risk. The first recommendation is that youth sports
leagues provide and require first aid training for coaches. Training
could be done by sports medicine professionals and include
recognition and immediate response to head, neck, and spine injuries,
as well as heat-related illnesses. The second recommendation is that
youth sports leagues have clear, enforceable return to play
guidelines for concussions, neck and back injuries, fractures, and
dislocations. The third recommendation is that baseball and softball
leagues consider the injury prevention potential of face guards on
batting helmets.
ARTICLE TITLE: Oxygen therapy: 50 years of uncertainty.
COMMENTS: Comment On: Comment On: RefSource:Pediatrics. 2000 Feb;
105(2):295-310
Comment On: Comment On: RefSource:Pediatrics. 2002 Sep;
110(3):540-4/PMID:12205257
ARTICLE SOURCE: Pediatrics (United States), Sep 2002, 110(3)
p615-6
AUTHOR(S): Tin W
AUTHOR'S ADDRESS: James Cook University Hospital, Middlesbrough, TS4
3BW, United Kingdom. win.tin@stees.nhs.uk.
PUBLICATION TYPE: Comment; Journal Article
ARTICLE TITLE: Retinopathy of prematurity outcome in infants with
prethreshold retinopathy of prematurity and oxygen saturation >94%
in room air: the high oxygen percentage in retinopathy of prematurity
study.
COMMENTS: Comment In: Comment In: RefSource:Pediatrics. 2002 Sep;
110(3):615-6
ARTICLE SOURCE: Pediatrics (United States), Sep 2002, 110(3)
p540-4
AUTHOR(S): McGregor ML; Bremer DL; Cole C; McClead RE; Phelps DL;
Fellows RR; Oden N
AUTHOR'S ADDRESS: Department of Ophthalmology, The Ohio State
University, Columbus, Ohio, USA. mcgregom@chi.osu.edu; Collective
Name: HOPE-ROP Multicenter Group. High Oxygen Percentage in
Retinopathy of Prematurity study.
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: OBJECTIVES: To determine the rate of progression from
prethreshold to threshold retinopathy of prematurity (ROP) in infants
excluded from Supplemental Therapeutic Oxygen for Prethreshold
Retinopathy of Prematurity (STOP-ROP) because their median arterial
oxygen saturation by pulse oximetry (SpO2) values were >94% in
room air at the time of prethreshold diagnosis and to compare them
with infants who were enrolled in STOP-ROP and had median SpO2 <
or =94% in room air. METHODS: Fifteen of the 30 centers that
participated in STOP-ROP elected to participate in the High Oxygen
Percentage in Retinopathy of Prematurity study (HOPE-ROP) from
January 1996 to March 1999. Infants were followed prospectively from
the time prethreshold ROP was diagnosed until ROP either progressed
to threshold in at least 1 study eye (adverse outcome) or resolved
(favorable outcome). RESULTS: A total of 136 HOPE-ROP infants were
compared with 229 STOP-ROP infants enrolled during the same time
period from the same 15 hospitals. HOPE-ROP infants were of greater
gestational age at birth (26.2 +/- 1.8 vs 25.2 +/- 1.4 weeks) and
greater postmenstrual age at the time of prethreshold ROP diagnosis
(36.7 +/- 2.5 vs 35.4 +/- 2.5 weeks). HOPE-ROP infants progressed to
threshold ROP 25% of the time compared with 46% of STOP-ROP infants.
After gestational age, race, postmenstrual age at prethreshold
diagnosis, zone 1 disease, and plus disease at prethreshold diagnosis
were controlled for, logistic regression analysis showed that
HOPE-ROP infants progressed from prethreshold to threshold ROP less
often than STOP-ROP infants (odds ratio: 0.607; 95% confidence
interval: 0.359-1.026). CONCLUSIONS: The mechanisms that result in
better ROP outcome for HOPE-ROP versus STOP-ROP are not fully
understood. It seems that an infant's SpO2 value at the time of
prethreshold diagnosis is a prognostic indicator for which infants
may progress to severe ROP. When other known prognostic indicators
are factored in, the SpO2 is of borderline significance.
ARTICLE TITLE: Disclosure of intraoperative events.
ARTICLE SOURCE: Surgery (United States), Sep 2002, 132(3) p531-2
AUTHOR(S): Jones JW; McCullough LB
AUTHOR'S ADDRESS: Department of Surgery, University of Missouri,
Columbia 65212, USA.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Randomization in surgical trials.
ARTICLE SOURCE: Surgery (United States), Sep 2002, 132(3) p513-8
AUTHOR(S): Hall JC; Hall JL
AUTHOR'S ADDRESS: University Department of Surgery at Royal Perth
Hospital, Western Australia.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: There are concerns that use of the term
"randomized" conveys a form of legitimacy to surgical trials that may
sometimes be inappropriate. The objective of this study was to review
the nature and use of randomization techniques in surgical trials.
METHODS: We evaluated aspects of the randomization process in 619
surgical trials published within 10 prestigious journals between
January 1990 and December 1999. RESULTS: Only 33% of the published
trials (202/619) adequately described a valid randomization process.
Furthermore, 78% (484/619) did not declare the use or extent of a
blinding technique and almost two-thirds of the published trials
failed to state how they concealed the randomization process.
CONCLUSIONS: Our study indicates that many published surgical trials
ignore basic aspects of the randomization process. It is difficult
for surgeons to have faith in trials that fail to demonstrate an
unbiased allocation of patients and ignore the need to maintain some
confidentiality about the allocation of patients into groups.
ARTICLE TITLE: Remembering September 11: reflections from Bellevue
Hospital and New York University Medical Center.
ARTICLE SOURCE: Surgery (United States), Sep 2002, 132(3) p502-5
AUTHOR(S): Marcus SG; Shamamian P; Cushman J
AUTHOR'S ADDRESS: Department of Surgery, New York University School
of Medicine, New York 10016, USA.
PUBLICATION TYPE: Journal Article :
ARTICLE TITLE: The World Trade Center terrorist attack: changing
priorities for surgeons in disaster response.
ARTICLE SOURCE: Surgery (United States), Sep 2002, 132(3) p506-12
AUTHOR(S): Briggs SM; Schnitzer JJ
AUTHOR'S ADDRESS: Department of Surgery, Massachusetts General
Hospital, Harvard Medical School, Boston 02114, USA.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: The Society of University Surgeons in the 21st
century--the mission, the vision, and the commitment to
excellence.
ARTICLE SOURCE: Surgery (United States), Aug 2002, 132(2) p119-26
AUTHOR(S): Evers BM
AUTHOR'S ADDRESS: Department of Surgery, University of Texas Medical
Branch, Galveston 77555, USA.
PUBLICATION TYPE: Addresses
ARTICLE TITLE: Society of University Surgeons statement on
surgical resident work hours and education.
ARTICLE SOURCE: Surgery (United States), Aug 2002, 132(2) p115-8
AUTHOR(S): Cole DJ; Bertagnolli MM; Nussbaum M
AUTHOR'S ADDRESS: Department of Surgery, Medical University of South
Carolina, Charleston 29425, USA; Collective Name: Society of
University Surgeons.
PUBLICATION TYPE: Guideline; Journal Article
ARTICLE TITLE: The changing prevalence of asthma?
ARTICLE SOURCE: Thorax (England), Oct 2002, 57 Suppl 2 pII36-II39
AUTHOR(S): Burney P
AUTHOR'S ADDRESS: Department of Public Health Sciences, King's
College London, UK. peter.burney@umds.ac.uk.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Preoperative predictors of outcome following lung
volume reduction surgery.
ARTICLE SOURCE: Thorax (England), Oct 2002, 57 Suppl 2 pII47-II52
AUTHOR(S): Sciurba FC
AUTHOR'S ADDRESS: Division of Pulmonary and Critical Care Medicine,
University of Pittsburgh, PA 15213, USA. sciurbafc@msx.upmc.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ARTICLE TITLE: Regular use of inhaled corticosteroids and the long
term prevention of hospitalisation for asthma.
ARTICLE SOURCE: Thorax (England), Oct 2002, 57(10) p880-4
AUTHOR(S): Suissa S; Ernst P; Kezouh A
AUTHOR'S ADDRESS: Division of Clinical Epidemiology, Royal Victoria
Hospital, McGill University Health Centre, McGill University,
Montreal, Canada. samy.suissa@clinepi.mcgill.ca.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Inhaled corticosteroids are effective at
preventing asthma morbidity and mortality. Most studies, however,
have focused on short term effects, raising uncertainty about their
effectiveness in the long term. METHODS: The Saskatchewan Health
databases were used to form two population based cohorts of asthma
patients aged 5-44 between 1975 and 1991. The first cohort included
all subjects from the start of asthma treatment, while the second
included subjects hospitalised for asthma from the date of discharge.
Subjects were followed up, starting 1 year after cohort entry and
continuing until 1997, 54 years of age, or death. The outcome was the
first asthma hospital admission and readmission, respectively, to
occur during follow up. A nested case-control design was used by
which all cases were matched on calendar time and several markers of
asthma severity to all available controls within the cohort. RESULTS:
The full cohort included 30 569 asthmatic subjects of which 3894 were
admitted to hospital for asthma and 1886 were readmitted. The overall
rate of asthma hospitalisation was 42.4 per 1000 asthma patients per
year. Regular use of inhaled corticosteroids was associated with
reductions of 31% in the rate of hospital admissions for asthma (95%
confidence interval (CI) 17 to 43) and 39% in the rate of readmission
(95% CI 25 to 50). The rate reduction found during the first 4 years
of follow up was sustained over the longer term. Regular use of
inhaled corticosteroids can potentially prevent between five hospital
admissions and 27 readmissions per 1000 asthma patients per year.
CONCLUSION: Regular use of low dose inhaled corticosteroids prevents
a large proportion of hospital admissions with asthma, both early and
later on in the course of the disease.
ARTICLE TITLE: "CF asthma": what is it and what do we do about
it?
ARTICLE SOURCE: Thorax (England), Aug 2002, 57(8) p742-8
AUTHOR(S): Balfour-Lynn IM; Elborn JS
AUTHOR'S ADDRESS: Department of Paediatric Respiratory Medicine,
Royal Brompton & Harefield NHS Trust, London SW3 6NP, UK.
i.balfourlynn@ic.ac.uk.
PUBLICATION TYPE: Status: Completed
Journal Article; Review; Review, Tutorial
ABSTRACT: The diagnosis of "CF asthma" is problematic and it is
difficult to determine which patients have a combination of CF and
asthma and which have asthma like symptoms caused by inflammation of
the CF lung. This may not matter, however; the relevance lies in the
possible approaches to treatment.
ARTICLE TITLE: The pulmonary physician in critical care. 8:
Ventilatory management of ALI/ARDS.
ARTICLE SOURCE: Thorax (England), Aug 2002, 57(8) p729-34
AUTHOR(S): Cordingley JJ; Keogh BF
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, Royal
Brompton Hospital, London SW3 6NP, UK.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Current data relating to ventilation in ARDS are reviewed.
Recent studies suggest that reduced mortality may be achieved by
using a strategy which aims at preventing overdistension of
lungs.
ARTICLE TITLE: Respiratory medications and risk of asthma
death.
ARTICLE SOURCE: Thorax (England), Aug 2002, 57(8) p683-6
AUTHOR(S): Lanes SF; Garcia Rodriguez LA; Huerta C
AUTHOR'S ADDRESS: Boehringer Ingelheim Pharmaceuticals Inc,
Ridgefield, CT 06877-0368, USA.
slanes@rdg.boehringer-ingelheim.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: The effect of respiratory medications on risk
of asthma death in the UK was studied using the General Practice
Research Database. METHODS: A total of 96 258 individuals with a
diagnosis of asthma were identified, 43 of whom had died as a result
of their asthma. For each case 20 controls were selected. Relative
risk (RR) estimates and 95% confidence intervals (CI) were computed
for each respiratory drug category controlling for effects of age,
sex, body mass index, smoking, frequency of visits to the GP,
hospital admissions for asthma, and visits to a specialist. RESULTS:
The strongest associations were found for at least 13 prescriptions
of short acting beta agonists during the previous year (RR=51.6, 95%
CI 7.9 to 345) and 7-12 prescriptions of short acting beta agonists
(RR=16.2, 95% CI 2.6 to 101). Short acting beta agonists and inhaled
steroids tended to be prescribed most frequently to the same
patients. In patients who received more than one prescription per
month of short acting beta agonists during the previous year, regular
use of inhaled steroids was associated with a 60% reduced risk of
asthma death (RR=0.4, 95% CI 0.2 to 1.0). CONCLUSIONS: Regular use of
inhaled steroids is associated with a decreased risk of asthma death,
and excessive use of short acting beta agonists is associated with a
markedly increased risk of asthma death.
ARTICLE TITLE: Do nurses do it better?
COMMENTS: Comment On: Comment On: RefSource:Thorax. 2002 Aug;
57(8):661-6
ARTICLE SOURCE: Thorax (England), Aug 2002, 57(8) p659-60
AUTHOR(S): Rafferty S; Elborn JS
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Chronic obstructive pulmonary disease. 1:
Susceptibility factors for COPD the genotype-environment
interaction.
ARTICLE SOURCE: Thorax (England), Aug 2002, 57(8) p736-41
AUTHOR(S): Sandford AJ; Silverman EK
AUTHOR'S ADDRESS: University of British Columbia McDonald Research
Laboratories/iCAPTURE Center, St Paul's Hospital, Vancouver, BC,
Canada. asandford@mrl.ubc.ca.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Genetic factors including alpha(1)-antitrypsin deficiency
are important in COPD. Candidate gene association studies in COPD are
reviewed. Efforts to identify interactions between genetic factors
and environmental determinants such as smoking may lead to improved
understanding of the pathogenesis of the disease.