MB's Articles of Interest - January 2002

ARTICLE TITLE: Algorithm for difficult intubation
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2001, 45(9) p1186
AUTHOR(S): Benomof JC
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Has basic research contributed to chronic pain treatment?
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2001, 45(9) p1128-35
AUTHOR(S): Jensen TS; Gottrup H; Kasch H; Nikolajsen L; Terkelsen AJ; Witting N
AUTHOR'S ADDRESS: Danish Pain Research Center, Aarhus University Hospital, Aarhus, Denmark.
PUBLICATION TYPE: Journal Article
<snip> Despite the explosion of new knowledge in pain processing and in molecular background for neuroplasticity, this progress has unfortunately not resulted in a corresponding improvement of our ability to treat chronic pain. The number of patients with chronic unrelieved pain is still high and newer types of treatment have so far not resulted in a substantially better treatment. Nevertheless, there is now an ongoing systematic research in which chronic pain conditions are assessed in a fashion so that mechanisms underlying pain can be dissected. <snip> It is likely that the development of new specific types of treatment will show efficacy if they are evaluated and analysed not on the global pain experience, but more specifically on those targets and elements of the pain experience they are aimed to deal with.
MB: In other words, 'No' & any management will have to be individualised and not applied to all patients. I wish they'd stop feeding half -truths and speculative theories at continuing 'education' events which can make the educatee worse. 2 of my peripheral friends had major disasters with medico-legal implications from doing what was suggested at such meetings. In their environments I would not have done what they did. They had thought that they should do what had been suggested to them at CE meetings.

ARTICLE TITLE: Pain and systematic reviews
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2001, 45(9) p1136-9
AUTHOR(S): Moore RA
AUTHOR'S ADDRESS: Pain Research & Nuffield Department of Anaesthetics, University of Oxford, The Churchill, Oxford, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: There is a huge medical literature, with very large amounts of information. Some of that information is useful, some not. The task is to distil the information, apply quality filters, and place it into context so that we can use the knowledge we have with wisdom. The process of systematically reviewing the literature helps us generate solid, unbiased knowledge. Using appropriate tools, like numbers needed to treat (NNT), we can provide a solid basis to allow practitioners and their patients to make the best, and best informed, choices about their care.
MB: This of course is impossible with sincere, if misguided, evangelists and /or those with conflicts of interest. There is just too much noise.

ARTICLE TITLE: Neuropathic pain: what do we do with all these theories?
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2001, 45(9) p1121-7
AUTHOR(S): Devor M
AUTHOR'S ADDRESS: Department of Cell and Animal Biology, Institute of Life Sciences, Hebrew University of Jerusalem, Israel.
PUBLICATION TYPE: Journal Article
ABSTRACT: Only a generation ago there were few ideas as to what might cause neuropathic pain, and even fewer relevant data. In contrast, we can currently point to hundreds of distinct cellular changes that are triggered by nerve injury and that might be relevant to the emergence of pain symptomatology. The number may soon increase to thousands. It is essential, therefore, to redirect efforts towards the development of experimental strategies for testing which of these are essential parts of the pain process and which are tangential. In this paper I point out four such strategies: timing, deletion, prevention and genetic heterogeneity, and summarize how one neuropathic pain theory, the ectopic pacemaker hypothesis, holds up to scrutiny.
MB: Don't believe him. Spare us any more lectures at CE meetings

ARTICLE TITLE: Nerve blocks in chronic pain therapy - are there any indications left?
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2001, 45(9) p1100-7
AUTHOR(S): Stanton-Hicks M
AUTHOR'S ADDRESS: Division of Anesthesiology for Pain Management and Research, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Although diagnostic imaging is now highly developed, neural blockade provides another opportunity to test for a source of pain that may frequently leave no signature. Likewise, many neuropathic pains can not be tested by neurodiagnostic methods. This paper makes a case for the continued use of regional anesthesia to assist in the diagnosis and therapy of chronic pain. In particular, the example of autonomic blocks and blocks of the axial spine are emphasized. Nerve blocks require an understanding of the anatomy, physiology, pharmacology, and the ability to interpret critically their results.
MB: It would be silly to think that all anaesthetists should be trained according to the last sentence. It is a prescribed requirement for training in anaesthesia but only a small minority should and will do it. The training thus should be at fellowship level or later, not as resistrars (trainees). Maybe we should have a much shorter registrar period followed by 2 or 3 year long fellowships in sub-specialities.

ARTICLE TITLE: The anaesthesiologist and chronic pain
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Oct 2001, 45(9) p1057-8
AUTHOR(S): Sjogren P; Hojsted J; Eriksen J
AUTHOR'S ADDRESS: H:S Department of Palliative Medicine, Bispebjerg University Hospital, Copenhagen, and H:S Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Denmark.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effects of remifentanil/propofol in comparison with isoflurane on dynamic cerebrovascular autoregulation in humans
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Sep 2001, 45(8) p971-6
AUTHOR(S): Engelhard K; Werner C; Mollenberg O; Kochs E
AUTHOR'S ADDRESS: Klinik fur Anaesthesiologie der Technischen Universitat Munchen, Klinikum rechts der Isar, Munich, Germany.
PUBLICATION TYPE: Journal Article
CONCLUSION: These data show that dynamic cerebrovascular autoregulation is maintained with remifentanil-based total intravenous anesthesia. This is consistent with the view that narcotics (and hypnotics) do not alter the physiologic cerebrovascular responses to changes in MAP. In contrast, 1.5 MAC isoflurane delays cerebrovascular autoregulation compared to the awake state.
MB: How would you know that the levels of anaesthesia were the same?

ARTICLE TITLE: Predictors of overall and cardiovascular mortality in peripheral arterial disease
ARTICLE SOURCE: Am J Cardiol (United States), Nov 1 2001, 88(9) p1057-60
AUTHOR(S): Pasqualini L; Schillaci G; Vaudo G; Innocente S; Ciuffetti G; Mannarino E
AUTHOR'S ADDRESS: Unit of Internal Medicine, Angiology and Arteriosclerosis, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effects of therapeutic doses of human atrial natriuretic peptide on load and myocardial performance in patients with congestive heart failure
ARTICLE SOURCE: Am J Cardiol (United States), Oct 15 2001, 88(8) p863-6
AUTHOR(S): Mizuno O; Onishi K; Dohi K; Motoyasu M; Okinaka T; Ito M; Isaka N; Nakano T
AUTHOR'S ADDRESS: The First Department of Internal Medicine, Mie University School of Medicine, Edobashi, Japan.
PUBLICATION TYPE: Journal Article
MB: The abstract is unintellibable. Consult full text if interested

ARTICLE TITLE: United states cholesterol guidelines 2001: expanded scope of intensive low-density lipoprotein-lowering therapy
ARTICLE SOURCE: Am J Cardiol (United States), Oct 11 2001, 88(7 Suppl 2) p23-7
AUTHOR(S): Grundy SM
AUTHOR'S ADDRESS: Center for Human Nutrition and the Departments of Internal Medicine and Clinical Nutrition, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: The new clinical guidelines of the US National Cholesterol Education Program (NCEP) were released in May 2001. These guidelines were published as the NCEP's Adult Treatment Panel (ATP) III report. They are derived from an extensive review of the emerging literature so as to provide an evidence-based report. Thanks to recent clinical trials of cholesterol-lowering therapy, it is possible to expand the scope of clinical management for both dietary and drug therapies. This expansion derives from a conclusive demonstration of efficacy, safety, and cost-effectiveness of therapies. This article will review briefly the major features of ATP III.

ARTICLE TITLE: Safety profile of perindopril.
ARTICLE SOURCE: Am J Cardiol (United States), Oct 4 2001, 88(7 Suppl) p36i-40i
AUTHOR(S): Clark LT
AUTHOR'S ADDRESS: Department of Medicine, State University of New York Health Science Center at Brooklyn, Brooklyn, New York, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
Perindopril has no known clinically significant drug-drug interactions. Thus, perindopril is a safe BP-lowering agent with documented tolerability in a wide range of patients with hypertension.
MB: I'm on it.

ARTICLE TITLE: Why perform randomized clinical trials for sentinel node surgery for breast cancer?
ARTICLE SOURCE: Am J Surg (United States), Oct 2001, 182(4) p411-3
AUTHOR(S): Krag D
AUTHOR'S ADDRESS: Department of Surgery, University of Vermont, College of Medicine, Given Building, 05405, Burlington, VT, USA.
PUBLICATION TYPE: Journal Article
At the conclusion of these trials it will be established within a narrow confidence interval whether sentinel node surgery alone provides the same important therapeutic benefits as axillary surgery but without the morbidity associated with axillary surgery.

ARTICLE TITLE: Rapid sequence induction: a national survey of practice
ARTICLE SOURCE: Anaesthesia (England), Nov 2001, 56(11) p1090-115
AUTHOR(S): Morris J; Cook TM
AUTHOR'S ADDRESS: Specialist Registrar and Consultant, Department of Anaesthesia, Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
PUBLICATION TYPE: Journal Article
This survey suggests that many anaesthetists do not follow best practice when performing a rapid sequence induction.
MB: That is a pity. The study was by survey so they revealed their deficiencies presumably from ignorance and self satisfaction.

ARTICLE TITLE: Almost 30% of anaesthetic machines in UK do not have anti-hypoxia device.
ARTICLE SOURCE: BMJ (England), Sep 15 2001, 323(7313) p629
AUTHOR(S): Saunders DI; Meek T
PUBLICATION TYPE: Letter

ARTICLE TITLE: Hospital criticised for poor selection of patients for transplants.
ARTICLE SOURCE: BMJ (England), Sep 15 2001, 323(7313) p589
AUTHOR(S): Kmietowicz Z
PUBLICATION TYPE: News
MB: There is a letter about the inadequacy of the investigation process---not that the conclusions were not correct. They could not tell. There were more deaths than thought justifiable but the investigation process was not sensible but followed politically correct guidelines.

ARTICLE TITLE: Wrong SIGN (Scottish Intercollegiate Guideline Network) , NICE (National Institute for Clinical Excellence) mess: is national guidance distorting allocation of resources?
ARTICLE SOURCE: BMJ (England), Sep 29 2001, 323(7315) p743-5
AUTHOR(S): Cookson R; McDaid D; Maynard A
AUTHOR'S ADDRESS: School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ.
PUBLICATION TYPE: Journal Article
MB: They point out that it's a big muddle & they use the word 'muddle'.
The 4 previous items are examples of the failure of the governance craze in the UK.

ARTICLE TITLE: The effect of cardiac output changes on end-expired volatile anaesthetic concentrations - a theoretical study
ARTICLE SOURCE: Anaesthesia (England), Nov 2001, 56(11) p1034-40
AUTHOR(S): Kennedy RR; Baker AB
AUTHOR'S ADDRESS: Clinical Senior Lecturer & Consultant Anaesthetist, Department of Anaesthesia, The Christchurch School of Medicine, Christchurch, New Zealand Nuffield Professor of Anaesthetics, University of Sydney, New South Wales, Australia.
PUBLICATION TYPE: Journal Article
A significant cardiac output change will produce a change in volatile anaesthetic uptake. An unexpected change in FE' should be considered as a possible signal of a sudden cardiac output change. The difference between agents may represent a balance between the amount of agent taken up and the size of the tissue 'sink' for that agent.
MB: That means that the end tidal level of the inhalational agent rises and of CO2 falls.

ARTICLE TITLE: The effect of cardiac output changes on end-tidal volatile anaesthetic concentrations
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Oct 2001, 29(5) p535-8
AUTHOR(S): Kennedy RR; Baker AB
AUTHOR'S ADDRESS: Department of Anaesthesia, The Christchurch School of Medicine, New Zealand.
PUBLICATION TYPE: Journal Article
ABSTRACT: Cardiac output is a major determinant of the rate of uptake of volatile anaesthetic agents. Theoretical work suggests a 30% change in cardiac output will produce a measurable change in end-tidal volatile agent. We present three patients in whom significant changes in haemodynamic parameters, consistent with a large fall in cardiac output, were accompanied by an increase in end-tidal volatile agent concentrations. The changes in end-tidal volatile agent concentrations were comparable in magnitude but in the opposite direction to the changes in end-tidal CO2. Clinically, an unexplained change in end-tidal concentration of a volatile agent may signify a large change in cardiac output.
MB: It was actually only the blood pressure that they were observing but BP probably does go up & down with cardiac output.

ARTICLE TITLE: Post-tonsillectomy pain: a prospective, randomised and double-blinded study to compare an ultrasonically activated scalpel technique with the blunt dissection technique
ARTICLE SOURCE: Anaesthesia (England), Nov 2001, 56(11) p1045-50
AUTHOR(S): Akural EI; Koivunen PT; Teppo H; Alahuhta SM; Lopponen HJ
AUTHOR'S ADDRESS: Consultant, and Professor, Department of Anaesthesiology, University of Oulu, Finland Consultant, and Specialist Registrar, Department of Otorhinolaryngology, Oulu University Hospital, PO Box 22 FIN-90029 OYS, Oulu, Finland.
PUBLICATION TYPE: Journal Article
In conclusion, we found that ultrasonically activated scalpel (Harmonic scalpel) tonsillectomy was associated with decreased severity in pharyngeal pain on the day of the operation but increased pharyngeal pain and otalgia during the second postoperative week.

ARTICLE TITLE: The real cost of pain management
ARTICLE SOURCE: Anaesthesia (England), Nov 2001, 56(11) p1031-3
AUTHOR(S): Phillips CJ
AUTHOR'S ADDRESS: Senior Lecturer in Health Economics, Centre for Health Economics and Policy Studies, University of Wales, Swansea, UK.
PUBLICATION TYPE: Journal Article
MB: It's about a number of problems inherent in the pain industry which we (the anaesthetic world) are not even belatedly trying to fix.

ARTICLE TITLE: Alternative medicine: a "mirror image" for scientific reasoning in conventional medicine.
ARTICLE SOURCE: Ann Intern Med (United States), Oct 2 2001, 135(7) p507-13
AUTHOR(S): Vandenbroucke JP; de Craen AJ
AUTHOR'S ADDRESS: Department of Clinical Epidemiology, Leiden University Medical Center, Building 1, PO Box 9600, 2300 RC Leiden, the Netherlands. vdbroucke@mail.medfac.leidenuniv.nl.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: A reflection on the scientific behavior of adherents of conventional medicine toward one form of alternative medicine-homeopathy-teaches us that physicians do reject seemingly solid evidence because it is not compatible with theory. Further reflection, however, shows that physicians do the same within conventional medical science: Sometimes they discard a theory because of new facts, but at other times they cling to a theory despite the facts. This essay highlights the seeming contradiction and discusses whether it still permits the building of rational medical science. We propose that rational science is compatible with physicians' behavior, provided that physicians acknowledge the subjective element in the evaluation of science, as exemplified in the crossword analogy by the philosopher Haack. This type of thinking fits very well with the Bayesian approach to decision making that has been advocated for decades in clinical medicine. It does not lead to complete and uncontrollable subjectivity because discernment between rivaling explanations is still possible through argument and counterargument.
MB: Very woolly thinking. Undoubtedly many/most doctors of all kinds act unscientifically. That does not make all theories of medicine equally valid. It's a bit like Communism & Christianity which have not failed. They have not actually ever been tried (ie there have never been any real communists and probably never any real Christian societies either).

ARTICLE TITLE: Update in cardiology.
ARTICLE SOURCE: Ann Intern Med (United States), Sep 18 2001, 135(6) p439-46
AUTHOR(S): Frishman WH
AUTHOR'S ADDRESS: New York Medical College/Westchester Medical Center,Valhalla, New York, USA.
PUBLICATION TYPE: Journal Article; Review; Review Literature

ARTICLE TITLE: Summaries for patients. Overuse of coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty.
ARTICLE SOURCE: Ann Intern Med (United States), Sep 4 2001, 135(5) pS-35
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Racial differences in cardiac revascularization rates: does "overuse" explain higher rates among white patients?
ARTICLE SOURCE: Ann Intern Med (United States), Sep 4 2001, 135(5) p328-37
AUTHOR(S): Schneider EC; Leape LL; Weissman JS; Piana RN; Gatsonis C; Epstein AM
AUTHOR'S ADDRESS: Department of Health Policy and Management, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Among a large and diverse sample of Medicare beneficiaries in five U.S. states, overuse of percutaneous transluminal coronary angioplasty (PTCA) was greater among white men than among other groups, but this difference did not fully account for racial disparities in revascularization. Overuse of cardiac revascularization varied significantly by geographic region.

ARTICLE TITLE: Initial prospective multicenter clinical trial of robotically-assisted coronary artery bypass grafting
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2001, 72(4) p1263-8; discussion 1268-9
AUTHOR(S): Damiano RJ; Tabaie HA; Mack MJ; Edgerton JR; Mullangi C; Graper WP; Prasad SM
AUTHOR'S ADDRESS: Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA. damianor@msnotes.wustl.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: This initial prospective multicenter trial documents the feasibility of robotically-assisted coronary bypass grafting. Further trials are warranted to establish the safety and efficacy of this new technology.
MB: I think I could do with a little robot. Are they as arrogant as human surgeons?

ARTICLE TITLE: Minimally invasive coronary bypass without general endotracheal anesthesia
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2001, 72(4) p1380-2
AUTHOR(S): Zenati MA; Paiste J; Williams JP; Strindberg G; Dumouchel JP; Griffith BP
AUTHOR'S ADDRESS: Division of Cardiothoracic Surgery, University of Pittsburgh Medical Center and Veterans Affairs Healthcare System, Pennsylvania 15213, USA. zenatim@msx.upmc.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: This report describes the case of a 51-year-old man with myocardial ischemia resulting from in-stent restenosis of the left anterior descending coronary artery who underwent a minimally invasive direct coronary artery bypass using thoracic epidural analgesia while awake, without general endotracheal anesthesia.
MB: Smart arses. One case. That journal should be ashamed of itself but I suppose it is edited by a surgeon.

ARTICLE TITLE: Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2001, 72(4) p1256-61; discussion 1261-2
AUTHOR(S): Toraman F; Karabulut EH; Alhan HC; Dagdelen S; Tarcan S
AUTHOR'S ADDRESS: Department of Cardiovascular Surgery, Acibadem Hospital, Istanbul, Turkey.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The use of magnesium in the preoperative and early postoperative periods is highly effective in reducing the incidence of Atrial fibrillation (AF) after coronary artery bypass grafting.

ARTICLE TITLE: Neurologic outcome after thoracic and thoracoabdominal aortic aneurysm repair
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2001, 72(4) p1225-30; discussion 1230-1
AUTHOR(S): Estrera AL; Miller CC; Huynh TT; Porat E; Safi HJ
AUTHOR'S ADDRESS: Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Hospital, 77030, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The combined adjuncts of distal aortic perfusion and cerebrospinal fluid drainage demonstrated improved neurologic outcome with repair of thoracic and thoracoabdominal aortic aneurysm (TAAA). In extent II aneurysms, adjuncts continue to make a considerable difference in the outcome and to provide significant protection against spinal cord morbidity. Future research should focus on spinal cord protection in patients with high-risk extent II aneurysms.

ARTICLE TITLE: Impact of hospital volume on clinical and economic outcomes for esophagectomy
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2001, 72(4) p1118-24
AUTHOR(S): Kuo EY; Chang Y; Wright CD
AUTHOR'S ADDRESS: Division of General Thoracic Surgery, Massachusetts General Hospital, Boston 02114, USA.
PUBLICATION TYPE: Journal Article
RESULTS: One thousand one hundred ninety-three patients underwent esophagectomy during this 8-year study period in Massachusetts. Three high volume hospitals performed 56.5% of all resections (674 of 1,193). Sixty-one low volume hospitals performed 43.5% of the resections (519 of 1,193) with an average volume of only 1 case of esophagectomy per year.
CONCLUSIONS: Hospitals that perform a high volume of esophagectomies have better results with early clinical outcomes and marked reductions in mortality compared with low volume hospitals.
MB: What a surprise

ARTICLE TITLE: The practice of medicine in the year 2010: revisited in 2001
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2001, 72(4) p1105-12
AUTHOR(S): Matloff JM
AUTHOR'S ADDRESS: jackmatloff@worldnet.att.net.
PUBLICATION TYPE: Journal Article
MB: Mostly about money & politics.

ARTICLE TITLE: Three-dimensional electromechanical mapping: imaging in the operating room of the future.
ARTICLE SOURCE: Ann Thorac Surg (United States), Sep 2001, 72(3) pS1083-9
AUTHOR(S): Bolotin G; Wolf T; van der Veen FH; Shachner R; Sazbon Y; Reisfeld D; Shofti R; Lorusso R; Ben-Haim S; Uretzky G
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Tel Aviv Sourasky Medical Center, Israel. bolotin@netvision.net.il.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: By providing both a clear view of the anatomical changes that occur during cardiac surgery, and an accurate assessment of tissue viability, electroanatomic mapping may serve as an important adjunct tool for imaging and analysis of the heart during cardiac surgery.

ARTICLE TITLE: An extracorporeal membrane oxygenation-based approach to cardiogenic shock in an older population.
ARTICLE SOURCE: Ann Thorac Surg (United States), May 2001, 71(5) p1421-7
AUTHOR(S): Smith C; Bellomo R; Raman JS; Matalanis G; Rosalion A; Buckmaster J; Hart G; Silvester W; Gutteridge GA; Smith B; Doolan L; Buxton BF
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Austin & Repatriation Medical Centre, Melbourne, Australia.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: An extracorporeal membrane oxygenation (ECMO) -based approach can be used with acceptable results in the treatment of refractory cardiogenic shock, even in older patients.

ARTICLE TITLE: Attenuation of neurologic injury during cardiac surgery
ARTICLE SOURCE: Ann Thorac Surg (United States), Nov 2001, 72(5) pS1838-44
AUTHOR(S): Murkin JM
AUTHOR'S ADDRESS: Department of Anesthesiology and Perioperative Medicine, London Health Sciences Center, University of Western Ontario, Canada. jmurkin@uwo.ca.
PUBLICATION TYPE: Journal Article
ABSTRACT: Neurologic injury after cardiac surgery can be divided into type I, including clinically apparent stroke, seizures stupor, or coma, and much more occurring type II injury, including intellectual deterioration, memory deficit, or seizures. Cerebral embolization is demonstrably etiologic in many such cases, and several new aortic cannulas are being introduced that are aimed at capturing or diverting potential cerebral emboli. No outcome data are yet available. Several potentially cerebroprotective pharmacologic therapies including thiopental, propofol, and nimodipine, have been assessed clinically but, generally, the results have been poor. Meta-analysis of the large North American aprotinin database of prospective, randomized, placebo-controlled clinical trials is suggestive of a cerebroprotective potential associated with high-dose aprotinin administration.

ARTICLE TITLE: Inappropriate use of antibiotics and the risk for delayed admission and masked diagnosis of infectious diseases: a lesson from Taiwan
ARTICLE SOURCE: Arch Intern Med (United States), Oct 22 2001, 161(19) p2366-70
AUTHOR(S): Liu YC; Huang WK; Huang TS; Kunin CM
AUTHOR'S ADDRESS: Sections of Infectious Diseases and Microbiology, Veterans General Hospital, Kaohsiung, Taiwan.
PUBLICATION TYPE: Journal Article
CONCLUSION: Use of antimicrobial drugs before coming to an emergency department was associated with a significantly increased risk for delayed and masked or missed diagnoses of infectious diseases and missed diagnosis of noninfectious diseases.
MB: I was admitted for 1 week for pneumonia for IV antibiotics. I had not had any antibiotics but no pathogens were grown. They were not surprised. What does it mean?

ARTICLE TITLE: Drug-related deaths in a department of internal medicine
ARTICLE SOURCE: Arch Intern Med (United States), Oct 22 2001, 161(19) p2317-23
AUTHOR(S): Ebbesen J; Buajordet I; Erikssen J; Brors O; Hilberg T; Svaar H; Sandvik L
AUTHOR'S ADDRESS: Foundation for Health Services Research, Central Hospital of Akershus, N-1474 Nordbyhagen, Norway. justebbe@online.no.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Fatal adverse drug events (ADEs) represent a major hospital problem, especially in elderly patients with multiple diseases. A higher number of drugs administered was associated with a higher frequency of fatal ADEs, but whether a high number of drugs is an independent risk factor for fatal ADEs is unsettled. Autopsy results and the findings of premortem and postmortem drug analyses were important for recognizing and excluding suspected fatal ADEs.

ARTICLE TITLE: Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome.
ARTICLE SOURCE: Arch Intern Med (United States), Sep 10 2001, 161(16) p2007-12
AUTHOR(S): Zeiner A; Holzer M; Sterz F; Schorkhuber W; Eisenburger P; Havel C; Kliegel A; Laggner AN
AUTHOR'S ADDRESS: University Clinic of Emergency Medicine, Medical School, University of Vienna, Austria.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study.
ARTICLE SOURCE: Arch Intern Med (United States), Sep 10 2001, 161(16) p1962-8
AUTHOR(S): Nieuwkerk PT; Sprangers MA; Burger DM; Hoetelmans RM; Hugen PW; Danner SA; van Der Ende ME; Schneider MM; Schrey G; Meenhorst PL; Sprenger HG; Kauffmann RH; Jambroes M; Chesney MA; de Wolf F; Lange JM
AUTHOR'S ADDRESS: Department of Medical Psychology (J4-410), Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, the Netherlands. p.t.nieuwkerk@amc.uva.nl; Collective Name: ATHENA Project.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: Only half of the patients took all antiretroviral medication in accordance with time and dietary instructions in the preceding week. Deviation from the antiretroviral regimen was associated with decreased drug exposure and a decreased likelihood of having suppressed plasma HIV-1 RNA loads. Patient adherence should remain a prime concern in the management of HIV-1 infection.

ARTICLE TITLE: Timing of initial administration of low-molecular-weight heparin prophylaxis against deep vein thrombosis in patients following elective hip arthroplasty: a systematic review.
ARTICLE SOURCE: Arch Intern Med (United States), Sep 10 2001, 161(16) p1952-60
AUTHOR(S): Hull RD; Pineo GF; Stein PD; Mah AF; MacIsaac SM; Dahl OE; Ghali WA; Butcher MS; Brant RF; Bergqvist D; Hamulyak K; Francis CW; Marder VJ; Raskob GE
AUTHOR'S ADDRESS: Thrombosis Research Unit, University of Calgary, Alberta, Canada. Jeanne.Sheldon@crha-health.ca.
CONCLUSIONS: The timing of initiating low-molecular-weight heparin significantly influences antithrombotic effectiveness. The practice of delayed initiation of low-molecular-weight heparin prophylaxis results in suboptimal antithrombotic effectiveness without a substantive safety advantage.
MB: Another nail in the epidural coffin but it won't die quickly. Very strange. Evidence seems to have no effect in this Era of the Evidence Based Medicine Craze.

ARTICLE TITLE: Does anticoagulant treatment reduce the mortality of acute pulmonary embolism?
ARTICLE SOURCE: Arch Intern Med (United States), Sep 24 2001, 161(17) p2148
AUTHOR(S): Cundiff DK
PUBLICATION TYPE: Journal Article
MB: They suggest that as 5-16% autopsies show pulmonary emboli the & 93% die within 2.5 hrs so that the clinical prevalence might be wrong. They don't include the California study. White NEJM 343, 1758; 2000.

ARTICLE TITLE: Better psychological functioning and higher social status may largely explain the apparent health benefits of wine: a study of wine and beer drinking in young Danish adults.
ARTICLE SOURCE: Arch Intern Med (United States), Aug 13-27 2001, 161(15) p1844-8
AUTHOR(S): Mortensen EL; Jensen HH; Sanders SA; Reinisch JM
AUTHOR'S ADDRESS: Danish Epidemiology Science Center, Institute of Preventive Medicine, Kommunehospitalet, DK-1399 Copenhagen K, Denmark. lykke@ipm.hosp.dk.
PUBLICATION TYPE: Journal Article
behaviors, wine drinking was associated with optimal functioning and beer drinking with suboptimal functioning. CONCLUSIONS: Our data demonstrate that wine drinking is a general indicator of optimal social, cognitive, and personality development in Denmark. Similar social, cognitive, and personality factors have also been associated with better health in many populations. Consequently, the association between drinking habits and social and psychological characteristics, in large part, may explain the apparent health benefits of wine.

ARTICLE TITLE: Religious struggle as a predictor of mortality among medically ill elderly patients: a 2-year longitudinal study.
ARTICLE SOURCE: Arch Intern Med (United States), Aug 13-27 2001, 161(15) p1881-5
AUTHOR(S): Pargament KI; Koenig HG; Tarakeshwar N; Hahn J
AUTHOR'S ADDRESS: Department of Psychology, Bowling Green State University, Bowling Green, OH 43403, USA. kpargam@bgnet.bgsu.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Certain forms of religiousness may increase the risk of death. Elderly ill men and women who experience a religious struggle with their illness appear to be at increased risk of death, even after controlling for baseline health, mental health status, and demographic factors.

ARTICLE TITLE: Religion and medicine.
ARTICLE SOURCE: Arch Intern Med (United States), Aug 13-27 2001, 161(15) p1811-2
AUTHOR(S): Rosner F
AUTHOR'S ADDRESS: Mount Sinai Services, Queens Hospital Center, 82-68 164th St, Jamaica, NY 11432, USA. rosnef01@hotmail.com.
PUBLICATION TYPE: Journal Article. Editorial.
MB: They don't refer to the above article although it's in the same issue.

ARTICLE TITLE: Delay in GMC hearing breached doctor's human rights.
ARTICLE SOURCE: BMJ (England), Sep 29 2001, 323(7315) p711
AUTHOR(S): Dyer C
PUBLICATION TYPE: News

ARTICLE TITLE: Journals fail to adhere to guidelines on conflicts of interest.
ARTICLE SOURCE: BMJ (England), Sep 22 2001, 323(7314) p651
AUTHOR(S): Smith R
PUBLICATION TYPE: News

ARTICLE TITLE: Medical editor lambasts journals and editors.
ARTICLE SOURCE: BMJ (England), Sep 22 2001, 323(7314) p651
AUTHOR(S): Smith R
PUBLICATION TYPE: News
MB: The whole show is corrupt.

ARTICLE TITLE: New York doctors witness sights seen only in wartime.
ARTICLE SOURCE: BMJ (England), Sep 22 2001, 323(7314) p649
AUTHOR(S): Tanne JH
PUBLICATION TYPE: News

ARTICLE TITLE: Seasonal variations in hospital admission for deep vein thrombosis and pulmonary embolism: analysis of discharge data.
ARTICLE SOURCE: BMJ (England), Sep 15 2001, 323(7313) p601-2
AUTHOR(S): Boulay F; Berthier F; Schoukroun G; Raybaut C; Gendreike Y; Blaive B
AUTHOR'S ADDRESS: Department of Public Health and Medical Information, Nice Teaching Hospital, BP 1179, 06003 Nice, Cedex 1, France.
PUBLICATION TYPE: Journal Article
MB: Worse in winter.

ARTICLE TITLE: University accused of violating academic freedom to safeguard funding from drug companies.
ARTICLE SOURCE: BMJ (England), Sep 15 2001, 323(7313) p591
AUTHOR(S): Dyer O
PUBLICATION TYPE: News
MB: New junior professors appointment was withdrawn after he criticised the drug company which was the major financier of his prospective departments research.

ARTICLE TITLE: Usefulness and validity of post-traumatic stress disorder as a psychiatric category.
ARTICLE SOURCE: BMJ (England), Sep 8 2001, 323(7312) p561-3
AUTHOR(S): Mezey G; Robbins I
AUTHOR'S ADDRESS: Forensic Psychiatry, St George's Hospital Medical School, Jenner Wing, London SW17 0RE. gmezey@sghms.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: Another muddle.

ARTICLE TITLE: Johns Hopkins faces further criticism over experiments.
ARTICLE SOURCE: BMJ (England), Sep 8 2001, 323(7312) p531
AUTHOR(S): Josefson D
PUBLICATION TYPE: News
MB: They lost their human research licence in July & now have another scandal.

ARTICLE TITLE: Baxter withdraws dialyser after 12 patients die.
ARTICLE SOURCE: BMJ (England), Sep 8 2001, 323(7312) p529
AUTHOR(S): Bosch X
PUBLICATION TYPE: News

ARTICLE TITLE: The safety of acupuncture.
COMMENTS: BMJ. 2001 Sep 1; 323(7311):485-6; : BMJ. 2001 Sep 1; 323(7311):486-7
ARTICLE SOURCE: BMJ (England), Sep 1 2001, 323 p467-8
AUTHOR(S): Vincent C
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Does bullying cause emotional problems? A prospective study of young teenagers.
ARTICLE SOURCE: BMJ (England), Sep 1 2001, 323p480-4
AUTHOR(S): Bond L; Carlin JB; Thomas L; Rubin K; Patton G
AUTHOR'S ADDRESS: Centre for Adolescent Health, Royal Children's Hospital, Parkville 3052, Victoria, Australia. bond@cryptic.rch.unimelb.edu.au.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: A history of victimisation and poor social relationships predicts the onset of emotional problems in adolescents. Previous recurrent emotional problems are not significantly related to future victimisation. These findings have implications for how seriously the occurrence of victimisation is treated and for the focus of interventions aimed at addressing mental health issues in adolescents.
MB: I don't think it is double blind etc. I think they only randomisation was the selection of the schools. All my recent articles about bullying have been from Australia. Is there not some bullying in the real world?

ARTICLE TITLE: Cardiovascular complications of recreational drugs.
ARTICLE SOURCE: BMJ (England), Sep 1 2001, 323 p464-6
AUTHOR(S): Ghuran A; van Der Wieken LR; Nolan J
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Renal medicine
ARTICLE SOURCE: BMJ (England), Oct 27 2001, 323pS2-S7319
AUTHOR(S): Glynne PA
AUTHOR'S ADDRESS: Department of Medicine, University College London Hospitals, London WC1E 6JF (p.glynne@ic.ac.uk).
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Row over breast cancer screening shows that scientists bring "some subjectivity into their work".
ARTICLE SOURCE: BMJ (England), Oct 27 2001, 323p956
AUTHOR(S): Mayor S
AUTHOR'S ADDRESS: London.
PUBLICATION TYPE: Journal Article
MB: It has been known for some centuries that evidence is not sufficient to establish reality. For a short time in philosophical terms the Cochrane system has been regarded as being infallible as the Pope. It is now apparent that some in that system have got themselves into positions of power and have personal agendas. Oh how the mighty have fallen.

ARTICLE TITLE: Caesarean section rate in England and Wales hits 21
ARTICLE SOURCE: BMJ (England), Oct 27 2001, 323 p951A
AUTHOR(S): Dobson R
AUTHOR'S ADDRESS: Abergavenny.
PUBLICATION TYPE: Journal Article
MB: Surely the desirable caesarian section rate is arbitrary.

ARTICLE TITLE: Doctors should be trained in advanced life support before students are
ARTICLE SOURCE: BMJ (England), Oct 20 2001, 323p935A
AUTHOR(S): White MC
AUTHOR'S ADDRESS: Cheltenham General Hospital, Cheltenham GL53 7AN mcwdoc@yahoo.com.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Cardiopulmonary resuscitation in adults. Revised guidelines are more evidence based
ARTICLE SOURCE: BMJ (England), Oct 13 2001, 323 p819-20
AUTHOR(S): Lockey AS; Nolan JP
AUTHOR'S ADDRESS: York District Hospital, York YO31 8HE.
PUBLICATION TYPE: Journal Article. Editorial
MB: There are now international guide lines. Australia was in the decision making.

ARTICLE TITLE: Effective physiotherapy.
ARTICLE SOURCE: BMJ (England), Oct 6 2001, 323 p788-90
AUTHOR(S): Herbert RD; Maher CG; Moseley AM; Sherrington C
AUTHOR'S ADDRESS: School of Physiotherapy, University of Sydney, PO Box 170, Lidcombe NSW 1825, Australia. R.Herbert@cchs.usyd.edu.au.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials.
COMMENTS: BMJ. 2001 Oct 6; 323 761-2
ARTICLE SOURCE: BMJ (England), Oct 6 2001, 323p773-6
AUTHOR(S): Lewis SJ; Egger M; Sylvester PA; Thomas S
AUTHOR'S ADDRESS: Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ. sjl@doctors.org.uk.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSIONS: There seems to be no clear advantage to keeping patients nil by mouth after elective gastrointestinal resection. Early feeding may be of benefit. An adequately powered trial is required to confirm or refute the benefits seen in small trials.

ARTICLE TITLE: Postoperative starvation after gastrointestinal surgery. Early feeding is beneficial.
COMMENTS: BMJ. 2001 Oct 6; 323 773-6
ARTICLE SOURCE: BMJ (England), Oct 6 2001, 323p761-2
AUTHOR(S): Silk DB; Gow NM
PUBLICATION TYPE: Comment; Editorial
MB: There appears to be some doubt after upper GI operations. They think multi-centre trials are needed.

ARTICLE TITLE: Johns Hopkins admits scientist used Indian patients as guinea pigs
ARTICLE SOURCE: BMJ (England), Nov 24 2001, 323p1204B
AUTHOR(S): Mudur G
AUTHOR'S ADDRESS: New Delhi.
PUBLICATION TYPE: News

ARTICLE TITLE: Indian doctors decry proposal to teach traditional medicine
ARTICLE SOURCE: BMJ (England), Nov 10 2001, 323 p1090
AUTHOR(S): Mudur G
AUTHOR'S ADDRESS: New Delhi.
PUBLICATION TYPE: News.
MB: We have some of this stuff paid for by medicare.

ARTICLE TITLE: Why active euthanasia and physician assisted suicide should be legalised
ARTICLE SOURCE: BMJ (England), Nov 10 2001, 323 p1079-80
AUTHOR(S): Doyal L; Doyal L
AUTHOR'S ADDRESS: St Bartholomew's and Royal London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AD.
PUBLICATION TYPE: Editorial.
MB: They seem a bit confused about what is allowed without specific legislation. They make assumptions about universally accepted ethics, which are not correct. That is a common philosophical error.

ARTICLE TITLE: Bronchial asthma: principles of diagnosis and treatment
ARTICLE SOURCE: Chest (United States), Nov 2001, 120(5) p1757-8
AUTHOR(S): Bashir NS
AUTHOR'S ADDRESS: University of New Mexico School of Medicine Albuquerque, NM.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Complications following percutaneous tracheostomy
ARTICLE SOURCE: Chest (United States), Nov 2001, 120(5) p1751-2
AUTHOR(S): Hedges S; Perkins V
AUTHOR'S ADDRESS: Dumfries and Galloway Royal Infirmary Dumfries, United Kingdom. Hopital d'Instruction des Armees Clamart, France.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The role of continuous positive airway pressure in the treatment of congestive heart failure
ARTICLE SOURCE: Chest (United States), Nov 2001, 120(5) p1675-85
AUTHOR(S): Yan AT; Bradley TD; Liu PP
AUTHOR'S ADDRESS: Heart and Stroke/Richard Lewar Centre of Excellence, (Drs. Yan and Liu), and the Centre for Sleep and Chronobiology (Dr. Bradley), University of Toronto, Toronto, Canada.
PUBLICATION TYPE: Journal Article
ABSTRACT: Congestive heart failure (CHF) is a serious medical condition frequently associated with sleep-related breathing disorders, which remain underdiagnosed and undertreated. Recent studies have provided important insight into the pathophysiology of sleep apnea syndrome in patients with CHF, with potential therapeutic implications. In addition to abolition of sleep apnea, continuous positive airway pressure (CPAP) treatment can improve cardiac function and relieve symptoms of CHF. Postulated mechanisms include beneficial hemodynamic effects on ventricular remodeling, unloading of fatigued respiratory muscles, and neurohormonal modulation. Although medium-term studies using CPAP to treat sleep-related breathing disorders associated with CHF have been encouraging, more definitive data from ongoing large clinical trials are necessary to clarify its therapeutic role.

ARTICLE TITLE: Transtracheal oxygenation : an alternative to endotracheal intubation during cardiac arrest
ARTICLE SOURCE: Chest (United States), Nov 2001, 120(5) p1663-70
AUTHOR(S): Ayoub IM; Brown DJ; Gazmuri RJ
AUTHOR'S ADDRESS: Medical Service, Section of Critical Care Medicine, North Chicago VA Medical Center and Department of Medicine, Division of Critical Care Medicine, Finch University of Health Sciences/The Chicago Medical School, North Chicago, IL.
PUBLICATION TYPE: Journal Article
CONCLUSION: continuous transtracheal oxygenation (TTO) was as effective as conventional positive-pressure ventilation with 100% O(2) for securing oxygenation, resuscitation, and short-term survival and more effective than O(2) delivered through a mask.
MB: Animals.

ARTICLE TITLE: "Alternative" therapies for asthma : reason for concern?
ARTICLE SOURCE: Chest (United States), Nov 2001, 120(5) p1433-4
AUTHOR(S): Ernst E
AUTHOR'S ADDRESS: Professor Ernst is from the Department of Complementary Medicine, School of Sport Medicine and Health Sciences, University of Exeter.
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Percutaneous Dilational Tracheostomy vs Open Tracheostomy
ARTICLE SOURCE: Chest (United States), Oct 2001, 120(4) p1423-4
AUTHOR(S): Anderson JD; Rabinovici R; Frankel HL
AUTHOR'S ADDRESS: Yale University School of Medicine New Haven, CT. Washington University School of Medicine St. Louis, MO.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effects of dobutamine on critical capillary po(2) and lactic acidosis threshold in patients with cardiovascular disease
ARTICLE SOURCE: Chest (United States), Oct 2001, 120(4) p1218-25
AUTHOR(S): Koike A; Kobayashi K; Adachi H; Shimizu N; Itoh H; Hiroe M; Wasserman K
AUTHOR'S ADDRESS: Cardiovascular Institute (Drs. Koike and Itoh), Tokyo.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Infusion of dobutamine was found to raise the critical PO(2) and lactic acidosis threshold (LAT) but not peak O(2). These findings suggest that some of the acute increase in blood flow induced by dobutamine infusion benefits exercising muscle by increasing capillary PO(2), thereby delaying the onset of lactic acidosis.
MB: I am not sure that dobutamine benefits anything. I have not used it because I could not think when to do so. I have only seen it used to adjust blood pressure.

ARTICLE TITLE: Predicting extubation failure : is it in (on) the cards?
ARTICLE SOURCE: Chest (United States), Oct 2001, 120(4) p1061-3
AUTHOR(S): Epstein SK
AUTHOR'S ADDRESS: Dr. Epstein is Associate Director, Medical Intensive Care Unit, Pulmonary and Critical Care Division, New England Medical Center, Associate Professor of Medicine, Tufts University School of Medicine, Boston, MA.
PUBLICATION TYPE: Journal Article
MB: I think he's a bit muddled. I think he wants objective (numerical) rather than subjective (clinical) criteria.

ARTICLE TITLE: Ventilator-associated pneumonia: science and hocus-pocus.
COMMENTS: Chest. 2001 Sep; 120(3):955-70/21439071
ARTICLE SOURCE: Chest (United States), Sep 2001, 120(3) p702-4
AUTHOR(S): Marik PE; Varon J
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The effect of incentive spirometry on postoperative pulmonary complications: a systematic review.
ARTICLE SOURCE: Chest (United States), Sep 2001, 120(3) p971-8
AUTHOR(S): Overend TJ; Anderson CM; Lucy SD; Bhatia C; Jonsson BI; Timmermans C
AUTHOR'S ADDRESS: School of Physical Therapy, University of Western Ontario, London, Ontario, Canada. mailto:toverend@uw
PUBLICATION TYPE: Journal Article; Review; Review, Academic
CONCLUSIONS: Presently, the evidence does not support the use of incentive spirometry (IS) for decreasing the incidence of postoperative pulmonary complications (PPCs) following cardiac or upper abdominal surgery.
MB: I have not seen them around lately. Maybe they have just faded away.

ARTICLE TITLE: International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-associated Pneumonia.
COMMENTS: Chest. 2001 Sep; 120(3):702-4/21439031
ARTICLE SOURCE: Chest (United States), Sep 2001, 120(3) p955-70
AUTHOR(S): Rello J; Paiva JA; Baraibar J; Barcenilla F; Bodi M; Castander D; Correa H; Diaz E; Garnacho J; Llorio M; Rios M; Rodriguez A; Sole-Violan J
AUTHOR'S ADDRESS: Hospital Universitari Joan XXIII, Tarragona, Spain. jrc@hj23.es.
PUBLICATION TYPE: Consensus Development Conference; Journal Article; Review
ABSTRACT: Ventilator-associated pneumonia (VAP) is an important health problem that still generates great controversy. A consensus conference attended by 12 researchers from Europe and Latin America was held to discuss strategies for the diagnosis and treatment of VAP. <snip> Consensus was reached on the importance of local epidemiology surveillance programs and on the need for customized empiric antimicrobial choices to respond to local patterns of pathogens and susceptibilities.

ARTICLE TITLE: Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications (PPCs) after pulmonary surgery.
ARTICLE SOURCE: Chest (United States), Sep 2001, 120(3) p705-10
AUTHOR(S): Nakagawa M; Tanaka H; Tsukuma H; Kishi Y
AUTHOR'S ADDRESS: Department of Anesthesiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka City, Japan. m.h.naka@f4.dion.ne.jp.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: These findings indicate that preoperative smoking abstinence of at least 4 weeks is necessary for patients who undergo pulmonary surgery, to reduce the incidence of PPCs.

ARTICLE TITLE: Captaining the ship during a storm: who should care for the critically ill?
ARTICLE SOURCE: Chest (United States), Sep 2001, 120(3) p694-6
AUTHOR(S): Azocar RJ; Lisbon A
PUBLICATION TYPE: Editorial
MB: About open & closed ICUs

ARTICLE TITLE: What is best for patients is best for the intensive care unit.
COMMENTS: Crit Care Med. 2001 Oct; 29(10):2007-19
ARTICLE SOURCE: Crit Care Med (United States), Oct 2001, 29(10) p2038-9
AUTHOR(S): Green TP
PUBLICATION TYPE: Comment; Editorial
MB: Same as above

ARTICLE TITLE: French intensivists do not apply American recommendations regarding decisions to forgo life-sustaining therapy.
COMMENTS: Crit Care Med. 2001 Oct; 29(10):2024-5
ARTICLE SOURCE: Crit Care Med (United States), Oct 2001, 29(10) p1887-92
AUTHOR(S): Pochard F; Azoulay E; Chevret S; Vinsonneau C; Grassin M; Lemaire F; Herve C; Schlemmer B; Zittoun R; Dhainaut JF
AUTHOR'S ADDRESS: Service de Psychiatrie et Service de Reanimation Medicale, Hopital Cochin, Paris, France; Collective Name: The French PROTOCETIC Group.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: A decision to withhold or withdraw life-sustaining therapy was implemented for half the patients who died in the French intensive care units studied. In many cases, the decision was taken without regard for one or more factors identified as relevant in U.S. guidelines.

ARTICLE TITLE: Paying attention to death.
COMMENTS: Crit Care Med. 2001 Oct; 29(10):2001-6
ARTICLE SOURCE: Crit Care Med (United States), Oct 2001, 29(10) p2037-8
AUTHOR(S): Levy MM
PUBLICATION TYPE: Comment; Editorial
MB: On the managing of deaths in ICUs.

ARTICLE TITLE: Renal replacement therapy in intensive care: one size does not fit all.
COMMENTS: Crit Care Med. 2001 Oct; 29(10):1910-5
ARTICLE SOURCE: Crit Care Med (United States), Oct 2001, 29(10) p2028-9
AUTHOR(S): Anderson RJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Family stress in the intensive care unit.
COMMENTS: Crit Care Med. 2001 Oct; 29(10):1893-7
ARTICLE SOURCE: Crit Care Med (United States), Oct 2001, 29(10) p2025-6
AUTHOR(S): Patricia Lange M
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: A rose by any other name: cardiac output.
COMMENTS: Crit Care Med. 2001 Oct; 29(10):1868-73
ARTICLE SOURCE: Crit Care Med (United States), Oct 2001, 29(10) p2021-2
AUTHOR(S): Pinsky MR
PUBLICATION TYPE: Comment; Editorial
MB: The editorial assumes injectable thermodilution.

ARTICLE TITLE: Recommendations for nonheartbeating organ donation. A position paper by the Ethics Committee, American College of Critical Care Medicine, Society of Critical Care Medicine.
ARTICLE SOURCE: Crit Care Med (United States), Sep 2001, 29(9) p1826-31
AUTHOR'S ADDRESS: Collective Name: Ethics Committee, American College of Critical Care Medicine; Collective Name: Society of Critical Care Medicine.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Rapacuronium for neuromuscular blockade in two myasthenic patients undergoing trans-sternal thymectomy
ARTICLE SOURCE: Eur J Anaesthesiol (England), Nov 2001, 18(11) p778-80
AUTHOR(S): Baraka AS; Taha SK; Rizk MS; Rachid-Chehab I; Jalbout MI; Bizri SH
AUTHOR'S ADDRESS: Anaesthesiology Department, American University of Beirut Medical Center, Beirut, Lebanon.
PUBLICATION TYPE: Journal Article
MB: Well it's gone now.

ARTICLE TITLE: Magnesium as part of balanced general anaesthesia with propofol, remifentanil and mivacurium: a double-blind, randomized prospective study in 50 patients
ARTICLE SOURCE: Eur J Anaesthesiol (England), Nov 2001, 18(11) p723-9
AUTHOR(S): Schulz-Stubner S; Wettmann G; Reyle-Hahn SM; Rossaint R
AUTHOR'S ADDRESS: Klinik fur Anasthesiologie am Universitatsklinikum der RWTH Aachen, Pauwelsstr. 30, 52074 Aachen, Germany.
PUBLICATION TYPE: Journal Article
ABSTRACT: Background and objective To test the hypothesis that magnesium sulphate reduces the amount of remifentanil needed for general anaesthesia in combination with propofol and mivacurium, we studied 50 patients undergoing elective pars plana vitrectomy in a double-blind, randomized prospective fashion. Methods Magnesium sulphate (50 mg kg-1 body weight) or placebo (equal volume of NaCl) was given slowly intravenously after induction of anaesthesia with propofol 1-2 mg kg-1. Anaesthesia was maintained with propofol (using electroencephalographic control), mivacurium (according to train-of-four monitoring of neuromuscular blockade) and remifentanil (according to heart rate and arterial pressure). Results We observed a significant reduction in remifentanil consumption from 0.14 to 0.09 &mgr; g kg-1> min-1 (P> < 0.01). Mivacurium consumption was also markedly reduced from 0.01 to 0.008 mg kg -1min-1 (P < 0.01), whereas propofol consumption remained unchanged. There was a trend towards lower postoperative pain scores, less pain medication requirements in 24 h after surgery and less postoperative nausea and vomiting in the magnesium group but not statistically significant. No side-effects were observed. Conclusion We can recommend the use of magnesium sulphate as a safe and cost-effective supplement to a general anaesthetic regimen with propofol, remifentanil and mivacurium, although we cannot clearly distinguish between a mechanism as a (co)analgesic agent at the NMDA-receptor site or its properties as a sympatholytic. The effect of a single bolus dose of 50 mg kg-1 on induction lasts for about 2 h. For longer cases, either a continuous infusion or repeated bolus doses might be necessary.
MB:They adjusted remifentanil according to pulse rate & BP & propofol by an EEG. There seems to be no point adding a third drug when one would have been sufficient.

ARTICLE TITLE: Inadvertent infusion of a high dose of potassium chloride via a thoracic epidural catheter
ARTICLE SOURCE: Eur J Anaesthesiol (England), Oct 2001, 18(10) p697-9
AUTHOR(S): Litz RJ; Kreinecker I; Hubler M; Albrecht DM
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care Medicine, University Hospital Carl-Gustav-Carus, Dresden, Germany.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Predonation of autologous blood is jeopardized by new regulations
ARTICLE SOURCE: Eur J Anaesthesiol (England), Oct 2001, 18(10) p629-31
AUTHOR(S): Frietsch T; Lorentz A
AUTHOR'S ADDRESS: Department of Anaesthesiology and Critical Care Medicine, Faculty of Clinical Medicine Mannheim, University of Heidelberg, Germany.
PUBLICATION TYPE: Journal Article
MB: There is reason to think that predonation may not be all good.

ARTICLE TITLE: Sexual activity as a trigger of myocardial infarction. A case-crossover analysis in the Stockholm Heart Epidemiology Programme (SHEEP).
ARTICLE SOURCE: Heart (England), Oct 2001, 86(4) p387-90
AUTHOR(S): Moller J; Ahlbom A; Hulting J; Diderichsen F; de Faire U; Reuterwall C; Hallqvist J
AUTHOR'S ADDRESS: Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden. jette.moller@phs.ki.se.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The increased risk of myocardial infarction after sexual activity and the further increase in risk among the less physically fit support the hypothesis of causal triggering by sexual activity. However, the absolute risk per hour is very low, and exposure is relatively infrequent. Thus having sex once a week only increases the annual risk of myocardial infarction slightly. Counselling should focus on encouraging patients to live a physically active life and not on abstaining from sexual activity.
MB: Why not just give up both? Maybe they would die during the other physical activity as well.

ARTICLE TITLE: What causes the symptoms of heart failure?
ARTICLE SOURCE: Heart (England), Nov 2001, 86(5) p574-8
AUTHOR(S): Coats AJ
AUTHOR'S ADDRESS: National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, Royal Brompton Hospital, London, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Risks of elective cardiac surgery: what do patients want to know?
ARTICLE SOURCE: Heart (England), Dec 2001, 86(6) p626-31
AUTHOR(S): Beresford N; Seymour L; Vincent C; Moat N
AUTHOR'S ADDRESS: Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To examine patients' individual requirements for risk disclosure before surgery. DESIGN: Structured interview and questionnaire. SETTING: 50 patients interviewed following coronary artery bypass grafting or valve replacement or repair. MAIN OUTCOME MEASURES: Patient assessment of the nature and probability of risks they would have wished to be informed of from a pool comprising death and 13 postoperative complications. RESULTS: Out of 50 patients, 21 (42%) wanted no risk information at all, 25 (50%) did not want to be advised of the risk of death, and 27 (54%) did not want information about the risk of permanent stroke. This contrasts with standard practice of routinely informing patients of the risk of death and stroke. However, there were pronounced individual patient preferences. Three groups of patients emerged: those requiring little or no risk information, those requiring information about major risks, and those requiring full risk disclosure. Patients were not generally concerned about the specific probabilities of any risk. CONCLUSIONS: Clinicians counselling patients before operation should routinely discuss patient preferences before risk disclosure, distinguishing among a preference for "no risk information", "all potentially relevant risks", and "those risks considered significant or likely to occur". The fact of individual patient preferences may undermine the concept of the "reasonable patient" in determination of the legal requirements for risk disclosure. Future studies, in addition to replicating the present findings, should examine the reasons underlying individual patient preferences and the long term implications of degrees of risk disclosure, particularly when adverse outcomes occur.
MB: Every human personality is not the same. I would have thought preferences & the reasons for preferences are important whatever the outcome of the surgery.

ARTICLE TITLE: Patients' experiences of intervention trials on the treatment of myocardial infarction: is it time to adjust the informed consent procedure to the patient's capacity?
ARTICLE SOURCE: Heart (England), Dec 2001, 86(6) p632-7
AUTHOR(S): Agard A; Hermeren G; Herlitz J
AUTHOR'S ADDRESS: Department of Medicine, Sahlgrens University Hospital, SE-413 45 Gothenburg, Sweden.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To investigate how patients included in trials on treatment in the early phase of acute myocardial infarction experience the consent procedure. DESIGN: A combined qualitative and quantitative interview concerning the patients' knowledge of the trial, their feelings about being asked to participate, and their attitudes towards the consent procedure. SETTING: Tertiary referral centre. PATIENTS: 31 patients who had given written informed consent for their participation in randomised intervention trials of acute myocardial infarction. RESULTS: The patients interviewed had only fragmentary knowledge about the trial they were involved in. Most considered that reading and signing a consent form was an unwanted or unnecessary procedure. Instead, they would have preferred to have been given concise verbal information about the study. Most were willing to allow a physician to decide for them in the event of their being too ill to be asked about their participation. CONCLUSIONS: Patients who are asked to participate in intervention trials in the early phase of acute myocardial infarction often appear to lack sufficient knowledge to reach an autonomous choice. There were problems and disadvantages associated with the process of obtaining written informed consent in this particular situation, especially regarding the need for the patient to sign a consent form during the acute phase of the disease.
MB: Sufficient to refute the idea that all patients must be informed & consent. A surgeon I know says, "I am informed. The patient consents."

ARTICLE TITLE: The athlete's heart
ARTICLE SOURCE: Heart (England), Dec 2001, 86(6) p722-6
AUTHOR(S): Oakley D
AUTHOR'S ADDRESS: Sheffield, UK.
PUBLICATION TYPE: Journal Article
MB: They are all neurotic & hypochondriacal.

ARTICLE TITLE: What is best for patients is best for the intensive care unit.
COMMENTS: Crit Care Med. 2001 Oct; 29(10):2007-19
ARTICLE SOURCE: Crit Care Med (United States), Oct 2001, 29(10) p2038-9
AUTHOR(S): Green TP
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Integrated analysis of protein and glucose metabolism during surgery: effects of anesthesia
ARTICLE SOURCE: J Appl Physiol (United States), Dec 2001, 91(6) p2523-30
AUTHOR(S): Schricker T; Lattermann R; Fiset P; Wykes L; Carli F
AUTHOR'S ADDRESS: Department of Anesthesia, Royal Victoria Hospital, Montreal, Quebec, Canada H3A 1A1.
PUBLICATION TYPE: Journal Article
Surgery causes a depression of whole body protein and glucose metabolism, independent of the anesthetic technique. There is a correlation between perioperative glucose production and protein breakdown.

ARTICLE TITLE: Ethics, revisited
ARTICLE SOURCE: J Appl Physiol (United States), Nov 2001, 91(5) p1911-2
AUTHOR(S): Benos DJ
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Normothermic versus hypothermic cardiopulmonary bypass during repair of congenital heart
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Oct 2001, 15(5) p563-6
AUTHOR(S): Rasmussen LS; Sztuk F; Christiansen M; Elliott MJ
AUTHOR'S ADDRESS: Department of Anesthesia, Center of Head and Orthopedics, Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Limitations of early cognitive function testing in the postoperative period
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Oct 2001, 15(5) p671
AUTHOR(S): Silbert BS; Scott DA; Maruff P; Evered L
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: New pain following cordotomy: clinical features, mechanisms, and clinical importance.
ARTICLE SOURCE: J Neurosurg (United States), Sep 2001, 95(3) p425-31
AUTHOR(S): Nagaro T; Adachi N; Tabo E; Kimura S; Arai T; Dote K
AUTHOR'S ADDRESS: Department of Anesthesiology, Ehime University School of Medicine, Shigenobu, Japan. tnagaro@m.ehime-u.ac.jp.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Low-dose postoperative aprotinin reduces mediastinal drainage and blood product use in patients undergoing primary coronary artery bypass grafting who are taking aspirin: a prospective, randomized, double-blind, placebo-controlled trial.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Sep 2001, 122(3) p457-63
AUTHOR(S): Alvarez JM; Jackson LR; Chatwin C; Smolich JJ
AUTHOR'S ADDRESS: Cardiothoracic Surgery Unit, Monash Medical Centre, Department of Medicine, Monash University, Clayton, Victoria, Australia. john.alvarez@health.wa.gov.au.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: These results suggest that postoperative administration of low-dose aprotinin in patients taking aspirin until just before primary coronary artery operations with cardiopulmonary bypass not only reduces the rate and total amount of postoperative mediastinal blood loss but also lowers postoperative blood product use.

ARTICLE TITLE: New heart failure therapy: the shape of things to come?
COMMENTS: J Thorac Cardiovasc Surg. 2001 Sep; 122(3):482-90
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Sep 2001, 122(3) p421-3
AUTHOR(S): Burkhoff D
PUBLICATION TYPE: Comment; Editorial; Review; Review, Tutorial

ARTICLE TITLE: Escape from antidiuresis: A good story
ARTICLE SOURCE: Kidney Int (United States), Oct 2001, 60(4) p1608-10
AUTHOR(S): Verbalis JG
AUTHOR'S ADDRESS: Washington, DC, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Difficulties in understanding human "acute tubular necrosis": Limited data and flawed animal models
ARTICLE SOURCE: Kidney Int (United States), Oct 2001, 60(4) p1220-4
AUTHOR(S): Rosen S; Heyman SN
AUTHOR'S ADDRESS: Departments of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA, and Department of Medicine, Hadassah Hospital, Mt. Scopus and the Hebrew University Medical School, Jerusalem, Israel.
PUBLICATION TYPE: Journal Article
ABSTRACT: This review summarizes the current understanding of the renal biopsy in "acute tubular necrosis" and the attempts to mimic this phenomenon in animal models. Paradoxically, only very limited necrosis is present in the biopsy of patients with this condition and differences in biopsies of patients with sustained and recovering renal failure cannot be clearly defined. The small amount of material examined, the variation in timing of the biopsy, the ability of the nephron to recover from sublethal injury, and the complexity of the clinical situation compound the difficulties in understanding this condition. Morphological findings in the animal studies are not equivalent to those in the human biopsy of "acute tubular necrosis," because they either have too much proximal tubular necrosis (ischemia-reflow model) or show severe injury to distal nephron segments (distal nephron model), the degree of which has not been clearly documented, as yet, in human material. The direct relevance of animal models in part may be tested by new noninvasive methods that define and quantify excreted proteins that reflect nephron injury or measure the status of renal oxygenation by radiological imaging techniques. Finally, it may be time to re-examine the morphology of "acute tubular necrosis," utilizing new techniques that illustrate induction of heat shock proteins, sublethal and apoptotic cellular injury, and alteration of gene expression.
MB: Why are they worried about it. I don't think I have ever used the term for acute renal failure.

ARTICLE TITLE: Assessment of undergraduate medical education in the UK: time to ditch motherhood and apple pie
ARTICLE SOURCE: Med Educ (England), Nov 2001, 35(11) p1006-7
AUTHOR(S): Fowell S; Bligh J
AUTHOR'S ADDRESS: Liverpool, UK Plymouth, UK.
PUBLICATION TYPE: Journal Article
MB: They have not got beyond platitudes.

ARTICLE TITLE: Solving problems with group work in problem-based learning: hold on to the philosophy.
COMMENTS: Med Educ. 2001 Sep; 35(9):820-1
ARTICLE SOURCE: Med Educ (England), Sep 2001, 35(9) p884-9
AUTHOR(S): Dolmans DH; Wolfhagen IH; van der Vleuten CP; Wijnen WH
AUTHOR'S ADDRESS: Department of Educational Development and Research, University of Maastricht, The Netherlands.
PUBLICATION TYPE: Journal Article
ABSTRACT: INTRODUCTION: Problem-based learning (PBL) has gained a foothold within many schools in higher education as a response to the problems faced within traditional education. DISCUSSION: Working with PBL tutorial groups is assumed to have positive effects on student learning. Several studies provide empirical evidence that PBL stimulates cognitive effects and leads to restructuring of knowledge and enhanced intrinsic interest in the subject matter. However, staff members do not always experience the positive effects of group work which they had hoped for. When confronted with problems in group work, such as students who only maintain an appearance of being actively involved and students who let others do the work, teachers all too often implement solutions which can be characterized as teacher- directed rather than student-directed. Teachers tend to choose solutions which are familiar from their own experience during professional training, i.e. using the teacher-directed model. These solutions are not effective in improving group work and the negative experiences persist. CONCLUSION: It is argued that teachers should hold on to the underlying educational philosophy when solving problems arising from group work in PBL, by choosing actions which are consistent with the student-directed view of education in PBL.

ARTICLE TITLE: Holding on to the philosophy and keeping the faith.
COMMENTS: Med Educ. 2001 Sep; 35(9):884-9
ARTICLE SOURCE: Med Educ (England), Sep 2001, 35(9) p820-1
AUTHOR(S): Norman G
AUTHOR'S ADDRESS: Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada. norman@mcmaster.ca.
PUBLICATION TYPE: Comment; Journal Article
MB: At last someone is calling the bluff ---& from Mc Master--the first PBL driven course.

ARTICLE TITLE: Stories as case knowledge: case knowledge as stories.
COMMENTS: Med Educ. 2001 Sep; 35(9):818-9
ARTICLE SOURCE: Med Educ (England), Sep 2001, 35(9) p862-6
AUTHOR(S): Cox K
AUTHOR'S ADDRESS: School of Medical Education, University of New South Wales, Sydney, Australia. k.cox@unsw.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSION: This paper makes four points. First, clinical stories recount pointed examples of 'what happened' that expand our expertise in handling 'a case like that'. Second, cases are the unit of clinical work. Case stories expand the dimensions and details of case knowledge, case-based reasoning and case management. Carefully collated case stories can comprise the 'real life' clinical curriculum. Third, stories provide a framework for 'web' or 'net' thinking that links all the objective and subjective details within the multifaceted complexity of case management. Fourth, personal stories explain how both numerical and non-linear influences determined what decision was actually made in that case.
MB: I like stories.

ARTICLE TITLE: Storytelling should be targeted where it is known to have greatest added value.
COMMENTS: Med Educ. 2001 Sep; 35(9):862-6
ARTICLE SOURCE: Med Educ (England), Sep 2001, 35(9) p818-9
AUTHOR(S): Greenhalgh T
AUTHOR'S ADDRESS: Primary Care and Population Sciences, UCLMS, London, UK. p.greenhalgh@pcps.ucl.ac.uk.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Will less liberal red-cell transfusion (with a lower haemoglobin threshold) still reduce rates of death and organ failure?
ARTICLE SOURCE: Med J Aust (Australia), Oct 1 2001, 175(7) p387
AUTHOR(S): Bellomo R
AUTHOR'S ADDRESS: Department of Intensive Care Austin & Repatration Medical Centre, Melbourne, VIC.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Inappropriate use of blood: is the problem intractable?
ARTICLE SOURCE: Med J Aust (Australia), Oct 1 2001, 175(7) p348-9
AUTHOR(S): Sibinga CT
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Appropriateness of red blood cell transfusions in major urban hospitals and effectiveness of an intervention
ARTICLE SOURCE: Med J Aust (Australia), Oct 1 2001, 175(7) p354-8
AUTHOR(S): Rubin GL; Schofield WN; Dean MG; Shakeshaft AP
AUTHOR'S ADDRESS: Department of Public Health and Community Medicine, University of Sydney at Westmead, NSW. grubin@med.usyd.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: About a third of RBC transfusions were assessed as inappropriate. The interventions had only a small effect on transfusion appropriateness.

ARTICLE TITLE: Anemia, transfusion, and mortality.
COMMENTS: N Engl J Med. 2001 Oct 25; 345(17):1230-6
ARTICLE SOURCE: N Engl J Med (United States), Oct 25 2001, 345(17) p1272-4
AUTHOR(S): Goodnough LT; Bach RG
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Blood transfusion in elderly patients with acute myocardial infarction.
COMMENTS: N Engl J Med. 2001 Oct 25; 345(17):1272-4
ARTICLE SOURCE: N Engl J Med (United States), Oct 25 2001, 345(17) p1230-6
AUTHOR(S): Wu WC; Rathore SS; Wang Y; Radford MJ; Krumholz HM
AUTHOR'S ADDRESS: Division of Cardiovascular Diseases, Brown University Medical School, Providence, RI, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Blood transfusion is associated with a lower short-term mortality rate among elderly patients with acute myocardial infarction if the hematocrit on admission is 30.0 percent or lower and may be effective in patients with a hematocrit as high as 33.0 percent on admission.

ARTICLE TITLE: Scientific background and rationale for a randomised controlled trial
ARTICLE SOURCE: Med J Aust (Australia), Oct 1 2001, 175(7) p386
AUTHOR(S): Ghersi D; Gebski VJ; Keech AC
AUTHOR'S ADDRESS: NHMRC Clinical Trials Centre, University of Sydney, NSW.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Competence and consent.
ARTICLE SOURCE: Med J Aust (Australia), Sep 17 2001, 175(6) p313-5
AUTHOR(S): Savulescu J; Kerridge IH
AUTHOR'S ADDRESS: Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Vic.
PUBLICATION TYPE: Journal Article
ABSTRACT: To perform a medical procedure on a competent patient who is refusing it may constitute battery; but to fail to perform a medical procedure on an incompetent patient who is refusing it may constitute negligence. Competence involves being able to understand the consequences of receiving medical treatment, and not receiving it, and being able to make a decision on the basis of that understanding. Competent people can sometimes make imprudent or irrational decisions. Cognitive impairment and mental illness do not necessarily render a person incompetent to consent to investigation and treatment. The suspicion of cognitive impairment or mental illness should prompt a thorough evaluation of competence and mental state. Treatment of incompetent people should be dictated by their best interests, advance directives or substituted judgement.
MB: Yeah, but how do you decide?

ARTICLE TITLE: Sponsorship, authorship and accountability.
ARTICLE SOURCE: Med J Aust (Australia), Sep 17 2001, 175(6) p294-6
AUTHOR(S): Davidoff F; De Angelis CD; Drazen JM; Nicholls MG; Hoey J; Hojgaard L; Horton R; Kotzin S; Nylenna M; Overbeke AJ; Sox HC; Van Der Weyden MB; Wilkes MS
AUTHOR'S ADDRESS: Collective Name: International Committee of Medical Journal Editors.
PUBLICATION TYPE: Editorial; Guideline; Practice Guideline

ARTICLE TITLE: Randomised controlled trials: elements of a good study.
COMMENTS: Med J Aust. 2001 Sep 3; 175(5):241/21470884
ARTICLE SOURCE: Med J Aust (Australia), Sep 3 2001, 175(5) p272-4
AUTHOR(S): Gebski VJ; Beller EM; Keech AC
AUTHOR'S ADDRESS: NHMRC Clinical Trials Centre, University of Sydney, NSW. val@ctc.usyd.edu.au.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Hospitalised patients' views on doctors and white coats.
ARTICLE SOURCE: Med J Aust (Australia), Aug 20 2001, 175(4) p219-22
AUTHOR(S): Gooden BR; Smith MJ; Tattersall SJ; Stockler MR
AUTHOR'S ADDRESS: Faculty of Medicine, University of Sydney, NSW.
CONCLUSIONS: Patients reported feeling more confident and better able to communicate with doctors who wore white coats. The recognition, symbolism and formality afforded by a white coat may enhance communication and facilitate the doctor-patient relationship.
MB: It's a bit late.

ARTICLE TITLE: Adult-to-adult living donor liver transplantation for fulminant hepatic failure.
COMMENTS: Med J Aust. 2001 Aug 20; 175(4):179-80/21470904
ARTICLE SOURCE: Med J Aust (Australia), Aug 20 2001, 175(4) p202-4
AUTHOR(S): House AK; Jeffrey GP; Edyvane KA; Barker AP; Chapman MD; Garas G; Ferguson J; van Heerden PV; Gibbs NM; Heath DI; Mitchell AW
AUTHOR'S ADDRESS: Liver Transplant Service of Western Australia, Sir Charles Gairdner Hospital, Perth. akhouse@cyllene.uwa.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: The outcome of fulminant hepatic failure without timely liver transplantation is poor. We describe a 19-year-old woman with fulminant hepatic failure due to acute hepatitis B infection who received a living donor liver transplant from her sister. The donor's recovery was uneventful, allowing hospital discharge on Day 6. Two months after transplantation the recipient developed a biliary stricture requiring surgery. One year after transplantation, her liver function was normal.
MB: In NY a donor died & the recipient survived. (Time Australia. Jan 28, 2002: p 37.) I hear it got onto the front page of NY Times too.

ARTICLE TITLE: Adult living donor liver transplantation: another Pandora's box?
COMMENTS: Med J Aust. 2001 Aug 20; 175(4):202-4/21470912
ARTICLE SOURCE: Med J Aust (Australia), Aug 20 2001, 175(4) p179-80
AUTHOR(S): McCaughan GW; Lynch SV
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Professional development and ethics for today's and tomorrow's doctors.
COMMENTS: Med J Aust. 2001 Aug 20; 175(4):205-10/21470913
ARTICLE SOURCE: Med J Aust (Australia), Aug 20 2001, 175(4) p183-4
AUTHOR(S): Breen KJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Ethics and evidence-based medicine.
ARTICLE SOURCE: Med J Aust (Australia), Aug 6 2001, 175(3) p161-4
AUTHOR(S): Leeder SR; Rychetnik L
AUTHOR'S ADDRESS: Department of Public Health and Community Medicine, Faculty of Medicine, University of Sydney, NSW. steve@medicine.usyd.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: Concerns about the ethics of evidence-based medicine (EBM) relate to possible alterations in the humane basis of clinical care. In collecting the evidence for EBM, scientists and doctors, not consumers, determine research objectives, interpret the data and implement the findings, and in doing so may disregard patients' priorities. Ethical standards, and what counts as evidence, are determined by socially or commercially powerful groups connected to powerful institutions. Such groups can generate evidence and determine "gold standard" knowledge, filtering out other, "inferior" knowledge. Applying the available evidence to predicting outcomes for individual patients involves uncertainty. Full disclosure of this uncertainty is a component of informed consent, but requires sensitivity to patients' tolerance of ambiguity. Ongoing debate about the ethics of EBM on all levels will ensure that EBM manifests intended and preferred social values and takes its rightful place in the practice of medicine and the development of health policy.
MB: You mean that EBM is not the gold standard. How sad.

ARTICLE TITLE: Evidence-based healthcare 10 years on: is the National Institute of Clinical Studies the answer?
ARTICLE SOURCE: Med J Aust (Australia), Aug 6 2001, 175(3) p124-5
AUTHOR(S): Silagy CA
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Mortality among patients admitted to hospitals on weekends as compared with weekdays.
COMMENTS: N Engl J Med. 2001 Aug 30; 345(9):692-4
ARTICLE SOURCE: N Engl J Med (United States), Aug 30 2001, 345(9) p663-8
AUTHOR(S): Bell CM; Redelmeier DA
AUTHOR'S ADDRESS: Department of Medicine, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, ON, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Patients with some serious medical conditions are more likely to die in the hospital if they are admitted on a weekend than if they are admitted on a weekday.

ARTICLE TITLE: Screening for colon cancer--can we afford colonoscopy?
COMMENTS: N Engl J Med. 2001 Aug 23; 345(8):555-60
ARTICLE SOURCE: N Engl J Med (United States), Aug 23 2001, 345(8) p607-8
AUTHOR(S): Detsky AS
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: One-time screening for colorectal cancer with combined fecal occult-blood testing and examination of the distal colon.
COMMENTS: N Engl J Med. 2001 Aug 23; 345(8):607-8
ARTICLE SOURCE: N Engl J Med (United States), Aug 23 2001, 345(8) p555-60
AUTHOR(S): Lieberman DA; Weiss DG
AUTHOR'S ADDRESS: Veterans Affairs Medical Center in Portland, OR 97207, USA. lieberma@ohsu.edu; Collective Name: Veterans Affairs Cooperative Study Group 380.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study
CONCLUSIONS: One-time screening with both a fecal occult-blood test with rehydration and sigmoidoscopy fails to detect advanced colonic neoplasia in 24 percent of subjects with the condition.

ARTICLE TITLE: Effect of prone positioning on the survival of patients with acute respiratory failure.
COMMENTS: N Engl J Med. 2001 Aug 23; 345(8):610-2
ARTICLE SOURCE: N Engl J Med (United States), Aug 23 2001, 345(8) p568-73
AUTHOR(S): Gattinoni L; Tognoni G; Pesenti A; Taccone P; Mascheroni D; Labarta V; Malacrida R; Di Giulio P; Fumagalli R; Pelosi P; Brazzi L; Latini R
AUTHOR'S ADDRESS: Istituto di Anestesia e Rianimazione, Universita di Milano, Ospedale Maggiore di Milano, Milan, Italy. gattinon@polic.cilea.it; Collective Name: Prone-Supine Study Group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: Although placing patients with acute respiratory failure in a prone position improves their oxygenation, it does not improve survival.
MB: We tried it about 1975 but we must have lost interest. Oh well. It does not matter.

ARTICLE TITLE: Reversal of catabolism by beta-blockade after severe burns.
COMMENTS: N Engl J Med. 2001 Oct 25; 345(17):1271-2
ARTICLE SOURCE: N Engl J Med (United States), Oct 25 2001, 345(17) p1223-9
AUTHOR(S): Herndon DN; Hart DW; Wolf SE; Chinkes DL; Wolfe RR
AUTHOR'S ADDRESS: Department of Surgery, University of Texas Medical Branch, Shriners Hospitals for Children, Galveston 77550, USA. dherndon@utMB:edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: BACKGROUND: The catecholamine-mediated hypermetabolic response to severe burns causes increased energy expenditure and muscle-protein catabolism. We hypothesized that blockade of beta-adrenergic stimulation with propranolol would decrease resting energy expenditure and muscle catabolism in patients with severe burns. METHODS: Twenty-five children with acute and severe burns (more than 40 percent of total body-surface area) were studied in a randomized trial. Thirteen received oral propranolol for at least two weeks, and 12 served as untreated controls. The dose of propranolol was adjusted to decrease the resting heart rate by 20 percent from each patient's base-line value. Resting energy expenditure and skeletal-muscle protein kinetics were measured before and after two weeks of beta-blockade (or no therapy, in controls). Body composition was measured serially throughout hospitalization. RESULTS: Patients in the control group and the propranolol group were similar with respect to age, weight, percentage of total body-surface area burned, percentage of body-surface area with third-degree burns, and length of time from injury to metabolic study. Beta-blockade decreased the heart rates and resting energy expenditure in the propranolol group, both as compared with the base-line values (P<0.001 and P=0.01, respectively) and as compared with the values in the control group (P=0.03 and P=0.001, respectively). The net muscle-protein balance increased by 82 percent over base-line values in the propranolol group (P=0.002), whereas it decreased by 27 percent in the control group (P not significant). The fat-free mass, as measured by whole-body potassium scanning, did not change substantially in the propranolol group, whereas it decreased by a mean (+/-SE) of 9+/-2 percent in the control group (P=0.003). CONCLUSIONS: In children with burns, treatment with propranolol during hospitalization attenuates hypermetabolism and reverses muscle-protein catabolism.
MB: Interesting that this was not evidence based but idea based. It would have been difficult to try it out on an animal first cause they are not allowed to suffer---in a controlled fashion.

ARTICLE TITLE: Antimicrobial use in animal feed--time to stop.
COMMENTS: N Engl J Med. 2001 Oct 18; 345(16):1147-54; : N Engl J Med. 2001 Oct 18; 345(16):1155-60; : N Engl J Med. 2001 Oct 18; 345(16):1161-6
ARTICLE SOURCE: N Engl J Med (United States), Oct 18 2001, 345(16) p1202-3
AUTHOR(S): Gorbach SL
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Air travel and venous thromboembolism--is the evidence in?
COMMENTS: N Engl J Med. 2001 Sep 13; 345(11):779-83
ARTICLE SOURCE: N Engl J Med (United States), Sep 13 2001, 345(11) p828-9
AUTHOR(S): Ansell JE
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Severe pulmonary embolism associated with air travel.
COMMENTS: N Engl J Med. 2001 Sep 13; 345(11):828-9/21418122
ARTICLE SOURCE: N Engl J Med (United States), Sep 13 2001, 345(11) p779-83
AUTHOR(S): Lapostolle F; Surget V; Borron SW; Desmaizieres M; Sordelet D; Lapandry C; Cupa M; Adnet F
AUTHOR'S ADDRESS: Service d'Aide Medicale Urgente 93, Hjpital Avicenne, Universite Paris XIII, Bobigny, France. frederic.lapostolle@avc.ap-hop-paris.fr.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: A greater distance travelled is a significant contributing risk factor for pulmonary embolism associated with air travel.
MB: Have a stop over in Singapore.

ARTICLE TITLE: What is a 'clinically meaningful' reduction in pain
ARTICLE SOURCE: Pain (Netherlands), Nov 2001, 94(2) p131-2
AUTHOR(S): Rowbotham MC
AUTHOR'S ADDRESS: UCSF Pain Clinical Research Center, UCSF Departments of Neurology and Anesthesia, 1701 Divisadero Street, Suite 480, 94115, San Francisco, CA, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Race, ethnicity and pain
ARTICLE SOURCE: Pain (Netherlands), Nov 2001, 94(2) p133-7
AUTHOR(S): Edwards CL; Fillingim RB; Keefe F
AUTHOR'S ADDRESS: Pain and Palliative Care Center, Duke University Medical Center, 932 Morreene Road, Rm 166, 27713, Durham, NC, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Are natriuretic peptides clinically useful as markers of heart failure?
ARTICLE SOURCE: Ann Clin Biochem (England), Sep 2001, 38(Pt 5) p575-83
AUTHOR(S): Kelly R; Struthers AD
AUTHOR'S ADDRESS: Department of Cardiology, St James Hospital, Dublin, Republic of Ireland.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The frequency and nature of drug administration error during anaesthesia
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Oct 2001, 29(5) p494-500
AUTHOR(S): Webster CS; Merry AF; Larsson L; McGrath KA; Weller J
AUTHOR'S ADDRESS: Department of Anaesthesia, Green Lane Hospital, Auckland, New Zealand.
PUBLICATION TYPE: Journal Article
Overall, one drug administration error was reported for every 133 anaesthetics. The two largest individual categories of error involved incorrect doses (20%) and substitutions (20%) with i.v. boluses of drug. Of the i.v. bolus substitutions, 69% occurred between different pharmacological classes. One patient was aware while under muscle relaxation, and two required prolonged ventilation. In addition, 47 transient physiological effects were reported, of which five required intervention. We conclude that drug administration error during anaesthesia is considerably more frequent than previously reported.

ARTICLE TITLE: Low-dose dexamethasone effectively prevents postoperative nausea and vomiting after ambulatory laparoscopic surgery
ARTICLE SOURCE: Can J Anaesth (Canada), Nov 2001, 48(10) p973-7
AUTHOR(S): Huang JC; Shieh JP; Tang CS; Tzeng JI; Chu KS; Wang JJ
AUTHOR'S ADDRESS: Department of Medical Research, and Anesthesiology, Chi-Mei Medical Center, Tainan. Kaohsiung Medical University, Kaohsiung, Taiwan.
PUBLICATION TYPE: Journal Article
CONCLUSION: Prophylactic iv dexamethasone 5 mg significantly reduces the incidence of PONV in women undergoing ambulatory laparoscopic tubal ligation. At this dose, dexamethasone is more effective than metoclopramide 10 mg or placebo.

ARTICLE TITLE: A standardized multidisciplinary approach reduces the use of allogeneic blood products in patients undergoing cardiac surgery
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 2001, 48(9) p894-901
AUTHOR(S): Van Der Linden P; De Hert S; Daper A; Trenchant A; Jacobs D; De Boelpaepe C; Kimbimbi P; Defrance P; Simoens G
AUTHOR'S ADDRESS: Department of Cardiac Anaesthesia, CHU Charleroi, Jumet, Belgium.
PUBLICATION TYPE: Journal Article
CONCLUSION: Development of a standardized multidisciplinary transfusion strategy markedly reduced the exposure of cardiac surgery patients to allogeneic blood.

ARTICLE TITLE: Rapid preparation of a patient with pheochromocytoma with labetolol and magnesium sulfate
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 2001, 48(9) p876-80
AUTHOR(S): Poopalalingam R; Chin EY
AUTHOR'S ADDRESS: Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore.
PUBLICATION TYPE: Journal Article
ABSTRACT: PURPOSE: To describe the rapid perioperative optimization and control of blood pressure in a young patient who presented with pheochromocytoma. He was non-compliant with phenoxybenzamine but insisted on early surgery. He was scheduled for laparoscopic resection of the tumour. Clinical features: This 32-yr-old man presented with uncontrolled hypertension for a few years for which he was treated with nifedipine. He subsequently defaulted follow-up. The patient presented again approximately three months from the day of surgery and was diagnosed to have a pheochromocytoma. The endocrinologist prescribed phenoxybenzamine and propanolol in addition to the nifedipine but the patient stopped taking both drugs six weeks prior to surgery due to their side effects. The patient was admitted the evening before surgery to the intensive care unit for rapid control of his blood pressure. Blood pressure was optimized with an infusion of labetolol and volume expansion titrated under central venous catheter and intraarterial blood pressure guidance throughout the night. On the morning of surgery, a magnesium sulfate infusion was started. The laparoscopic surgery proceeded uneventfully and the patient was hemodynamically stable. There were two transient periods of hypotension after induction and at removal of tumour respectively which were corrected with a brief adrenaline infusion. No adverse outcome was noted. CONCLUSION: This case highlights the possibility of a more rapid perioperative control of pheochromocytoma using high doses of labetolol and a magnesium sulfate infusion to achieve stable intraoperative hemodynamics during laparoscopic resection of pheochromocytoma.
MB: One patient! Giving beta blockers without alpha blockers is a dangerous. I had to urgently do one many years ago who'd been given propranolol and arrested. I gave a phentolamine infusion. She was permanently blind from the arrest.

ARTICLE TITLE: IM droperidol as premedication attenuates intraoperative hypothermia:
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 2001, 48(9) p854-8
AUTHOR(S): Toyota K; Sakura S; Saito Y; Shido A; Matsukawa T
AUTHOR'S ADDRESS: Department of Anesthesiology, Shimane Medical University, Izumo City, and the Department of Anesthesiology,Yamanashi Medical University, Yamanashi, Japan.
PUBLICATION TYPE: Journal Article
ABSTRACT: PURPOSE: Perioperative hypothermia results largely from core-to-peripheral heat redistribution. Droperidol, which is often used for premedication, promotes vasodilation, and thus may affect redistribution of heat. Accordingly, we tested the hypothesis that preanesthetic droperidol would affect perioperative hypothermia. METHODS: Twenty-three ASA physical status I patients scheduled for arthroscopic ligament reconstruction were randomly assigned to two groups to receive no premedication or im droperidol 0.1 mg*kg(-1) 30 min before anesthesia. Anesthesia was induced and maintained with propofol and fentanyl. We monitored core (tympanic) and peripheral (palm) temperatures, and skin (fingertip) blood flow for two hours after the induction of anesthesia during surgery. RESULTS: Before the induction of anesthesia, patients given droperidol were more deeply sedated than those given no premedication. Core temperature, which was similar in both groups before induction, decreased significantly more in the control than in the droperidol patients (0.75 +/- 0.34 degrees C and 0.37 +/- 0.20 degrees C, respectively, at 75 min after induction; P <0.01). Preinduction peripheral temperature and skin blood flow were lower in the control group than in the droperidol group, but the two variables became similar in both groups after induction. CONCLUSION: The results of the present study confirm our hypothesis that premedication with droperidol affects perioperative hypothermia. Droperidol may prevent core-to-peripheral heat redistribution after the induction of anesthesia.

ARTICLE TITLE: Preoperative core temperatures in elective surgical patients show an unexpected skewed distribution
ARTICLE SOURCE: Can J Anaesth (Canada), Oct 2001, 48(9) p850-3
AUTHOR(S): Mitchell AM; Kennedy RR
AUTHOR'S ADDRESS: Department of Anesthesia, Christchurch Hospital, Christchurch, New Zealand.
PUBLICATION TYPE: Journal Article
ABSTRACT: PURPOSE: To document the preoperative core temperature of adult elective surgical patients. METHODS: A prospective audit obtained sublingual temperatures from 446 adult elective surgical patients on arrival in the preoperative holding area. RESULTS: Temperatures ranged from 35.7 degrees C to 37.8 degrees C with a mean of 36.5 degrees C (0.4 SD). The median was 36.4 degrees C and the mode was 36.1 degrees C. There was a skewed distribution with a clustering of values at the lower end of the range. All recordings were within the accepted normothermic range. CONCLUSION: The asymmetric distribution we observed differs from previously published normothermia data which shows a symmetrical distribution of temperatures. This skewed distribution has not previously been documented and we interpret it as being due to the effect of preoperative cooling factors.
MB: They have a flimsy gown, plastic covered mattress and one blanket folded in half. Why does such information be continually documented but nothing is done about it. Only 4 RPAH anaesthetists' patients have a blanket on the bed and 2 blankets covering them to come to the theatre.

ARTICLE TITLE: Understanding hemodynamic responses to tracheal intubation.
COMMENTS: Can J Anaesth. 2001 Sep; 48(8):732-6/21430727
ARTICLE SOURCE: Can J Anaesth (Canada), Sep 2001, 48(8) p723-6
AUTHOR(S): Hung O
PUBLICATION TYPE: Comment; Editorial
MB: They have missed the point. The editorial goes along with the assumption that drugs would be the solution to the CV transients associated with intubation but point out the deficiencies in available methods. Why not establish stable anaesthesia as though surgery was to be done without intubation before intubation? Sevoflurane makes this quite easy even for the novice. One such novice has just decided that even he could be an anaesthetist after I got him to do what he thought was an impossible risk case.

ARTICLE TITLE: I was sick and you came to visit me: time spent at the bedsides of seriously ill patients with poor prognoses
ARTICLE SOURCE: Am J Med (United States), Oct 1 2001, 111(5) p385-9
AUTHOR(S): Sulmasy DP; Rahn M
AUTHOR'S ADDRESS: John J. Conley Department of Ethics, Saint Vincent Catholic Medical Centers (DPS, MR), St. Vincent's, Manhattan, New York, New York, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: To learn how much time hospital staff and families spend at the bedsides of seriously ill patients with poor prognoses.An observational study was made of 58 inpatients with cancer, acquired immunodeficiency syndrome, heart failure, obstructive lung disease, or advanced dementia, along with their families and the physicians and nurses working on the medical floors of a university hospital, using direct videotape surveillance of patients' doorways.The mean (+/-SD) total visitor-minutes spent in the rooms of these patients was 321 +/- 297 minutes per day. On average, patients spent 18 hours 39 minutes per day alone. Mean visit durations were 3 +/- 3 minutes for attending physicians (including consultants), 3 +/- 2 minutes for house officers, 2 +/- 1 minutes for nurses, and 24 +/- 51 minutes for family. The total person-visits per patient per day were 3 +/- 3 for attending physicians, 9 +/- 8 for house officers, 45 +/- 23 for nurses, and 13 +/- 21 for family. Patient sex and age were not significantly associated with total visitor-minutes. In a repeated-measures analysis of variance model, nonwhite patients received fewer total visitor-minutes than did white patients, and patients with dementia received fewer total visitor-minutes than did patients with other diagnoses, especially those with malignancy. Do-not-resuscitate orders were associated with slightly more total visitor-minutes.These seriously ill patients with poor prognoses spent most of their time in the hospital alone. Staff visits were frequent but brief. These data do not confirm anecdotal reports that staff members spend less time at the bedsides of patients with do-not-resuscitate orders. Patients with advanced dementia and minority patients appear to have less bedside contact. Further study is required to confirm these findings and to understand optimal visit time for medical inpatients with poor prognoses.
MB: What is the point of other than relatives visiting the demented? It is interesting to visit one own relatives when they are terminal but not demented and those who are not terminal and not demented but depersonalised by the system