MB's Articles of Interest - January 2003

ARTICLE TITLE: Acute effects of caffeine on heart rate variability.
ARTICLE SOURCE: Am J Cardiol (United States), Oct 15 2002, 90(8) p906-7
AUTHOR(S): Sondermeijer HP; van Marle AG; Kamen P; Krum H
AUTHOR'S ADDRESS: University of Leiden, Leiden, The Netherlands.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
In summary, the present study has found that compared with placebo, acute ingestion of caffeine in 10 normal subjects resulted
in increased blood pressure and decreased heart rate variability (HRV) measures of parasympathetic nervous system activity (PNSA), without changes in heart rate. These findings suggest that acute ingestion of caffeine directly reduces PNSA in the short term in humans.
MB. I doubt that this is definitive.

ARTICLE TITLE: Intravenous lidocaine versus intravenous amiodarone (in a new aqueous formulation) for incessant ventricular tachycardia.
ARTICLE SOURCE: Am J Cardiol (United States), Oct 15 2002, 90(8) p853-9
AUTHOR(S): Somberg JC; Bailin SJ; Haffajee CI; Paladino WP; Kerin NZ; Bridges D; Timar S; Molnar J
AUTHOR'S ADDRESS: Rush University, Chicago, Illinois, USA. jsomberg@Rush.edu; Collective Name: Amio-Aqueous Investigators.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
<snip> Amiodarone had a 33% drug failure rate, whereas there was a 91% drug failure rate for lidocaine. The 24-hour survival was 39% on amiodarone and 9% on lidocaine (p <0.01). Drug-related hypotension with aqueous amiodarone was less frequent than with lidocaine. This study found that amiodarone is more effective than lidocaine in the treatment of shock-resistant VT.
MB. Until they gave me amiodarone I'd reverted to VF after 10 shocks.

ARTICLE TITLE: Determining the optimal paddle force for external defibrillation.
ARTICLE SOURCE: Am J Cardiol (United States), Oct 1 2002, 90(7) p812-3
AUTHOR(S): Deakin CD; Sado DM; Petley GW; Clewlow F
AUTHOR'S ADDRESS: Shackleton Department of Anaesthetics, Southampton University Hospital NHS Trust, Southampton, United Kingdom. charlesdeakin@doctors.org.uk.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effects of atorvastatin on fasting and postprandial lipoprotein subclasses in coronary heart disease patients versus control subjects.
ARTICLE SOURCE: Am J Cardiol (United States), Oct 1 2002, 90(7) p689-96
AUTHOR(S): Schaefer EJ; McNamara JR; Tayler T; Daly JA; Gleason JA; Seman LJ; Ferrari A; Rubenstein JJ
AUTHOR'S ADDRESS: Atherosclerosis Research Laboratory, Lipid and Heart Disease Prevention Clinic, Department of Medicine, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA. eschaefer@hnrc.tufts.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: The effects of atorvastatin at 20, 40, and 80 mg/day on plasma lipoprotein subclasses were examined in a randomized, placebo-controlled fashion over 24 weeks in 103 patients in the fasting state who had coronary heart disease (CHD) with low-density lipoprotein (LDL) cholesterol levels >130 mg/dl. <snip> Our data indicate that atorvastatin treatment normalizes levels of all classes of triglyceride-rich lipoproteins and LDL in both the fasting and fed states in patients with CHD compared with control subjects.
MB. 10mg's enough for me.

ARTICLE TITLE: Effect of morning versus evening intake of simvastatin on the serum cholesterol level in patients with coronary artery disease.
ARTICLE SOURCE: Am J Cardiol (United States), Oct 1 2002, 90(7) p784-6
AUTHOR(S): Lund TM; Torsvik H; Falch D; Christophersen B; Skardal R; Gullestad L
AUTHOR'S ADDRESS: Department of Internal Medicine, Baerum Hospital, Oslo, Norway.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
In conclusion, we have confirmed that under study conditions, simvastatin has a slightly better lipid-lowering effect when
taken as an evening dose instead of a morning dose. However, other factors such as compliance and nonlipid effects of statins
may soften the recommendation to give statins as evening medication.
MB. Apparently it is usual to recommend taking these things in the evening but it makes little difference. I take it in the morning. I'd like to swap my warfarin to mornings as well but my cardiologist discouraged me from fiddling with it.

ARTICLE TITLE: Getting more people on statins.
ARTICLE SOURCE: Am J Cardiol (United States), Sep 15 2002, 90(6) p683-5
AUTHOR(S): Roberts WC
PUBLICATION TYPE: Editorial
MB. Sounds as though he wants everyone to be on statins.

ARTICLE TITLE: The new National Cholesterol Education Program guidelines: clinical challenges for more widespread therapy of lipids to treat and prevent coronary heart disease.
ARTICLE SOURCE: Arch Intern Med (United States), Oct 14 2002, 162(18) p2033-6
AUTHOR(S): Eidelman RS; Lamas GA; Hennekens CH
AUTHOR'S ADDRESS: Mount Sinai Medical Center, Cardiology Research, 4300 Alton Rd, Suite 207A, Miami Beach, FL 33140, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Current concepts in insulin resistance, type 2 diabetes mellitus, and the metabolic syndrome.
ARTICLE SOURCE: Am J Cardiol (United States), Sep 5 2002, 90(5A) p19G-26G
AUTHOR(S): Reusch JE
AUTHOR'S ADDRESS: Denver Veterans Affairs Medical Center, 1055 Clairmont Street, M/C 111 H, Denver, CO 80220, USA. Jane.Reusch@UCHSC.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
Studies have shown that enhancing insulin sensitivity with insulin sensitizers, such as thiazolidinediones, may improve insulin resistance and limit the development of adverse cardiovascular consequences.

ARTICLE TITLE: A prospective review of the decline of excisional breast biopsy.
ARTICLE SOURCE: Am J Surg (United States), Oct 2002, 184(4) p353-5
AUTHOR(S): Crowe JP; Rim A; Patrick R; Rybicki L; Grundfest S; Kim J; Lee K; Levy L
AUTHOR'S ADDRESS: The Cleveland Clinic Breast Center, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Our data indicate that core biopsies are being performed more often than excisional biopsies. Nevertheless, one in three biopsies done at our institution is excisional.

ARTICLE TITLE: Financing graduate medical education and limiting resident work hours: a political assessment(1).
ARTICLE SOURCE: Am J Surg (United States), Sep 2002, 184(3) p187-95
AUTHOR(S): Knapp R
AUTHOR'S ADDRESS: Association of American Medical Colleges, 2450 N Street, NW, Washington DC 20037-1127, USA.
PUBLICATION TYPE Journal Article

ARTICLE TITLE: Impact of a multimodal anti-emetic prophylaxis on patient satisfaction in high-risk patients for postoperative nausea and vomiting.
ARTICLE SOURCE: Anaesthesia (England), Oct 2002, 57(10) p1022-7
AUTHOR(S): Eberhart LH; Mauch M; Morin AM; Wulf H; Geldner G
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care Medicine, Philipps-University of Marburg, Germany. eberhart@mailer.uni-marberg.de.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
A multimodal anti-emetic approach can considerably reduce the incidence of PONV in high-risk patients and is associated with a high patient satisfaction as measured by the willingness-to-pay method.
MB. I wonder where the obsession for fiddling with PONV arises from. I don't think it's that bad & it does goes away.

ARTICLE TITLE: Pharmacological agents as cerebral protectants during deep hypothermic circulatory arrest in adult thoracic aortic surgery. A survey of current practice.
ARTICLE SOURCE: Anaesthesia (England), Oct 2002, 57(10) p1016-21
AUTHOR(S): Dewhurst AT; Moore SJ; Liban JB
AUTHOR'S ADDRESS: Department of Anaesthesia, St George's Hospital, Blackshaw Road, London SW17 0QT, UK.
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: A postal survey was sent to members of the Association of Cardiothoracic Anaesthetists to ascertain current practice in the use of pharmacological agents as cerebral protectants during deep hypothermic circulatory arrest. The response rate was 60%. Eighty-three per cent of respondents used some form of pharmacological agent specifically for cerebral protection. Fifty-nine per cent of respondents used thiopental, 29% used propofol and 48% used a variety of other agents, the most common of these being a steroid. There were variations in the dose and timing of administration of drugs. Few respondents believed that there was a body of evidence to support this use of pharmacological agents. Only 35% of respondents believed there to be sufficient evidence to support the use of thiopental. Similarly, only 11% of respondents believe that there is evidence supporting the use of propofol, and 16% the use of steroids. The above findings demonstrate that it would not be possible to create a "best practice" set of guidelines at present. A national database of all cases of adult thoracic surgery involving deep hypothermic cardiac arrest, with methodology and outcome, could probably establish such guidelines, evidence based.
MB. They could but have not. Sounds like fashion based medicine.

ARTICLE TITLE: Herbal medicines - harmless or harmful?
COMMENTS: Comment On: Comment On: RefSource:Anaesthesia. 2002 Sep; 57(9):889-99
ARTICLE SOURCE: Anaesthesia (England), Oct 2002, 57(10) p947-8
AUTHOR(S): Sehgal A; Hall JE
MB. Well they don't know but think they should be stopped 2 weeks preoperatively.

ARTICLE TITLE: Diagnosis and treatment of acute tubular necrosis.
ARTICLE SOURCE: Ann Intern Med (United States), Nov 5 2002, 137(9) p744-52
AUTHOR(S): Esson ML; Schrier RW
AUTHOR'S ADDRESS: University of Colorado Health Sciences Center, Box B178, 4200 East 9th Avenue, Denver, CO 80262, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
More aggressive dialysis (for example, given daily) with biocompatible membranes may improve survival in some patients with acute renal failure. CONCLUSIONS: New information about the importance of early diagnosis and supportive care for patients with acute tubular necrosis (ATN) has emerged. However, randomized trials of these interventions are needed to test their effect on the morbidity and mortality of ATN.
MB. Sounds pretty muddled to me.

ARTICLE TITLE: Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis.
COMMENTS: Comment In: Comment In: RefSource:Ann Intern Med. 2002 Nov 5; 137(9):766-7; Summary For Patients In: Summary For Patients In: RefSource:Ann Intern Med. 2002 Nov 5; 137(9):I31
ARTICLE SOURCE: Ann Intern Med (United States), Nov 5 2002, 137(9) p715-25
AUTHOR(S): Salpeter SR; Ormiston TM; Salpeter EE
AUTHOR'S ADDRESS: Stanford University School of Medicine, Palo Alto, California, USA. shelley.salpeter@hhs.co.santa-clara.ca.us.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSIONS: Cardioselective beta-blockers do not produce clinically significant adverse respiratory effects in patients with mild to moderate reactive airway disease. The results were similar for patients with concomitant chronic airways obstruction. Given their demonstrated benefit in such conditions as heart failure, cardiac arrhythmias, and hypertension, cardioselective beta-blockers should not be withheld from patients with mild to moderate reactive airway disease.

ARTICLE TITLE: Outcome of congestive heart failure in elderly persons: influence of left ventricular systolic function. The Cardiovascular Health Study.
COMMENTS: Summary For Patients In: Summary For Patients In: RefSource:Ann Intern Med. 2002 Oct 15; 137(8):I26
ARTICLE SOURCE: Ann Intern Med (United States), Oct 15 2002, 137(8) p631-9
AUTHOR(S): Gottdiener JS; McClelland RL; Marshall R; Shemanski L; Furberg CD; Kitzman DW; Cushman M; Polak J; Gardin JM; Gersh BJ; Aurigemma GP; Manolio TA
AUTHOR'S ADDRESS: St. Francis Hospital, Roslyn, New York; Mayo Clinic, Rochester, Minnesota 55905, USA. gottdien@ziplink.net.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Community-dwelling elderly persons, especially those with impaired left ventricular function, have a substantial risk for death from congestive heart failure. However, more deaths occur from heart failure in persons with normal systolic function because left ventricular function is more often normal than impaired in elderly persons with heart failure.
MB. Sounds like gobbledy-gook to me.

ARTICLE TITLE: The genetics of colorectal cancer.
COMMENTS: Comment In: Comment In: RefSource:Ann Intern Med. 2002 Oct 1; 137(7):I48
ARTICLE SOURCE: Ann Intern Med (United States), Oct 1 2002, 137(7) p603-12
AUTHOR(S): Calvert PM; Frucht H
AUTHOR'S ADDRESS: Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial .

ARTICLE TITLE: Association of renal insufficiency with treatment and outcomes after myocardial infarction in elderly patients.
COMMENTS: Comment In: Comment In: RefSource:Ann Intern Med. 2002 Oct 1; 137(7):615-6; Comment In: Comment In: RefSource:Ann Intern Med. 2002 Oct 1; 137(7):I12
ARTICLE SOURCE: Ann Intern Med (United States), Oct 1 2002, 137(7) p555-62
AUTHOR(S): Shlipak MG; Heidenreich PA; Noguchi H; Chertow GM; Browner WS; McClellan MB
AUTHOR'S ADDRESS: General Internal Medicine Section, Veterans Affairs Medical Center (111A1) and University of California, San Francisco, , 4150 Clement Street, San Francisco, CA 94121, USA. shlip@itsa.ucsf.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Renal insufficiency was an independent risk factor for death in elderly patients after myocardial infarction. Targeted interventions may be needed to improve treatment for this high-risk population.

ARTICLE TITLE: The mammography dilemma: a crisis for evidence-based medicine?
COMMENTS: Comment On: Comment On: RefSource:Ann Intern Med. 2002 Sep 3; 137(5 Part 1):347-60; Comment In: Comment In: RefSource:Ann Intern Med. 2002 Sep 3; 137(5 Part 1):361-2
ARTICLE SOURCE: Ann Intern Med (United States), Sep 3 2002, 137(5 Part 1) p363-5
AUTHOR(S): Goodman SN
PUBLICATION TYPE: Comment; Editorial
MB. It's a big mess. The evidence based industry (Cochrane) is now looking for funding to study the evidence-based dogma. This editorial contains some questionable formal philosophy. They say that Popper was a logical positivist at one time. I think he knew the logical positivists & was associated with them but thought they were wrong as they were. They have gone but evidence based medicine has been the result of their remnants. Logical positivism went away about 1950 but evidence based medicine emerged probably in the 1980s.

ARTICLE TITLE: US mammography programme beset by flaws.
ARTICLE SOURCE: BMJ (England), Nov 2 2002, 325(7371) p987
AUTHOR(S): Charatan F
PUBLICATION TYPE: News
MB. Many groups do it badly because the US standards are low it seems because of the political imperative to do them.

ARTICLE TITLE: The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women age 40 to 49 years.
COMMENTS: Comment In: Comment In: RefSource:Ann Intern Med. 2002 Sep 3; 137(5 Part 1):361-2; Summary For Patients In: Summary For Patients In: RefSource:Ann Intern Med. 2002 Sep 3; 137(5 Part 1):I28
ARTICLE SOURCE: Ann Intern Med (United States), Sep 3 2002, 137(5 Part 1) p305-12
AUTHOR(S): Miller AB; To T; Baines CJ; Wall C
AUTHOR'S ADDRESS: University of Toronto, Toronto, Canada. a.miller@dkfz-heidelberg.de.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: After 11 to 16 years of follow-up, four or five annual screenings with mammography, breast physical examination, and breast self-examination had not reduced breast cancer mortality compared with usual community care after a single breast physical examination and instruction on breast self-examination. The study data show that true effects of 20% or greater are unlikely.

ARTICLE TITLE: Multidetector computed tomography (MDCT) in coronary surgery: first experiences with a new tool for diagnosis of coronary artery disease.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2002, 74(4) pS1398-402
AUTHOR(S): Treede H; Becker C; Reichenspurner H; Knez A; Detter C; Reiser M; Reichart B
AUTHOR'S ADDRESS: Department of Cardiac Surgery, Ludwig-Maximilians-University Munich, Germany. treede@uke.uni-hamburg.de.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Multidetector computed tomography (MDCT) scanning is an effective noninvasive technique for the diagnosis of coronary artery disease. In selected patients, MDCT scanning might be able to replace selective coronary angiography (SCA) as a preoperative test for CABG procedures. The intrathoracic situs can be clearly exposed as it is important for the planning of minimally invasive coronary artery bypass grafting (CABG) procedures.

ARTICLE TITLE: Hybrid robotic coronary artery surgery and angioplasty in multivessel coronary artery disease.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2002, 74(4) pS1358-62
AUTHOR(S): Stahl KD; Boyd WD; Vassiliades TA; Karamanoukian HL
AUTHOR'S ADDRESS: Section of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Weston 33331, USA. stahlk@ccf.org.
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: BACKGROUND: Complete surgical revascularization that includes left internal thoracic artery grafting to the left anterior descending coronary artery remains the gold standard of treatment for coronary artery disease. Not all patients are good candidates for sternotomy. Therefore, we sought to identify a strategy that would combine the long-term advantages of internal thoracic artery grafting to lessen surgical trauma while still allowing complete revascularizationCONCLUSIONS: Hybrid endoscopic atraumatic internal thoracic artery to anterior descending coronary artery graft surgery combined with angioplasty is a reasonable revascularization strategy in multiple vessel coronary artery disease in selected patients..

ARTICLE TITLE: Prophylactic positive end-expiratory pressure and reduction of postoperative blood loss in open-heart surgery.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2002, 74(4) p1191-4
AUTHOR(S): Collier B; Kolff J; Devineni R; Gonzalez LS
AUTHOR'S ADDRESS: Department of General/Cardiothoracic Surgery, Conemaugh Memorial Medical Center, Johnstown, Pennsylvania 15905-4398, USA. chiltoncollier@pol.net.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: This study demonstrates that the use of postoperative PEEP levels of 10 cm H2O, although safe, does not reduce chest-tube output or transfusion requirements.
MB. It was a good try.

ARTICLE TITLE: Effect of blood transfusion on long-term survival after cardiac operation.
COMMENTS: Comment In: Comment In: RefSource:Ann Thorac Surg. 2002 Oct; 74(4):986-7
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2002, 74(4) p1180-6
AUTHOR(S): Engoren MC; Habib RH; Zacharias A; Schwann TA; Riordan CJ; Durham SJ
AUTHOR'S ADDRESS: Department of Anesthesiology, St. Vincent Mercy Medical Center, and Medical College of Ohio, Toledo 43608, USA. engoren@pol.net.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: We found that blood transfusions during or after coronary artery bypass operations were associated with increased long-term mortality.
MB. They admit there is only association but the title implies causation. The disease could well have been worse in those judged to need blood. There is no mention of volume of blood loss in relation to blood given. There are similar articles in the past about GI surgery again with no analysis of volume of blood loss & how this might be related to the magnitude of the operation & thus the severity of the disease

ARTICLE TITLE: Transfusion and outcome in heart surgery.
COMMENTS: Comment On: Comment On: RefSource:Ann Thorac Surg. 2002 Oct; 74(4):1180-6
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2002, 74(4) p986-7
AUTHOR(S): Speiss BD
PUBLICATION TYPE: Comment; Editorial
MB.They speculate with lots of 'perhapses' that mortality might be because of low availability of oxygen from transfused blood. If this were important in the real world, massive transfusion of several blood volumes (as occurs often in liver transplants) would be impossible.

ARTICLE TITLE: Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient.
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Oct; 30(10):2389-91
ARTICLE SOURCE: Crit Care Med (United States), Oct 2002, 30(10) p2249-54
AUTHOR(S): Taylor RW; Manganaro L; O'Brien J; Trottier SJ; Parkar N; Veremakis C
AUTHOR'S ADDRESS: Department of Critical Care Medicine, St. John's Mercy Medical Center, St. Louis, MO 63141, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Transfusion of packed red blood cells is associated with nosocomial infection. This association continues to exist when adjusted for probability of survival and age. In addition, mortality rates and length of intensive care unit and hospital stay are significantly increased in transfused patients.
MB. They don't report the reason for giving the blood. Without that information it's impossible to attribute causation.

ARTICLE TITLE: Blood transfusion and the risk of nosocomial infection: an underreported complication?
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Oct; 30(10):2249-54
ARTICLE SOURCE: Crit Care Med (United States), Oct 2002, 30(10) p2389-91
AUTHOR(S): Gazmuri RJ; Shakeri SA
PUBLICATION TYPE: Comment; Editorial
MB. Emphasise minimising blood loss including blood sample sizes. They note that patients with CV problems might be better with higher Hb levels. Failing production of evidence to refute such a supposition its not sensible to assume that that is not so. Their circumspection about the matter is 'evidence' of the dumbing by the 'evidence based heresy'.

ARTICLE TITLE: Anemia and blood transfusion in critically ill patients.
COMMENTS: Comment In: Comment In: RefSource:JAMA. 2002 Sep 25; 288(12):1525-6
ARTICLE SOURCE: JAMA (United States), Sep 25 2002, 288(12) p1499-507
AUTHOR(S): Vincent JL; Baron JF; Reinhart K; Gattinoni L; Thijs L; Webb A; Meier-Hellmann A; Nollet G; Peres-Bota D
AUTHOR'S ADDRESS: Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, Brussels, 1070, Belgium. jlvincen@ulb.ac.be; Collective Name: ABC (Anemia and Blood Transfusion in Critical Care) Investigators.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: This multicenter observational study reveals the common occurrence of anemia and the large use of blood transfusion in critically ill patients. Additionally, this epidemiologic study provides evidence of an association between transfusions and diminished organ function as well as between transfusions and mortality.

ARTICLE TITLE: Red blood cell transfusions in critically ill patients.
COMMENTS: Comment On: Comment On: RefSource:JAMA. 2002 Sep 25; 288(12):1499-50
ARTICLE SOURCE: JAMA (United States), Sep 25 2002, 288(12) p1525-6
AUTHOR(S): Hebert PC; Fergusson DA
PUBLICATION TYPE: Comment; Editorial
MB. All such studies have shown only associations. They omit the critical factor of the disease process resulting in transfusion. If bleeding is occuring blood may & should be given before any triggering Hb level might be reached.

ARTICLE TITLE: Is it safe to train residents to perform cardiac surgery?
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2002, 74(4) p1043-8; discussion 1048-9
AUTHOR(S): Baskett RJ; Buth KJ; Legare JF; Hassan A; Friesen CH; Hirsch GM; Ross DB; Sullivan JA
AUTHOR'S ADDRESS: The Maritime Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada. rogerbaskett@hotmail.com.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In this analysis of our experience with residency training, the operative morbidity and mortality in coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) patients was similar for residents and staff. Training residents to perform cardiac surgery appears to be safe.
MB. How would they justify training if the results were different. The trainees might have been given the easier cases.

ARTICLE TITLE: In the eye of both patient and spouse: memory is poor 1 to 2 years after coronary bypass and angioplasty.
ARTICLE SOURCE: Ann Thorac Surg (United States), Sep 2002, 74(3) p689-93; discussion 694
AUTHOR(S): Bergh C; Backstrom M; Jonsson H; Havinder L; Johnsson P
AUTHOR'S ADDRESS: Dept of Coronary Artery Disease, Heart and Lung Center, Lund University Hospital, Sweden. cecilia.bergh@skane.se.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: No subjective differences were found in patients who had undergone either coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. Spouse ratings agreed with each other and with patient ratings. Positive correlations were found between the questionnaire factors, suggesting that perceived health and well-being are associated with subjective cognition.
MB. They questioned both patient & the spouse.

ARTICLE TITLE: Pulmonary hypertension: hemodynamic diagnosis and management.
ARTICLE SOURCE: Arch Intern Med (United States), Sep 23 2002, 162(17) p1925-33
AUTHOR(S): Chatterjee K; De Marco T; Alpert JS
AUTHOR'S ADDRESS: Chatterjee Center for Cardiac Research, University of California, San Francisco 94143, USA. chatterj@medicine.ucsf.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial .

ARTICLE TITLE: Medical complications and outcomes after hip fracture repair.
ARTICLE SOURCE: Arch Intern Med (United States), Oct 14 2002, 162(18) p2053-7
AUTHOR(S): Lawrence VA; Hilsenbeck SG; Noveck H; Poses RM; Carson JL
AUTHOR'S ADDRESS: Division of General Medicine, Audie L. Murphy Division, South Texas Veterans Health Care System, San Antonio, TX, USA. vlawrence@uthscsa.edu.
PUBLICATION TYPE: Journal Article
RESULTS: Of 8930 patients, 1737 (19%) had postoperative medical complications. Cardiac and pulmonary complications were most frequent (8% and 4% of patients, respectively). Similar numbers of patients had serious cardiac or pulmonary complications (2% and 3%, respectively). <snip>. Mortality was similar for serious cardiac or pulmonary complications (30 day: 22% and 17%, respectively; 1 year: 36% and 44%, respectively) and highest for patients with multiple complications (30 day: 29%-38%; 1 year: 43%-62%).

ARTICLE TITLE: Mortality after admission to hospital with fractured neck of femur: database study.
ARTICLE SOURCE: BMJ (England), Oct 19 2002, 325(7369) p868-9
AUTHOR(S): Goldacre MJ; Roberts SE; Yeates D
AUTHOR'S ADDRESS: Unit of Health-Care Epidemiology, Department of Public Health, Institute of Health Sciences, University of Oxford, Oxford OX3 7LF. michael.goldacre@dphpc.ox.ac.uk.
PUBLICATION TYPE: Journal Article :

ARTICLE TITLE: Venous thromboembolism in patients undergoing laparoscopic and arthroscopic surgery and in leg casts.
ARTICLE SOURCE: Arch Intern Med (United States), Oct 28 2002, 162(19) p2173-6
AUTHOR(S): Bergqvist D; Lowe G
AUTHOR'S ADDRESS: Department of Surgical Sciences, University Hospital, SE-751 85 Uppsala, Sweden. david.bergqvist@kirurgi.uu.se.
PUBLICATION TYPE: Journal Article; Meta-Analysis
ABSTRACT: The risk of venous thrombosis and need for prophylaxis in patients having undergone minimally invasive procedures and in patients immobilized in a leg plaster are poorly defined. We performed a literature search to evaluate the risk of developing venous thromboembolism after 2 minimally invasive procedures, laparoscopic surgery and arthroscopy, and in patients with lower limb plaster casts. Despite problems of "contamination" because some surgeons use prophylaxis in some of these patients, we were able to determine that (1) laparoscopic cholecystectomy can be considered a low-risk procedure and therefore routine use of prophylaxis is probably not justified; (2) patients undergoing arthroscopic knee surgery are at low to moderate risk and thus prophylaxis is optional; and (3) patients with plaster cast immobilization because of trauma have a moderate risk of thrombosis and should receive prophylaxis.

ARTICLE TITLE: Measuring "goodness" in individuals and healthcare systems.
COMMENTS: Comment In: Comment In: RefSource:BMJ. 2002 Sep 28; 325(7366):669-70
ARTICLE SOURCE: BMJ (England), Sep 28 2002, 325(7366) p704-7
AUTHOR(S): Pringle M; Wilson T; Grol R
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB. Hopeless.

ARTICLE TITLE: What's a good doctor, and how can you make one?
ARTICLE SOURCE: BMJ (England), Sep 28 2002, 325(7366) p667-8
AUTHOR(S): Hurwitz B; Vass A
PUBLICATION TYPE: Editorial
MB. Written by a Prof of Medicine & the Arts.

ARTICLE TITLE: How can good performance among doctors be maintained?
COMMENTS: Comment On: Comment On: RefSource:BMJ. 2002 Sep 28; 325(7366):704-7
ARTICLE SOURCE: BMJ (England), Sep 28 2002, 325(7366) p669-70
AUTHOR(S): West M
PUBLICATION TYPE: Comment; Editorial
MB. Written by a Prof of Organisational Psychology in a Business School.

ARTICLE TITLE: Students' heads are so full of lists they have forgotten how to listen.
ARTICLE SOURCE: BMJ (England), Sep 28 2002, 325(7366) p677
AUTHOR(S): Shooter M
PUBLICATION TYPE: Interview; News
MB. A depressed Prof of Psychiatry.

ARTICLE TITLE: World Medical Association isolates Netherlands on euthanasia.
ARTICLE SOURCE: BMJ (England), Sep 28 2002, 325(7366) p675
AUTHOR(S): Sheldon T
PUBLICATION TYPE: News
MB. The President of the Dutch Medical Association was the only dissenter.

ARTICLE TITLE: First Belgian to use new euthanasia law provokes storm of protest.
ARTICLE SOURCE: BMJ (England), Oct 19 2002, 325(7369) p854
AUTHOR(S): Watson R
PUBLICATION TYPE: News

ARTICLE TITLE: No consent should be needed for using leftover body material for scientific purposes. Against.
COMMENTS: Comment On: Comment On: RefSource:BMJ. 2002 Sep 21; 325(7365):648-51
ARTICLE SOURCE: BMJ (England), Sep 21 2002, 325(7365) p648-51
AUTHOR(S): Savulescu J
AUTHOR'S ADDRESS: University of Oxford, Oxford OX1 3LZ. julian.savulescu@philosophy.ox.ac.uk.
PUBLICATION TYPE: Comment; Journal Article; Review; Review, Tutorial

ARTICLE TITLE: No consent should be needed for using leftover body material for scientific purposes. For.
COMMENTS: Comment In: Comment In: RefSource:BMJ. 2002 Sep 21; 325(7365):648-51
ARTICLE SOURCE: BMJ (England), Sep 21 2002, 325(7365) p648-51
AUTHOR(S): van Diest PJ
AUTHOR'S ADDRESS: Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, Netherlands. pj.vandiest@vumc.nl.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Junior doctor charged with manslaughter after medical error.
ARTICLE SOURCE: BMJ (England), Sep 21 2002, 325(7365) p616
AUTHOR(S): Dyer C
PUBLICATION TYPE: Legal Cases; News
MB. There have been several instances of deaths due to routine treatment where the wrong stuff has been put into the CSF but the system has not been fixed. Previous ones were charged but not convicted.

ARTICLE TITLE: Observational study of upper gastrointestinal haemorrhage in elderly patients given selective cyclo-oxygenase-2 inhibitors or conventional non-steroidal anti-inflammatory drugs.
COMMENTS: Comment In: Comment In: RefSource:BMJ. 2002 Sep 21; 325(7365):607-8/
ARTICLE SOURCE: BMJ (England), Sep 21 2002, 325(7365) p624
AUTHOR(S): Mamdani M; Rochon PA; Juurlink DN; Kopp A; Anderson GM; Naglie G; Austin PC; Laupacis A
AUTHOR'S ADDRESS: Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue-G215, Toronto, Ontario, Canada. muhammad.mamdani@ices.on.ca.
PUBLICATION TYPE: Journal Article
PATIENTS: Subjects aged > or =66 years who started taking non-selective NSAIDs (n=5391), diclofenac plus misoprostol (n=5087), rofecoxib (n=14 583), or celecoxib (n=18 908) and a randomly selected control cohort not exposed to NSAIDs (n=100 000CONCLUSIONS: This population based observational study found a lower short term risk of upper gastrointestinal haemorrhage for selective COX-2 inhibitors compared with non-selective NSAIDs.
MB. But there's not no risk.

ARTICLE TITLE: Doctors' perceptions of palliative care for heart failure: focus group study.
COMMENTS: Comment In: Comment In: RefSource:BMJ. 2002 Oct 26; 325(7370):915-6
ARTICLE SOURCE: BMJ (England), Sep 14 2002, 325(7364) p581-5
AUTHOR(S): Hanratty B; Hibbert D; Mair F; May C; Ward C; Capewell S; Litva A; Corcoran G
AUTHOR'S ADDRESS: Department of Public Health, University of Liverpool, Liverpool L69 3GB. B.Hanratty@liverpool.ac.uk.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Greater consideration should be given to the care of patients dying with heart failure, clarifying the roles of doctors and nurses in different specialties, and reshaping the services provided for them. Many of the organisational and professional issues are not peculiar to patients dying with heart failure, and addressing such concerns as the lack of coordination and continuity in medical care would benefit all patients.
MB. Dis-coordination is universal

ARTICLE TITLE: Long-term trends in the incidence of and survival with heart failure.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 31; 347(18):1442-4
ARTICLE SOURCE: N Engl J Med (United States), Oct 31 2002, 347(18) p1397-402
AUTHOR(S): Levy D; Kenchaiah S; Larson MG; Benjamin EJ; Kupka MJ; Ho KK; Murabito JM; Vasan RS
AUTHOR'S ADDRESS: National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Heart failure - an epidemic of uncertain proportions.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 31; 347(18):1397-402
ARTICLE SOURCE: N Engl J Med (United States), Oct 31 2002, 347(18) p1442-4
AUTHOR(S): Redfield MM
PUBLICATION TYPE: Comment; Editorial
MB. They think what I have suggested below ie that treatment with ACE inhibitors + beta blockers are making those that would have died survive. That's what's happening with me.

ARTICLE TITLE: Palliative care for heart failure.
COMMENTS: Comment On: Comment On: RefSource:BMJ. 2002 Oct 26; 325(7370):929; Comment On: Comment On: RefSource:BMJ. 2002 Sep 14; 325(7364):581-5
ARTICLE SOURCE: BMJ (England), Oct 26 2002, 325(7370) p915-6
AUTHOR(S): Stewart S; McMurray JJ
PUBLICATION TYPE: Comment; Editorial
MB. Very pessimistic. They say that cardiac transplant, the only cure for chronic heart failure, is like giving a whole life boat for one person on the Titanic. They don't seem to distinguish patients whose cardiac failure is reversed by quite simple but revolutionary therapy. In one cardiac transplant unit half the patients have been taken off the waiting list as they no longer need transplantation.

ARTICLE TITLE: Shipman inquiry calls for major changes in death certification.
ARTICLE SOURCE: BMJ (England), Oct 26 2002, 325(7370) p919
AUTHOR(S): Dyer C
PUBLICATION TYPE: News
MB. Silly.

ARTICLE TITLE: Adverse events with medical devices may go unreported.
COMMENTS: Comment On: Comment On: RefSource:BMJ. 2002 Aug 3; 325(7358):272-5
ARTICLE SOURCE: BMJ (England), Oct 19 2002, 325(7369) p905
AUTHOR(S): Baker N; Tweedale C; Ellis CJ
PUBLICATION TYPE: Comment; Journal Article
MB. Infected IV catheters.

ARTICLE TITLE: Patients' decisions about whether or not to take antihypertensive drugs: qualitative study.
ARTICLE SOURCE: BMJ (England), Oct 19 2002, 325(7369) p873
AUTHOR(S): Benson J; Britten N
AUTHOR'S ADDRESS: General Practice and Primary Care Research Unit, Institute of Public Health, Cambridge CB2 2SR. jab62@medschl.cam.ac.uk.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: Patients' ideas may derive from considerations unrelated to the drugs' pharmacology. Doctors who want their patients to make well informed choices about antihypertensives and to reach concordant decisions about prescribing should explore how individuals strike this balance, to personalise discussion of drug use.
MB. It just means that the doctor never knows if the patient is taking what the doctor thinks they are.
When I reassured my cardiologist that I am religiously taking the drugs he's prescribed he looks at me sceptically. I did tell him that I'd reduced the beta blocker by a third because my pulse rate was regularly <40/min.

ARTICLE TITLE: Predictors of normotension on withdrawal of antihypertensive drugs in elderly patients: prospective study in second Australian national blood pressure study cohort.
ARTICLE SOURCE: BMJ (England), Oct 12 2002, 325(7368) p815
AUTHOR(S): Nelson MR; Reid CM; Krum H; Muir T; Ryan P; McNeil JJ
AUTHOR'S ADDRESS: Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Prahran 3181, Australia. mark.nelson@med.monash.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Age, blood pressure control, and the number of antihypertensive drugs are important factors in the clinical decision to withdraw drug treatment. Because of consistent rates of return to antihypertensive treatment, all patients from whom such treatment is withdrawn should be monitored indefinitely to detect a recurrence of hypertension.

ARTICLE TITLE: Oregon's residents to vote on universal health care.
ARTICLE SOURCE: BMJ (England), Oct 19 2002, 325(7369) p854
AUTHOR(S): Josefson D
PUBLICATION TYPE: News
MB. They voted no on Nov 5, 2002.

ARTICLE TITLE: Electronic tagging of people with dementia who wander.
ARTICLE SOURCE: BMJ (England), Oct 19 2002, 325(7369) p847-8
AUTHOR(S): Hughes JC; Louw SJ
PUBLICATION TYPE: Editorial
MB. They sound a bit confused to me too. They can't separate human rights form human safety.

ARTICLE TITLE: Where does blood go? Prospective observational study of red cell transfusion in north England.
ARTICLE SOURCE: BMJ (England), Oct 12 2002, 325(7368) p803
AUTHOR(S): Wells AW; Mounter PJ; Chapman CE; Stainsby D; Wallis JP
AUTHOR'S ADDRESS: National Blood Service, Newcastle Centre, Newcastle upon Tyne NE2 4NQ.
PUBLICATION TYPE: Journal Article
CONCLUSION: In the north east of England more than half of red cell units are transfused for medical indications. Demand for red cell transfusion increases with age. With anticipated changes in the age structure of the population the demand for blood will increase by 4.9% by 2008.
MB. That assumes that the indications will stay the same.

ARTICLE TITLE: Why men with prostate cancer want wider access to prostate specific antigen testing: qualitative study.
COMMENTS: Comment In: Comment In: RefSource:BMJ. 2002 Oct 5; 325(7367):725-6
ARTICLE SOURCE: BMJ (England), Oct 5 2002, 325(7367) p737
AUTHOR(S): Chapple A; Ziebland S; Shepperd S; Miller R; Herxheimer A; McPherson A
AUTHOR'S ADDRESS: Department of Primary Health Care, University of Oxford, Institute of Health Sciences, Oxford OX3 7LF. alison.chapple@dphpc.ox.ac.uk.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The few men in this study who subscribed to the argument that evidence of the benefits of treatment is a prerequisite for a screening programme did not want to see screening introduced. Men who proposed an alternative set of principles for testing gave reasons that did not all relate to overoptimism about the benefits of early diagnosis. People who plan services and people who respond to requests for testing need to understand men's perspectives and concerns.
MB. I doubt that patients could understand and be empowered enough to understand the complexities of screening theory probabilities. I have difficulty with it. I have had difficulty escaping the system when I showed a marginal PSA done for nocturia which some time later turned out to be latent cardiac failure.

ARTICLE TITLE: Prostate specific antigen testing for prostate cancer.
COMMENTS: Comment On: Comment On: RefSource:BMJ. 2002 Oct 5; 325(7367):737; Comment On: Comment On: RefSource:BMJ. 2002 Oct 5; 325(7367):740/; Comment On: Comment On: RefSource:BMJ. 2002 Oct 5; 325(7367):766-70
ARTICLE SOURCE: BMJ (England), Oct 5 2002, 325(7367) p725-6
AUTHOR(S): Thornton H; Dixon-Woods M
PUBLICATION TYPE: Comment; Editorial
MB. This does not set out the problem comprehensively or clearly. They do not emphasise the impossibility for patients to make scientific decisions. They make an ethical distinction between screening initiated by individual patients and screening as part of a universal screening programme. I would have thought the doctor was equally responsible in both situations ie a bad outcome after patient initiation as distinct from a bad individual outcome from mass screening.

ARTICLE TITLE: A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Sep 12; 347(11):839-40
ARTICLE SOURCE: N Engl J Med (United States), Sep 12 2002, 347(11) p781-9
AUTHOR(S): Holmberg L; Bill-Axelson A; Helgesen F; Salo JO; Folmerz P; Haggman M; Andersson SO; Spangberg A; Busch C; Nordling S; Palmgren J; Adami HO; Johansson JE; Norlen BJ
AUTHOR'S ADDRESS: Regional Oncologic Center, University Hospital, Uppsala, Sweden; Collective Name: Scandinavian Prostatic Cancer Group Study Number 4.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: In this randomized trial, radical prostatectomy significantly reduced disease-specific mortality, but there was no significant difference between surgery and watchful waiting in terms of overall survival.

ARTICLE TITLE: Colombian doctors are killed as their neutrality is ignored.
ARTICLE SOURCE: BMJ (England), Oct 5 2002, 325(7367) p732
AUTHOR(S): Johnson O
PUBLICATION TYPE: News
MB. The dissidents kill health care workers to make health facilities collapse to help to make the government collapse. This is an extreme form of alienation. That means that they make it impossible to get treatment for themselves.

ARTICLE TITLE: Meta-analysis of effects and side effects of low dosage tricyclic antidepressants in depression: systematic review.
ARTICLE SOURCE: BMJ (England), Nov 2 2002, 325(7371) p991
AUTHOR(S): Furukawa TA; McGuire H; Barbui C
AUTHOR'S ADDRESS: Department of Psychiatry, Nagoya City University Medical School, Nagoya 467-8601, Japan. furukawa@med.nagoya-cu.ac.jp.
PUBLICATION TYPE: Journal Article; Meta-Analysis; Review; Review, Academic

ARTICLE TITLE: Lethal injection: a stain on the face of medicine.
ARTICLE SOURCE: BMJ (England), Nov 2 2002, 325(7371) p1026-8
AUTHOR(S): Groner JI
AUTHOR'S ADDRESS: Department of Surgery, Children's Hospital, Columbus, OH 43205, USA. gronerj@chi.osu.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Pulmonary embolism: what have we learned since Virchow? Natural history, pathophysiology, and diagnosis.
ARTICLE SOURCE: Chest (United States), Oct 2002, 122(4) p1440-56
AUTHOR(S): Dalen JE
AUTHOR'S ADDRESS: University of Arizona, 1840 East River Road, Suite 207, Tucson, AZ, USA. jamesdalen@yahoo.com.
PUBLICATION TYPEJournal Article; Review; Review, Tutorial
MB. Quite a bit.

ARTICLE TITLE: The effectiveness of IV beta-agonists in treating patients with acute asthma in the emergency department: a meta-analysis.
COMMENTS: Comment In: Comment In: RefSource:Chest. 2002 Oct; 122(4):1116-8
ARTICLE SOURCE: Chest (United States), Oct 2002, 122(4) p1200-7
AUTHOR(S): Travers AH; Rowe BH; Barker S; Jones A; Camargo CA
AUTHOR'S ADDRESS: Division of Emergency Medicine, University of Alberta, 1G1.50 WMC, 8440-112th Street, Edmonton, AB, T6G 2B7 Canada. ahtravers@shaw.ca.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSIONS: Evidence is lacking to support the use of IV beta(2)-agonists in emergency department (ED) patients with severe acute asthma. Moreover, the clinical benefit appears questionable, while the potential clinical risks are obvious. The only recommendations for IV beta-(2)agonist use should be in those patients in whom inhaled therapy is not feasible, or in the context of a controlled clinical trial comparing IV beta(2)-agonists with standard care vs standard care alone.

ARTICLE TITLE: Beta(2)-agonists: deja vu all over again: the second-generation controversy.
COMMENTS: Comment On: Comment On: RefSource:Chest. 2002 Sep; 122(3):798-805
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p763-5
AUTHOR(S): Bernstein IL
PUBLICATION TYPE: Comment; Editorial
MB. They have still not done the appropriate experiments to determine what should be done in asthma. I've been waiting since the 1960s for them to sort out the combinations of effects of steroids with beta agonists. They admit that this has not been done.

ARTICLE TITLE: ICU echocardiography: should we use it in a heart beat?
COMMENTS: Comment On: Comment On: RefSource:Chest. 2002 Oct; 122(4):1370-6
ARTICLE SOURCE: Chest (United States), Oct 2002, 122(4) p1121-3
AUTHOR(S): Ketzler JT; McSweeney ME; Coursin DB
PUBLICATION TYPE: Comment; Editorial
MB. They are commenting use of echo-cardiography in ICUs. Much of their discussion is about how it can be organised. It's obvious that additional information from an echo can't make things worse unless the intensivists are very stupid.

ARTICLE TITLE: Lack of agreement between thermodilution and fick cardiac output in critically ill patients.
COMMENTS: Comment In: Comment In: RefSource:Chest. 2002 Sep; 122(3):771-4
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p990-7
AUTHOR(S): Dhingra VK; Fenwick JC; Walley KR; Chittock DR; Ronco JJ
AUTHOR'S ADDRESS: Division of Critical Care Medicine, Vancouver Hospital and Health Sciences Center, University of British Columbia, Vancouver, BC, Canada. vdhingra@vanhosp.bc.ca.
PUBLICATION TYPE: Journal Article
ABSTRACT: STUDY OBJECTIVE:s: Individual comparison of cardiac output via intermittent thermodilution and Fick technique over a wide range of cardiac outputs. DESIGN: Prospective clinical investigation. SETTING: Multidisciplinary ICUs of two teaching hospitals in Vancouver, British Columbia. PARTICIPANTS: Eighteen critically ill patients who had pulmonary and systemic arterial catheters and in whom active support was being withdrawn. INTERVENTIONS: Measurement of thermodilution cardiac output and calculation of Fick cardiac output while support was withdrawn. Active support was withdrawn in a three-step process: removal of vasopressors followed by decrease in fraction of inspired oxygen to 0.21, and finally removal of mechanical ventilation<snip> CONCLUSIONS: There was good consistency of each of the measurements with a low coefficient of variation. The bias for the whole group was small, but the limits of agreement extended into a clinically relevant area, resulting in a lack of agreement. In patients with high cardiac outputs, the Fick tended to consistently produce higher cardiac outputs compared to thermodilution, suggesting a systematic error.

ARTICLE TITLE: What is the best way to measure cardiac output? Who cares, anyway?
COMMENTS: Comment On: Comment On: RefSource:Chest. 2002 Sep; 122(3):990-7226
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p771-4
AUTHOR(S): Caruso LJ; Layon AJ; Gabrielli A
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Medical literature and vena cava filters: so far so weak.
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p963-7
AUTHOR(S): Girard P; Stern JB; Parent F
AUTHOR'S ADDRESS: Departement thoracique, Institut Mutualiste Montsouris, Paris, France. philippe.girard@imm.fr.
PUBLICATION TYPE: Evaluation Studies; Journal Article; Review; Review, Academic
CONCLUSIONS: Until more relevant data become available, literature reviews about vena cava filters will remain narrative, and many if not most indications for filter placement will remain a matter of opinion.

ARTICLE TITLE: Deep venous thrombosis in a general hospital.
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p960-2
AUTHOR(S): Stein PD; Patel KC; Kalra NK; El Baage TY; Savarapu P; Silbergleit A; Check FE
AUTHOR'S ADDRESS: St. Joseph Mercy Oakland Hospital, Pontiac, MI 48341, USA. steinp@trinity-health.org.
PUBLICATION TYPE: Journal Article
<snip>RESULTS: The prevalence of proximal DVT in adults > or = 20 years old was 271 of 34,567 patients (0.78%). DVT was associated with pulmonary embolism in 57 of 271 patients (21.0%). <snip> CONCLUSION: Proximal DVT continues to be a frequent illness among hospitalized patients.
MB. They must be talking about more central veins as distinct from calf veins.

ARTICLE TITLE: Improving care for patients with chronic heart failure in the community: the importance of a disease management program.
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p906-12
AUTHOR(S): Akosah KO; Schaper AM; Havlik P; Barnhart S; Devine S
AUTHOR'S ADDRESS: Gundersen Lutheran Medical Foundation, La Crosse, WI 54601, USA. kakosah@gundluth.org.
PUBLICATION TYPE: Evaluation Studies; Journal Article
ABSTRACT: STUDY OBJECTIVE: Utilizing a comparison group of patients with congestive heart failure (CHF) discharged to their primary care physicians, we sought to determine if disease management in a short-term, aggressive-intervention heart failure clinic (HFC) following hospital discharge is associated with improved outcomes. CONCLUSIONS: A comprehensive disease management program for patients discharged with a diagnosis of CHF resulted in fewer rehospitalizations and improved event-free survival compared to patients followed up by their primary care physicians.
MB. It's better to go to a CCF Clinic.

ARTICLE TITLE: A waist is a terrible thing to mind: central obesity, the metabolic syndrome, and sleep apnea hypopnea syndrome.
COMMENTS: Comment On: Comment On: RefSource:Chest. 2002 Sep; 122(3):829-39
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p774-8
AUTHOR(S): Brown LK
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Evolution of the stone heart after prolonged cardiac arrest.
ARTICLE SOURCE: Chest (United States), Sep 2002, 122(3) p1006-11
AUTHOR(S): Klouche K; Weil MH; Sun S; Tang W; Povoas HP; Kamohara T; Bisera J
AUTHOR'S ADDRESS: Institute of Critical Care Medicine, Palm Springs, CA, USA.
PUBLICATION TYPE: Journal Article
METHODS: Ventricular fibrillation (VF) was induced in 40 anesthetized male domestic pigs weighing between 38 kg and 43 kg. After 4 min, 7 min, or 10 min of untreated VF, electrical defibrillation was attempted. <snip> CONCLUSION: Progressive impairment in diastolic function terminates in a stone heart after prolonged intervals of cardiac arrest. .

ARTICLE TITLE: Ventilator-associated pneumonia and ventilator-induced lung injury: two peas in a pod.
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Oct; 30(10):2278-83
ARTICLE SOURCE: Crit Care Med (United States), Oct 2002, 30(10) p2391-2
AUTHOR(S): Kollef M
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Who says you're too tired?
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Oct; 30(10):2322-9
ARTICLE SOURCE: Crit Care Med (United States), Oct 2002, 30(10) p2396-7
AUTHOR(S): Stryjewski G; Slonim AD
PUBLICATION TYPE: Comment; Editorial
MB. Discuss some of the difficulties in doing studies to show differences in performance if tired.

ARTICLE TITLE: One good turn deserves another!
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Sep; 30(9):1983-6
ARTICLE SOURCE: Crit Care Med (United States), Sep 2002, 30(9) p2146-8
AUTHOR(S): Marik PE; Fink MP
PUBLICATION TYPE: Comment; Editorial; Review; Review, Tutorial
MB. About turning patients on ventilators.

ARTICLE TITLE: Nephrologist care and mortality in patients with chronic renal insufficiency.
ARTICLE SOURCE: Arch Intern Med (United States), Sep 23 2002, 162(17) p2002-6
AUTHOR(S): Avorn J; Bohn RL; Levy E; Levin R; Owen WF; Winkelmayer WC; Glynn RJ
AUTHOR'S ADDRESS: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. .
PUBLICATION TYPE: Journal Article
CONCLUSIONS: For patients with long-standing renal disease, earlier consultation with a nephrologist and more frequent specialist encounters is associated with lower mortality in the first year of dialysis. These findings need to be confirmed in younger and less indigent patients as well.
MB. As always, specialist care is better.

ARTICLE TITLE: Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients.
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Sep; 30(9):2156-7
ARTICLE SOURCE: Crit Care Med (United States), Sep 2002, 30(9) p2051-8
AUTHOR(S): Metnitz PG; Krenn CG; Steltzer H; Lang T; Ploder J; Lenz K; Le Gall JR; Druml W
AUTHOR'S ADDRESS: Department of Reanimation Medicale, Hopital St. Louis, University Lariboisiere-St. Louis, Paris, France. philipp.metnitz@univie.ac.at.
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: OBJECTIVES: Acute renal failure is a complication in critically ill patients that has been associated with an excess risk of hospital mortality. Whether this reflects the severity of the disease or whether acute renal failure is an independent risk factor is unknown. <snip> PATIENTS AND SETTING: A total of 17,126 patients admitted consecutively to 30 medical, surgical, and mixed intensive care units in Austria over a period of 2 yrs. <snip> Five interventions were associated with nonsurvival (mechanical ventilation, single vasoactive medication, multiple vasoactive medication, cardiopulmonary resuscitation, and treatment of complicated metabolic acidosis/alkalosis). In contrast, the use of enteral nutrition predicted a favorable outcome. CONCLUSIONS: The results of our study suggest that acute renal failure in patients undergoing renal replacement therapy presents an excess risk of in-hospital death. This increased risk cannot be explained solely by a more pronounced severity of illness. Our results provide strong evidence that acute renal failure presents a specific and independent risk factor for poor prognosis.
MB. They don't give any indications of causation. The title is misleading.

ARTICLE TITLE: Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis.
ARTICLE SOURCE: JAMA (United States), Nov 20 2002, 288(19) p2449-57
AUTHOR(S): Devereaux PJ; Schunemann HJ; Ravindran N; Bhandari M; Garg AX; Choi PT; Grant BJ; Haines T; Lacchetti C; Weaver B; Lavis JN; Cook DJ; Haslam DR; Sullivan T; Guyatt GH
AUTHOR'S ADDRESS: Depatment of Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada L8N 3Z5. philipj@mcmaster.ca.
CONCLUSIONS: Hemodialysis care in private not-for-profit centers is associated with a lower risk of mortality compared with care in private for-profit centers.
MB. Private not-for-profit are places owned by charities or religious groups. Public would be government owned.

ARTICLE TITLE: Patients are dying of acute renal failure.
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Sep; 30(9):2051-8
ARTICLE SOURCE: Crit Care Med (United States), Sep 2002, 30(9) p2156-7
AUTHOR(S): Kellum JA; Angus DC
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Peritoneal dialysis in acute renal failure - why the bad outcome?
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Sep 19; 347(12):895-902
ARTICLE SOURCE: N Engl J Med (United States), Sep 19 2002, 347(12) p933-5
AUTHOR(S): Daugirdas JT
PUBLICATION TYPE: Comment; Editorial
MB. About a randomised trial of haemfiltration vs peritoneal dialysis in Viet Nam.

ARTICLE TITLE: Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates.
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Sep; 30(9):2142-3
ARTICLE SOURCE: Crit Care Med (United States), Sep 2002, 30(9) p1950-9
AUTHOR(S): Coles JP; Minhas PS; Fryer TD; Smielewski P; Aigbirihio F; Donovan T; Downey SP; Williams G; Chatfield D; Matthews JC; Gupta AK; Carpenter TA; Clark JC; Pickard JD; Menon DK
AUTHOR'S ADDRESS: Division of Anaesthesia, University of cambridge, Addenbrooke's Hospital, Cambridge, UK. jpc44@wbic.cam.ac.uk.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Hyperventilation increases the volume of severely hypoperfused tissue within the injured brain, despite improvements in cerebral perfusion pressure and intracranial pressure. Significant hyperperfusion is uncommon, even at a time when conventional clinical management includes a role for modest hyperventilation. These reductions in regional cerebral perfusion are not associated with ischemia, as defined by global monitors of oxygenation, but may represent regions of potentially ischemic brain tissue.

ARTICLE TITLE: Hyperventilation in head injury: what have we learned in 43 years?
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Sep; 30(9):1950-9
ARTICLE SOURCE: Crit Care Med (United States), Sep 2002, 30(9) p2142-3
AUTHOR(S): Diringer M
PUBLICATION TYPE: Comment; Editorial
MB. Not much it seems.

ARTICLE TITLE: Myocardial infarction redefined: the new ACC/ESC definition, based on cardiac troponin, increases the apparent incidence of infarction.
ARTICLE SOURCE: Heart (England), Oct 2002, 88(4) p343-7
AUTHOR(S): Ferguson JL; Beckett GJ; Stoddart M; Walker SW; Fox KA
AUTHOR'S ADDRESS: Department of Cardiology, The Royal Infirmary of Edinburgh, Lauriston Place, Edinburgh, UK.
PUBLICATION TYPE: Journal Article
INTERVENTIONS: Measurement of concentrations of conventional cardiac biomarkers (creatine kinase and its MB isoenzyme, CK-MB) and concentrations of the highly specific diagnostic indicator of myocardial damage, cardiac troponin I (cTnI) 12-24 hours after the onset of acute chest pain. MAIN OUTCOME MEASURES: Frequency of myocardial infarction as assessed by conventional diagnostic criteria (creatine kinase and CK-MB) plus clinical symptoms of infarction, versus frequency of infarction based on high sensitivity troponin assays. RESULTS: Among patients with acute coronary syndromes but non-diagnostic ECG changes, 40% (32/80) fulfilled the new criteria for myocardial infarction using high sensitivity cTnI measurement, compared with 29% (23/80) using the conventional diagnostic criteria for myocardial infarction. CONCLUSIONS: The implications of the redefinition of myocardial infarction on patients, their care, and the use of health care resources are substantial.

ARTICLE TITLE: Changing the diagnostic criteria for myocardial infarction in patients with a suspected heart attack affects the measurement of 30 day mortality but not long term survival.
ARTICLE SOURCE: Heart (England), Oct 2002, 88(4) p337-42
AUTHOR(S): Packham C; Gray D; Weston C; Large A; Silcocks P; Hampton J
AUTHOR'S ADDRESS: University Division of Public Health Sciences, Queens Medical Centre, Nottingham, UK. chris.packham@nottingham.ac.uk.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: The classification system used had a substantial effect on the numbers of patients identified as having had a myocardial infarct, and on the 30 day survival. There were significant numbers of patients with more atypical presentations, not labelled as myocardial infarction, who did badly following discharge. More research is needed on these patients.

ARTICLE TITLE: Hot new therapy for sepsis and the acute respiratory distress syndrome.
COMMENTS: Comment On: Comment On: RefSource:J Clin Invest. 2002 Sep; 110(6):801-6
ARTICLE SOURCE: J Clin Invest (United States), Sep 2002, 110(6) p737-9
AUTHOR(S): Slutsky AS
AUTHOR'S ADDRESS: Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada. arthur.slutsky@utoronto.ca.
PUBLICATION TYPE: Comment; Journal Article
MB. I could not work out what this was about. I wonder if it'd been rejected by all the really clinical journals.

ARTICLE TITLE: Organization of language areas in bilingual patients: a cortical stimulation study.
ARTICLE SOURCE: J Neurosurg (United States), Oct 2002, 97(4) p857-64
AUTHOR(S): Roux FE; Tremoulet M
AUTHOR'S ADDRESS: Institut National de la Sante et de la Recherche Medicale, Unite 455, Hjpital Purpan, Toulouse, France. rouxfran@compuserve.com.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In this series, the authors found that bilingual patients could have common but also different cortical areas for both languages in temporoparietal areas and in frontal areas. <snip>

ARTICLE TITLE: Organ donation rates in a neurosurgical intensive care unit.
ARTICLE SOURCE: J Neurosurg (United States), Oct 2002, 97(4) p811-4
AUTHOR(S): Dickerson J; Valadka AB; Levert T; Davis K; Kurian M; Robertson CS
AUTHOR'S ADDRESS: Department of Neurosurgery, Baylor College of Medicine, Houston, Texas 77030, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Close working relationships among physicians, nurses, and organ procurement organization (OPO)coordinators can result in higher donation rates than have been reported previously. Aggressive resuscitation and stabilization of all patients, early identification of potential organ donors, prompt declaration of brain death, and attempts by the OPO coordinator to build rapport with families are all important factors that may increase donation rates

ARTICLE TITLE: Treatment of chronic pain by using intrathecal drug therapy compared with conventional pain therapies: a cost-effectiveness analysis.
ARTICLE SOURCE: J Neurosurg (United States), Oct 2002, 97(4) p803-10
AUTHOR(S): Kumar K; Hunter G; Demeria DD
AUTHOR'S ADDRESS: Department of Surgery, Section of Neurosurgery, Regina General Hospital, University of Saskatchewan, Regina, Saskatchewan, Canada. kkumar@reginahealth.sk.ca.
PUBLICATION TYPE: Owner: NLM; Status: Completed
Clinical Trial; Journal Article; Randomized Controlled Trial

ARTICLE TITLE: Immediate administration of tranexamic acid and reduced incidence of early rebleeding after aneurysmal subarachnoid hemorrhage: a prospective randomized study.
COMMENTS: Comment In: Comment In: RefSource:J Neurosurg. 2002 Oct; 97(4):751; discussion 751-2
ARTICLE SOURCE: J Neurosurg (United States), Oct 2002, 97(4) p771-8
AUTHOR(S): Hillman J; Fridriksson S; Nilsson O; Yu Z; Saveland H; Jakobsson KE
AUTHOR'S ADDRESS: Neurosurgical Department, University Hospital Linkoping, University Hospital Lund, Sweden. jan.hillman@lio.se.
PUBLICATION TYPE: Owner: NLM; Status: Completed
Clinical Trial; Journal Article; Randomized Controlled Trial

ARTICLE TITLE: Effects of decreasing endotracheal tube cuff pressures during neck retraction for anterior cervical spine surgery.
ARTICLE SOURCE: J Neurosurg (United States), Sep 2002, 97(2 Suppl) p176-9
AUTHOR(S): Ratnaraj J; Todorov A; McHugh T; Cheng MA; Lauryssen C
AUTHOR'S ADDRESS: Department of Anesthesiology, Washington University School of Medicine, Saint Louis, Missouri, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial .

ARTICLE TITLE: Mechanisms of snowboarding-related severe head injury: shear strain induced by the opposite-edge phenomenon.
ARTICLE SOURCE: J Neurosurg (United States), Sep 2002, 97(3) p542-8
AUTHOR(S): Nakaguchi H; Tsutsumi K
AUTHOR'S ADDRESS: Department of Neurosurgery, Suwa Central Hospital, Chino city, Nagano, Japan. hnakaguchi@hi-ho.ne.jp.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: The majority of severe head injuries associated with snowboarding that occur after a simple fall on the slope are believed to involve the opposite-edge phenomenon, which results from a fall backward on a gentle or moderate slope causing occipital impact. The use of a device to protect the occiput is proposed to reduce head injuries associated with snowboarding
MB. How about not snowboarding.

ARTICLE TITLE: Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population.
ARTICLE SOURCE: J Neurosurg (United States), Sep 2002, 97(3) p531-6
AUTHOR(S): Nilsson OG; Lindgren A; Brandt L; Saveland H
AUTHOR'S ADDRESS: Department of Neurosurgery, Lund University Hospital, Sweden. ola.nilsson@neurokir.lu.se.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Primary hemorrhage intracerebral (ICH) remains a stroke subtype associated with a high mortality rate and for which the level of consciousness on admission is the strongest predictor of fatal outcome both at 30 days and during the 1st year after bleeding. A preictal history of heart disease increased the 30-day mortality rate
MB. Why do editors persist in allowing the attribution of causation when the authors have shown only association.

ARTICLE TITLE: Reduction of transfusion rates in the surgical correction of sagittal synostosis.
ARTICLE SOURCE: J Neurosurg (United States), Sep 2002, 97(3) p503-9
AUTHOR(S): Hentschel S; Steinbok P; Cochrane DD; Kestle J
AUTHOR'S ADDRESS: Department of Surgery, University of British Columbia, British Columbia's Children's Hospital, Vancouver, Canada.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: A history of curriculum reform: the Sherbrooke story.
ARTICLE SOURCE: Med Educ (England), Oct 2002, 36(10) p896
AUTHOR(S): Bligh J
PUBLICATION TYPE: Editorial
MB. They make allusion to Newcastle. I've seen little evidence of objective reform from the reforms.

ARTICLE TITLE: A comparison of practice outcomes of graduates from traditional and non-traditional medical schools in Australia.
ARTICLE SOURCE: Med Educ (England), Oct 2002, 36(10) p985-91
AUTHOR(S): Pearson SA; Rolfe I; Ringland C; Kay-Lambkin F
AUTHOR'S ADDRESS: Faculty of Medicine and Health Sciences, University of Newcastle, Newcastle, Australia.
PUBLICATION TYPE: Journal Article
Medical school background was not related to main occupation; over 90% of all graduates were employed in clinician positions. A greater proportion of Newcastle than Sydney graduates were either training or qualified in family medicine or psychiatry rather than in other specialties. The school of graduation was not related to practice environment; fewer than 20% of all graduates were working in rural locations and around 25% were employed in the public sector. There were no differences in outcome between Newcastle and Sydney graduates who had entered medical school under similar academic criteria. CONCLUSION: Our study suggests that initial selection procedures of medical school candidates with particular background characteristics and attributes may influence practice outcomes. Further research is required to confirm these findings
MB. After all that trouble the only difference is more GP & Psychiatry trainees from Newcastle compared to Sydney. I wonder what's going to emerge from Sydney now that we've been 'reformed'. I don't expect we'll find anything more substantial.

ARTICLE TITLE: When enough is enough: a conceptual basis for fair and defensible practice performance assessment.
ARTICLE SOURCE: Med Educ (England), Oct 2002, 36(10) p925-30
AUTHOR(S): Schuwirth LW; Southgate L; Page GG; Paget NS; Lescop JM; Lew SR; Wade WB; Baron-Maldonado M
AUTHOR'S ADDRESS: Department of Educational Development and Research, University of Maastricht, The Netherlands. L.schuwirth@educ.unimaas.nl.
PUBLICATION TYPE:Journal Article
ABSTRACT: INTRODUCTION: An essential element of practice performance assessment involves combining the results of various procedures in order to see the whole picture. This must be derived from both objective and subjective assessment, as well as a combination of quantitative and qualitative assessment procedures. Because of the severe consequences an assessment of practice performance may have, it is essential that the procedure is both defensible to the stakeholders and fair in that it distinguishes well between good performers and underperformers. LESSONS FROM COMPETENCE ASSESSMENT: Large samples of behaviour are always necessary because of the domain specificity of competence and performance. The test content is considerably more important in determining which competency is being measured than the test format, and it is important to recognise that the process of problem-solving process is more idiosyncratic than its outcome. It is advisable to add some structure to the assessment but to refrain from over-structuring, as this tends to trivialise the measurement. IMPLICATIONS FOR PRACTICE PERFORMANCE ASSESSMENT: A practice performance assessment should use multiple instruments. The reproducibility of subjective parts should not be increased by over-structuring, but by sampling through sources of bias. As many sources of bias may exist, sampling through all of them may not prove feasible. Therefore, a more project-orientated approach is suggested using a range of instruments. At various timepoints during any assessment with a particular instrument, questions should be raised as to whether the sampling is sufficient with respect to the quantity and quality of the observations, and whether the totality of assessments across instruments is sufficient to see 'the whole picture'. This policy is embedded within a larger organisational and health care context.
MB. Typical educational gobbledy-gook

ARTICLE TITLE: Towards an acceptance of performance assessment.
ARTICLE SOURCE: Med Educ (England), Oct 2002, 36(10) p959-64
AUTHOR(S): Finucane PM; Barron SR; Davies HA; Hadfield-Jones RS; Kaigas TM
AUTHOR'S ADDRESS: Medical Council of Ireland, Dublin, Ireland, University of British Columbia, Vancouver, Canada. paulfinucane@mcirl.ie.
PUBLICATION TYPE: Journal Article
ABSTRACT: The utility of any assessment tool critically depends on its level of acceptance by those on whom the assessment impacts. Performance assessment impacts on three distinct groups: patients/consumers, doctors and employers. While these groups may have conflicting beliefs and expectations of performance assessment, the process must be made acceptable to all. This can happen through an exploration of the beliefs and wishes of the key stakeholders in relation to performance assessment, together with the potential rewards and costs. This paper draws on the psychology literature in describing an effective model for change management. It outlines some strategies for each of the three key elements of any successful strategy for change, i.e. getting started, facilitating the transition and ensuring consolidation. Such a practical approach will foster the acceptance of performance assessment structures among all stakeholders.

ARTICLE TITLE: Is insight important? measuring capacity to change performance.
ARTICLE SOURCE: Med Educ (England), Oct 2002, 36(10) p965-71
AUTHOR(S): Hays RB; Jolly BC; Caldon LJ; McCrorie P; McAvoy PA; McManus IC; Rethans JJ
AUTHOR'S ADDRESS: School of Medicine, James Cook University, Townsville, Australia. Richard.Hays@jcu.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSION: There may be individuals in whom insight is so lacking that they are beyond remediation. If there is a dichotomy between adequate and inadequate levels of insight, testing this could be a cost-effective way of determining where efforts for remediation should be focussed.
MB. How do you objectively determine 'insight'?

ARTICLE TITLE: Surviving cardiac arrest.
COMMENTS: Comment On: Comment On: RefSource:Med J Aust. 2002 Sep 16; 177(6):305-9
ARTICLE SOURCE: Med J Aust (Australia), Sep 16 2002, 177(6) p284-5
AUTHOR(S): O'Rourke MF
PUBLICATION TYPE: Comment; Editorial
MB. Advocating more widespread availability of defibrillators in oz.

ARTICLE TITLE: Cardiac arrests treated by ambulance paramedics and fire fighters.
COMMENTS: Comment In: Comment In: RefSource:Med J Aust. 2002 Sep 16; 177(6):284-5
ARTICLE SOURCE: Med J Aust (Australia), Sep 16 2002, 177(6) p305-9
AUTHOR(S): Smith KL; McNeil JJ
AUTHOR'S ADDRESS: Department of Epidemiology and Preventive Medicine, Monash Medical School, Monash University, Melbourne, Australia. karen.smith@med.monash.edu.au; Collective Name: Emergency Medical Response Steering Committee.
PUBLICATION TYPE: Journal Article
ABSTRACT: The Emergency Medical Response (EMR) program is a Victorian Government initiative in which fire fighters trained in cardiopulmonary resuscitation and equipped with automatic external defibrillators are dispatched to suspected cardiac arrests simultaneously with ambulance paramedics across metropolitan Melbourne. During the first 12 months (February 2000 to February 2001) of the expanded EMR program, 2942 events involved simultaneous dispatch of ambulance paramedics and fire fighters. In 430 events, patients had suffered a cardiac arrest of presumed cardiac cause, and resuscitation was attempted by the emergency medical services. Fire fighters provided the initial defibrillation to 41 (26.5%) patients presenting in ventricular fibrillation. Survival to hospital discharge for bystander-witnessed ventricular fibrillation cardiac arrests was 21.8%. The mean emergency services (fire and ambulance) response time to cardiac arrest patients was 6.03 (SD, 1.65) minutes. The mean time to defibrillation for ventricular fibrillation patients was 8.75 (SD, 2.07) minutes.

ARTICLE TITLE: Inhaled steroids - too much of a good thing?
ARTICLE SOURCE: Med J Aust (Australia), Sep 16 2002, 177(6) p288-9
AUTHOR(S): Wilson JW; Robertson CF
PUBLICATION TYPE Editorial

ARTICLE TITLE: Assault-related admissions to hospital in Central Australia.
COMMENTS: Comment In: Comment In: RefSource:Med J Aust. 2002 Sep 16; 177(6):286-7
ARTICLE SOURCE: Med J Aust (Australia), Sep 16 2002, 177(6) p300-4
AUTHOR(S): Williams GF; Chaboyer WP; Schluter PJ
AUTHOR'S ADDRESS: NT Department of Health and Community Services, Alice Springs Hospital, NT 0871, Australia. ged.williams@nt.gov.au.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSION: The frequency of assault-related admissions to hospital, especially among the Aboriginal population, suggests that this major public health issue is escalating.

ARTICLE TITLE: Low molecular weight heparins and heparinoids.
ARTICLE SOURCE: Med J Aust (Australia), Oct 7 2002, 177(7) p379-83
AUTHOR(S): Eikelboom JW; Hankey GJ
AUTHOR'S ADDRESS: Department of Haematology, Royal Perth Hospital, GPO Box X2213, Perth, WA 6001, Australia. john.eikelboom@health.wa.gov.au.
PUBLICATION TYPE: Journal Article
Low molecular weight (LMW) heparins should: be avoided or used with caution in patients undergoing neuraxial anaesthesia, owing to the potential for epidural haematoma formation; not be used (ie, are contraindicated) in patients with immune heparin-induced thrombocytopenia, as they may cross-react with anti-heparin antibodies. Conventional unfractionated heparin retains a role in the management of patients at high risk of bleeding, undergoing invasive procedures, and patients with renal failure owing to its shorter half-life, reversibility with protamine sulfate, and extrarenal metabolism. The heparinoid danaparoid sodium is effective for the treatment of heparin-induced thrombocytopenia.

ARTICLE TITLE: The prevention of mental disorders in young people.
ARTICLE SOURCE: Med J Aust (Australia), Oct 7 2002, 177 Suppl pS97-S100
AUTHOR(S): Andrews G; Wilkinson DD
AUTHOR'S ADDRESS: Research Unit for Anxiety Disorders, St Vincent's Hospital, 299 Forbes Street, Darlinghurst, Sydney, NSW 2010, Australia. gavina@crufad.unsw.edu.au.
PUBLICATION TYPE: Journal Article; Review; Review, Academic .
MB. Part of a supplement of 11 articles in 47 pages on depression.

ARTICLE TITLE: Screening for depression in general practice and related medical settings.
ARTICLE SOURCE: Med J Aust (Australia), Oct 7 2002, 177 Suppl pS111-6
AUTHOR(S): Hickie IB; Davenport TA; Ricci CS
AUTHOR'S ADDRESS: beyondblue: the national depression initiative, PO Box 6100, Hawthorn, West, VIC 3122, Australia. ian.hickie@beyondblue.org.au.
PUBLICATION TYPE: Journal Article; Meta-Analysis

ARTICLE TITLE: Warfarin, aspirin, or both after myocardial infarction.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Sep 26; 347(13):1019-22
; Summary For Patients In: Summary For Patients In: RefSource:CMAJ. 2002 Oct 29; 167(9):1036
ARTICLE SOURCE: N Engl J Med (United States), Sep 26 2002, 347(13) p969-74
AUTHOR(S): Hurlen M; Abdelnoor M; Smith P; Erikssen J; Arnesen H
AUTHOR'S ADDRESS: Department of Cardiology, Ulleval University Hospital, Oslo, Norway.
PUBLICATION TYPE: Owner: NLM; Status: Completed
Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: Warfarin, in combination with aspirin or given alone, was superior to aspirin alone in reducing the incidence of composite events after an acute myocardial infarction but was associated with a higher risk of bleeding

ARTICLE TITLE: Walking compared with vigorous exercise for the prevention of cardiovascular events in women.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Sep 5; 347(10):755-6/
ARTICLE SOURCE: N Engl J Med (United States), Sep 5 2002, 347(10) p716-25
AUTHOR(S): Manson JE; Greenland P; La Croix AZ; Stefanick ML; Mouton CP; Oberman A; Perri MG; Sheps DS; Pettinger MB; Siscovick DS
AUTHOR'S ADDRESS: Division of Preventive Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston 02215, USA. jmanson@rics.bwh.harvard.edu.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: These prospective data indicate that both walking and vigorous exercise are associated with substantial reductions in the incidence of cardiovascular events among postmenopausal women, irrespective of race or ethnic group, age, and body-mass index. Prolonged sitting predicts increased cardiovascular risk.
MB. Why over-do yourself?

ARTICLE TITLE: Physical inactivity among young people.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Sep 5; 347(10):709-15
ARTICLE SOURCE: N Engl J Med (United States), Sep 5 2002, 347(10) p706-7
AUTHOR(S): Troiano RP
AUTHOR'S ADDRESS: National Cancer Institute, Bethesda, MD 20892, USA.
PUBLICATION TYPE: Comment; Journal Article
MB. About fat children.

ARTICLE TITLE: Digoxin - new perspective on an old drug.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 31; 347(18):1403-11
ARTICLE SOURCE: N Engl J Med (United States), Oct 31 2002, 347(18) p1394-5
AUTHOR(S): Eichhorn EJ; Gheorghiade M
AUTHOR'S ADDRESS: Medical City Dallas Hospital, Dallas, TX 75230, USA.
PUBLICATION TYPEComment; Historical Article; Journal Article

ARTICLE TITLE: Sex-based differences in the effect of digoxin for the treatment of heart failure.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 31; 347(18):1394-5
ARTICLE SOURCE: N Engl J Med (United States), Oct 31 2002, 347(18) p1403-11
AUTHOR(S): Rathore SS; Wang Y; Krumholz HM
AUTHOR'S ADDRESS: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale-New Haven Hospital, New Haven, Conn, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The effect of digoxin therapy differs between men and women. Digoxin therapy is associated with an increased risk of death from any cause among women, but not men, with heart failure and depressed left ventricular systolic function. [Copyright 2002 Massachusetts Medical
MB. How sad.

ARTICLE TITLE: Aspirin and mortality from coronary bypass surgery.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 24; 347(17):1359-60
ARTICLE SOURCE: N Engl J Med (United States), Oct 24 2002, 347(17) p1309-17
AUTHOR(S): Mangano DT
AUTHOR'S ADDRESS: Ischemia Research and Education Foundation, San Francisco, CA 94134, USA. dtb@iref.org; Collective Name: Multicenter Study of Perioperative Ischemia Research Group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study
CONCLUSIONS: Early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk of death and ischemic complications involving the heart, brain, kidneys, and gastrointestinal tract.

ARTICLE TITLE: Aspirin with bypass surgery--from taboo to new standard of care.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 24; 347(17):1309-17
ARTICLE SOURCE: N Engl J Med (United States), Oct 24 2002, 347(17) p1359-60
AUTHOR(S): Topol EJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Outcomes after total versus subtotal abdominal hysterectomy.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 24; 347(17):1360-2
ARTICLE SOURCE: N Engl J Med (United States), Oct 24 2002, 347(17) p1318-25
AUTHOR(S): Thakar R; Ayers S; Clarkson P; Stanton S; Manyonda I
AUTHOR'S ADDRESS: Department of Gynecology, St. George's Hospital, London, United Kingdom.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Neither subtotal nor total abdominal hysterectomy adversely affects pelvic organ function at 12 months. Subtotal abdominal hysterectomy results in more rapid recovery and fewer short-term complications but infrequently causes cyclical bleeding or cervical prolapse.

ARTICLE TITLE: Nonsurgical reduction of the interventricular septum in patients with hypertrophic cardiomyopathy.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 24; 347(17):1306-7
ARTICLE SOURCE: N Engl J Med (United States), Oct 24 2002, 347(17) p1326-33
AUTHOR(S): Shamim W; Yousufuddin M; Wang D; Henein M; Seggewiss H; Flather M; Coats AJ; Sigwart U
AUTHOR'S ADDRESS: National Heart and Lung Institute, Royal Brompton and Harefield Hospital, Imperial College of Science, Technology and Medicine, London.
PUBLICATION TYPE: Evaluation Studies; Journal Article
METHODS: Sixty-four consecutive patients with hypertrophic cardiomyopathy and a mean (+/-SD) age of 48.5+/-17.2 years underwent nonsurgical reduction of the septum by injection of ethanol into the septal perforator branch of the left anterior descending coronary artery. CONCLUSIONS: Nonsurgical septal reduction leads to sustained improvements in both subjective and objective measures of exercise capacity in association with a persistent reduction in resting and stress-induced left ventricular outflow tract gradients. It is also associated with a high incidence of procedure-related complete heart block, however, often requiring permanent pacing

ARTICLE TITLE: A national survey of provisions in clinical-trial agreements between medical schools and industry sponsors.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 24; 347(17):1362-3
ARTICLE SOURCE: N Engl J Med (United States), Oct 24 2002, 347(17) p1335-41
AUTHOR(S): Schulman KA; Seils DM; Timbie JW; Sugarman J; Dame LA; Weinfurt KP; Mark DB; Califf RM
AUTHOR'S ADDRESS: Center for Clinical and Genetic Economics, Duke University Medical Center, Durham, NC, USA. kevin.schulman@duke.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Academic institutions routinely engage in industry-sponsored research that fails to adhere to International Committee of Medical Journal Editors (ICMJE) guidelines regarding trial design, access to data, and publication rights. Our findings suggest that a reevaluation of the process of contracting for clinical research is urgently needed.
MB. Corruption!

ARTICLE TITLE: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1270-1
ARTICLE SOURCE: N Engl J Med (United States), Oct 17 2002, 347(16) p1227-32
AUTHOR(S): Veronesi U; Cascinelli N; Mariani L; Greco M; Saccozzi R; Luini A; Aguilar M; Marubini E
AUTHOR'S ADDRESS: Department of Senology, European Institute of Oncology, Milan, Italy. umberto.veronesi@ieo.it.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The long-term survival rate among women who undergo breast-conserving surgery is the same as that among women who undergo radical mastectomy. Breast-conserving surgery is therefore the treatment of choice for women with relatively small breast cancers.
MB. It depends on whose doing the choosing.

ARTICLE TITLE: Patient safety: fatigue among clinicians and the safety of patients.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1271-2; Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1272-4
ARTICLE SOURCE: N Engl J Med (United States), Oct 17 2002, 347(16) p1249-55
AUTHOR(S): Gaba DM; Howard SK
AUTHOR'S ADDRESS: Patient Safety Center of Inquiry, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA. gaba@stanford.edu.
PUBLICATION TYPE: Journal Article
MB. This & the next articles are about system reform.

ARTICLE TITLE: Duty hours for resident physicians - tough choices for teaching hospitals.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1271-2
ARTICLE SOURCE: N Engl J Med (United States), Oct 17 2002, 347(16) p1275-8
AUTHOR(S): Weinstein DF
AUTHOR'S ADDRESS: Massachusetts General Hospital, Boston, MA 02114-2696, USA.
PUBLICATION TYPE Journal Article

ARTICLE TITLE: The debate over residents' work hours.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1271-2
ARTICLE SOURCE: N Engl J Med (United States), Oct 17 2002, 347(16) p1296-302
AUTHOR(S): Steinbrook R
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: A series on patient safety.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1249-55
ARTICLE SOURCE: N Engl J Med (United States), Oct 17 2002, 347(16) p1272-4
AUTHOR(S): Leape L; Epstein AM; Hamel MB
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Rethinking medical training - the critical work ahead.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1249-55; Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1275-8; Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 17; 347(16):1296-302
ARTICLE SOURCE: N Engl J Med (United States), Oct 17 2002, 347(16) p1271-2
AUTHOR(S): Drazen JM; Epstein AM
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Defying death - HIV mutation to evade cytotoxic T lymphocytes.
ARTICLE SOURCE: N Engl J Med (United States), Oct 10 2002, 347(15) p1203-4
AUTHOR(S): Lieberman J
AUTHOR'S ADDRESS: Center for Blood Research, Boston, MA 02115, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB. About evolutionary mutation of HIV to be pathogenic in man whereas it's not in the presumptive original host, the chimp.

ARTICLE TITLE: Hyperbaric-oxygen therapy for acute carbon monoxide poisoning.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 3; 347(14):1057-67
ARTICLE SOURCE: N Engl J Med (United States), Oct 3 2002, 347(14) p1105-6
AUTHOR(S): Thom SR
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Hyperbaric oxygen for acute carbon monoxide poisoning.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 3; 347(14):1054-5; Comment In: Comment In: RefSource:N Engl J Med. 2002 Oct 3; 347(14):1105-6
ARTICLE SOURCE: N Engl J Med (United States), Oct 3 2002, 347(14) p1057-67
AUTHOR(S): Weaver LK; Hopkins RO; Chan KJ; Churchill S; Elliott CG; Clemmer TP; Orme JF; Thomas FO; Morris AH
AUTHOR'S ADDRESS: Department of Internal Medicine, Pulmonary and Critical Care Division, LDS Hospital, Salt Lake City, Utah 84143, USA. lweaver@ihc.com.
PUBLICATION TYPE: Status: Completed
Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Three hyperbaric-oxygen treatments within a 24-hour period appeared to reduce the risk of cognitive sequelae 6 weeks and 12 months after acute carbon monoxide poisoning. [Copyright 2002 Massachusetts Medical Society].

ARTICLE TITLE: Carbon monoxide poisoning.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Oct 3; 347(14):1057-67
ARTICLE SOURCE: N Engl J Med (United States), Oct 3 2002, 347(14) p1054-5
AUTHOR(S): Piantadosi CA
AUTHOR'S ADDRESS: Duke University Medical Center, Durham, NC 27710, USA.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Randomized trials in alternative/complementary medicine.
ARTICLE SOURCE: QJM (England), Oct 2002, 95(10) p643-5
AUTHOR(S): Charlton BG
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Paracetamol toxicity: epidemiology, prevention and costs to the health-care system.
ARTICLE SOURCE: QJM (England), Sep 2002, 95(9) p609-19
AUTHOR(S): Sheen CL; Dillon JF; Bateman DN; Simpson KJ; Macdonald TM
AUTHOR'S ADDRESS: Medicines Monitoring Unit, Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee, UK. chris@memo.dundee.ac.uk.
PUBLICATION TYPEJournal Article; Review; Review, Tutorial
ABSTRACT: Paracetamol has been used as an analgesic and antipyretic for many years, with toxicity first noted in the 1960s. Since then the incidence of poisoning has increased, and paracetamol is now the most common drug in self-poisoning, with a high rate of morbidity and mortality. The use, abuse and ways of reducing paracetamol toxicity are reviewed, but in view of the potential for harm, serious consideration should be given to changing the legal status of paracetamol, possibly to a prescription-only medicine.

ARTICLE TITLE: FDA fails to reduce accessibility of paracetamol despite 450 deaths a year.
ARTICLE SOURCE: BMJ (England), Sep 28 2002, 325(7366) p678
AUTHOR(S): Moynihan R
PUBLICATION TYPENews
MB. 26,000 admission & 450 deaths/year in the US!!!!

ARTICLE TITLE: Declining value of preoperative autologous donation.
ARTICLE SOURCE: Transfusion (United States), Jul 2002, 42(7) p819-23
AUTHOR(S): Goldman M; Savard R; Long A; Gelinas S; Germain M
AUTHOR'S ADDRESS: Hema-Quebec, Montreal, Canada. Mindy.Goldman@Hema-Quebec.qc.ca.
PUBLICATION TYPE: Journal Article
CONCLUSION: Patients participating in the PABD program successfully avoided allogeneic transfusion in over 85 percent of cases. However, declining utilization rates and frequent 1-unit transfusions demonstrate the decreasing utility of PABD over time.
MB. They don't say if blood loss has fallen, they've allowed the Hb to fall or that they have just lost interest. There could be greater administrative & other risks with PABD than from regular blood donors.

ARTICLE TITLE: Mortality and morbidity in patients with very low postoperative Hb levels who decline blood transfusion.
ARTICLE SOURCE: Transfusion (United States), Jul 2002, 42(7) p812-8
AUTHOR(S): Carson JL; Noveck H; Berlin JA; Gould SA
AUTHOR'S ADDRESS: Department of Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, USA. carson@umdnj.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The risk of death was low in patients with postoperative Hb levels of 7.1 to 8.0 g per dL, although morbidity occurred in 9.4 percent. As postoperative blood counts fall the risk of mortality and/or morbidity rises and becomes extremely high below 5 to 6 g per dL.

ARTICLE TITLE: Intraoperative blood salvage: a mathematical perspective.
ARTICLE SOURCE: Transfusion (United States), Apr 2002, 42(4) p451-5
AUTHOR(S): Hay SN; Monk TG; Brecher ME
AUTHOR'S ADDRESS: Department of Pathology, University of North Carolina and Transfusion Medicine Service, University of North Carolina Hospitals, Chapel Hill 27514, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: Intraoperative blood salvage (IBS) can be modeled with a convergent geometric series, and the amount of blood loss is dependent on the difference between the patient's starting Hct, the minimum allowable Hct, and the fractional recovery of RBCs. Such modeling illustrates the limited utility of IBS as a sole blood-conservation strategy.
MB. It does encourage surgeons to loose less blood.

ARTICLE TITLE: Hemodynamic and hormonal responses to the sudden interruption of caval flow: insights from a prospective study of hepatic vascular exclusion during major liver resections.
ARTICLE SOURCE: Anesth Analg (United States), Nov 2002, 95(5) p1173-8,
AUTHOR(S): Eyraud D; Richard O; Borie DC; Schaup B; Carayon A; Vezinet C; Movschin M; Vaillant JC; Coriat P; Hannoun L
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care, Groupe Hospitalier Pitie-Salpetriere, Assistance Publique-Hopitaux de Paris, University Pierre et Marie Curie, 47 Boulevard de l'Hopital, 75013 Paris, France. daniel.eyraud@psl.ap-hop-paris.fr.
PUBLICATION TYPEClinical Trial; Journal Article
IMPLICATIONS: Hemodynamic and hormonal responses to the acute interruption of caval venous return to the heart were investigated in patients undergoing liver resection with hepatic vascular exclusion. A compensatory role for arginine vasopressin and sympathetic systems that provoked increased vascular resistance was demonstrated.
MB. I would not have thought the endocrine observations were important. IF the aorta and vena cava are closed simultaneously not much happens. If you monitor radial a, femoral a, femoral v and SVC you can get the 'correct' quantity of blood above & below the clamps

ARTICLE TITLE: Preoperative risk factors of intraoperative hypothermia in major surgery under general anesthesia.
ARTICLE SOURCE: Anesth Analg (United States), Nov 2002, 95(5) p1381-3,
AUTHOR(S): Kasai T; Hirose M; Yaegashi K; Matsukawa T; Takamata A; Tanaka Y
AUTHOR'S ADDRESS: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kamigyoku, Kyoto 602-8566, Japan. kasai@koto.kpu-m.ac.jp.
PUBLICATION TYPE: Clinical Trial; Journal Article
IMPLICATIONS: Increases in age and height and decreases in weight systolic blood pressure and heart rate are major preoperative risk factors of intraoperative hypothermia during major surgery.
MB. Other factors would be more important than the things they elected to measure.

ARTICLE TITLE: Acute postoperative pain management at home after ambulatory surgery: a French pilot survey of general practitioners' views.
ARTICLE SOURCE: Anesth Analg (United States), Nov 2002, 95(5) p1258-62,
AUTHOR(S): Robaux S; Bouaziz H; Cornet C; Boivin JM; Lefevre N; Laxenaire MC
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care Medicine, School of Medicine, University Hospital of Nancy, 29 avenue du Marechal de Lattre de Tassigny, 54035 Nancy Cedex, France.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: We assessed the views of French general practitioners concerning pain relief at home after ambulatory surgery in a cross-sectional prospective survey. The results revealed that there is need for improvement, mainly in prescribing more suitable analgesic protocols and optimizing postdischarge relationships between physicians.

ARTICLE TITLE: A randomized, double-blinded comparison of thoracic epidural ropivacaine, ropivacaine/fentanyl, or bupivacaine/fentanyl for postthoracotomy analgesia.
ARTICLE SOURCE: Anesth Analg (United States), Nov 2002, 95(5) p1344-50,
AUTHOR(S): Macias A; Monedero P; Adame M; Torre W; Fidalgo I; Hidalgo F
AUTHOR'S ADDRESS: Department of Anesthesia and Critical Care, Clinica Universitaria, University of Navarre, Navarre, Spain.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: Thoracic epidural ropivacaine/fentanyl provided adequate pain relief and similar analgesia to bupivacaine/fentanyl during the first 2 postoperative days after posterolateral thoracotomy. Plain 0.2% ropivacaine was associated with worse pain control and an increased incidence of postoperative nausea and vomiting. We conclude that epidural ropivacaine/fentanyl offers no clinical advantage compared with bupivacaine/fentanyl for postthoracotomy analgesia.
MB. Why did they bother doing that study?

ARTICLE TITLE: The auditory steady-state response is not a suitable monitor of anesthesia.
ARTICLE SOURCE: Anesth Analg (United States), Nov 2002, 95(5) p1318-23, table of contents
AUTHOR(S): Pockett S; Tan SM
AUTHOR'S ADDRESS: Department of Physics, University of Auckland, Private Bag 92019, Auckland, New Zealand. s.pockett@auckland.ac.nz.
PUBLICATION TYPE: Journal Article
MB. Good.

ARTICLE TITLE: Epidural anesthesia and analgesia in liver resection.
ARTICLE SOURCE: Anesth Analg (United States), Nov 2002, 95(5) p1179-81,
AUTHOR(S): Matot I; Scheinin O; Eid A; Jurim O
AUTHOR'S ADDRESS: Department of Anesthesiology, Hadassah University Medical Center, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.
PUBLICATION TYPE: Clinical Trial; Journal Article
ABSTRACT: IMPLICATIONS: In patients undergoing major liver resection, the decision to introduce an epidural catheter and the timing of its removal should be made with care because of the prolonged changes in platelet count and in prothrombin time that develop in some patients.
MB. How about not doing it at all? That operation is likely to have lots of blood + coagulation disorders. When will the epidural craze go away?

ARTICLE TITLE: Substance abuse among physicians: a survey of academic anesthesiology programs.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2002, 95(4) p1024-30,
AUTHOR(S): Booth JV; Grossman D; Moore J; Lineberger C; Reynolds JD; Reves JG; Sheffield D
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA. booth006@mc.duke.edu.
PUBLICATION TYPE: Journal Article
Surveys were sent to the department chairs of the 133 US anesthesiology training programs accredited at the end of 1997. There was a response rate of 93%. The incidence of known drug abuse was 1.0% among faculty members and 1.6% among residents. IMPLICATIONS: This survey indicates that the frequency of controlled substance abuse among anesthesiologists has changed little in the past few years, despite an increase in the control and accounting procedures for controlled substances as well as increased mandatory education.

ARTICLE TITLE: The mission of the cochrane anesthesia review group: preparing and disseminating systematic reviews of the effect of health care in anesthesiology.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2002, 95(4) p1012-8,
AUTHOR(S): Pedersen T; Moller AM; Cracknell J
AUTHOR'S ADDRESS: Department of Anesthesiology, Bispebjerg University Hospital, Copenhagen, Denmark. doctp@yahoo.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: This article illustrates the basic principles of evidence-based medicine and the work within the Cochrane Collaboration and the Cochrane Anesthesia Review Group. It describes how important randomized controlled trials and systematic reviews are in providing the best evidence to answer clinically relevant questions.
MB. They'd like to be thought of as missionaries. They are now having doubts. They want more money to help them find evidence that evidence-base is the basis of reality. http://www.smh.com.au/articles/2003/01/17/1042520777393.html

ARTICLE TITLE: Cyclosporine can increase isoflurane MAC.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2002, 95(4) p930-4
AUTHOR(S): Niemann CU; Stabernack C; Serkova N; Jacobsen W; Christians U; Eger EI
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative Care, University of California, San Francisco, California 94143, USA. niemannc@anesthesia.ucsf.edu.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: The immunosuppressive drug, cyclosporine, which is frequently used after organ transplantation, increases the amount of a commonly used anesthetic (isoflurane) necessary to avoid movement to painful stimuli in the rat.

ARTICLE TITLE: Persistent pain after cardiac surgery: an audit of high thoracic epidural and primary opioid analgesia therapies.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2002, 95(4) p820-3,
AUTHOR(S): Ho SC; Royse CF; Royse AG; Penberthy A; McRae R
AUTHOR'S ADDRESS: Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia.
PUBLICATION TYPE: Clinical Trial; Journal Article
IMPLICATIONS: Persistent wound pain after coronary artery bypass surgery is common, but it is usually is mild and infrequently interferes with daily living. An audit of two pain relief strategies (epidural analgesia or opiate analgesia) did not show any difference in the incidence of persistent pain.

ARTICLE TITLE: Propacetamol as adjunctive treatment for postoperative pain after cardiac surgery.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2002, 95(4) p813-9,
AUTHOR(S): Lahtinen P; Kokki H; Hendolin H; Hakala T; Hynynen M
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care and Department of Surgery, Kuopio University Hospital, Kuopio, Finland. pasi.lahtinen@kuh.fi.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: This is the first placebo-controlled study to investigate the efficacy of propacetamol as a complementary analgesic to opioids after cardiac surgery. Propacetamol did not enhance analgesia, nor did it decrease cumulative opioid consumption or reduce adverse effects in a dose of 2 g given every sixth hour for 3 days after surgery.

ARTICLE TITLE: High thoracic epidural anesthesia for coronary artery bypass grafting using two different surgical approaches in conscious patients.
ARTICLE SOURCE: Anesth Analg (United States), Oct 2002, 95(4) p791-7,
AUTHOR(S): Kessler P; Neidhart G; Bremerich DH; Aybek T; Dogan S; Lischke V; Byhahn C
AUTHOR'S ADDRESS: Department of Anesthesiology, J. W. Goethe University Hospital Center, Frankfurt, Germany. p.kessler@em.uni-frankfurt.de.
PUBLICATION TYPE: Journal Article
We investigated the feasibility and complications of sole TEA in 20 patients undergoing beating-heart arterial revascularization via partial lower sternotomy for single-vessel disease (minimally invasive direct coronary artery bypass grafting [MIDCAB] technique; n = 10) or complete median sternotomy for multivessel disease (off-pump coronary artery bypass grafting [OPCAB] technique; n = 10). <snip>. Because of surgical pneumothorax (OPCAB), insufficient anesthesia, or phrenic nerve palsy (both MIDCAB), three patients required intraoperative conversion to general anesthesia. <snip> IMPLICATIONS. The sole use of high thoracic epidural anesthesia was studied in 20 patients who underwent beating-heart coronary artery bypass grafting using either median or partial lower sternotomy while awake.
MB. 15% failure rate. How foolhardy can you get?

ARTICLE TITLE: Public performance reports and the will for change.
COMMENTS: Comment On: Comment On: RefSource:JAMA. 2002 Sep 25; 288(12):1484-90
ARTICLE SOURCE: JAMA (United States), Sep 25 2002, 288(12) p1523-4
AUTHOR(S): Berwick DM
PUBLICATION TYPE: Comment; Editorial
MB. About the pitfalls in trying to fix system faults. You might make it worse.

ARTICLE TITLE: Are bad outcomes from questionable clinical decisions preventable medical errors? A case of cascade iatrogenesis.
ARTICLE SOURCE: Ann Intern Med (United States), Sep 3 2002, 137(5 Part 1) p327-33
AUTHOR(S): Hofer TP; Hayward RA
AUTHOR'S ADDRESS: VA Center for Practice Management and Outcomes Research and the Quality Enhancement Research Initiative (QUERI), VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. thofer@umich.edu.
PUBLICATION TYPE: Journal Article
MB. It's really about safety being achieved by dealing with large numbers rather than trying to work out why errors occurred

ARTICLE TITLE: Mid-career burnout in generalist and specialist physicians.
ARTICLE SOURCE: JAMA (United States), Sep 25 2002, 288(12) p1447-50
AUTHOR(S): Spickard A; Gabbe SG; Christensen JF
AUTHOR'S ADDRESS: Vanderbilt University Medical Center, NAshville, TN, USA. Anderson.Spickard-Jr@vanderbilt.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Depression: a call for papers.
ARTICLE SOURCE: JAMA (United States), Sep 18 2002, 288(11) p1400-1
AUTHOR(S): Glass RM
PUBLICATION TYPE: Editorial
MB. They want evidence-based papers. That's being a bit optimistic.

ARTICLE TITLE: Evaluating the teaching of evidence-based medicine.
COMMENTS: Erratum In: Erratum In: RefSource:JAMA 2002 Nov 13; 288(18):2268
ARTICLE SOURCE: JAMA (United States), Sep 4 2002, 288(9) p1110-2
AUTHOR(S): Hatala R; Guyatt G
AUTHOR'S ADDRESS: Department of Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada.
PUBLICATION TYPE: Editorial
MB. Assuming that evidence is required to do the assessing there is practically none.

ARTICLE TITLE: Pedophilia.
ARTICLE SOURCE: JAMA (United States), Nov 20 2002, 288(19) p2458-65
AUTHOR(S): Fagan PJ; Wise TN; Schmidt CW; Berlin FS
AUTHOR'S ADDRESS: Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Lutherville, Md, USA. pfagan@jhmi.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Pathophysiological characterization of isolated diastolic heart failure in comparison to systolic heart failure.
ARTICLE SOURCE: JAMA (United States), Nov 6 2002, 288(17) p2144-50
AUTHOR(S): Kitzman DW; Little WC; Brubaker PH; Anderson RT; Hundley WG; Marburger CT; Brosnihan B; Morgan TM; Stewart KP
AUTHOR'S ADDRESS: Section of Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045. dkitzman@wfubmc.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: CONTEXT: Many older patients with symptoms of congestive heart failure have a preserved left ventricular ejection fraction (LVEF). However, the pathophysiology of this disorder, presumptively termed diastolic heart failure (DHF), is not well characterized and it is unknown whether it represents true heart failure. OBJECTIVE: To assess the 4 key pathophysiological domains that characterize classic heart failure by systematically performing measurements in older patients with presumed DHF and comparing these results with those from age-matched healthy volunteers and patients with classic systolic heart failure (SHF). DESIGN AND SETTING: Observational clinical investigation conducted in 1998 in a general community and teaching hospital in Winston-Salem, NC. PARTICIPANTS: A total of 147 subjects aged at least 60 years. Fifty-nine had isolated DHF defined as clinically presumed heart failure, LVEF of at least 50%, and no evidence of significant coronary, valvular, or pulmonary disease. Sixty had typical SHF (LVEF < or =35%). Twenty-eight were age-matched healthy volunteer controls. MAIN OUTCOME MEASURES: Left ventricular structure and function, exercise capacity, neuroendocrine function, and quality of life. RESULTS: By echocardiography, mean (SE) LVEF was 60% (2%) in patients with DHF vs 31% (2%) in those with SHF and 54% (2%) in controls. Mean (SE) LV mass-volume ratio was markedly increased in patients with DHF (2.12 [0.14] g/mL) vs those with SHF (1.22 [0.14] g/mL) (P<.001) and vs controls (1.49 [0.17] g/mL) (P =.002). Peak oxygen consumption by expired gas analysis during cycle ergometry was similar in the DHF and SHF groups (14.2 [0.5] and 13.1 [0.5] mL/kg per minute, respectively; P =.40) and in both was markedly reduced compared with healthy controls (19.9 [0.7] mL/kg per minute) (P =.001 for both). Ventilatory anaerobic threshold was similar in the DHF and SHF groups (9.1 [0.3] and 8.7 [0.3]; mL/kg per minute, respectively; P<.001) and in both was reduced compared with healthy controls (11.5 [0.4] mL/kg per minute) (P<.001). Norepinephrine levels were similar in the DHF (306 [64] pg/mL) and SHF (287 [62] pg/mL) groups (P =.56) and in both were markedly increased vs healthy controls (169 [80] pg/mL) (P =.007 and.03, respectively). Brain natriuretic peptide was substantially increased in both the DHF (56 [30] pg/mL) and the SHF (154 [28] pg/mL) groups compared with healthy controls (3 [38] pg/mL) (P =.02 and.001, respectively). Quality-of-life decrement score as assessed by the Minnesota Living with Heart Failure Questionnaire was substantially increased from the benchmark score of 10 in both groups (SHF: 43.8 [3.9]; DHF: 24.8 [4.4]). CONCLUSION: Patients with isolated DHF have similar though not as severe pathophysiologic characteristics compared with patients with typical SHF, including severely reduced exercise capacity, neuroendocrine activation, and impaired quality of life.
MB. I'd been wondering what diastolic failure was. It's cardiac failure with good LV function - like ejection fractions. Well, now you know.

ARTICLE TITLE: Complication rates of scalene regional anesthesia.
COMMENTS: Comment On: Comment On: RefSource:J Bone Joint Surg Am. 2002 May; 84-A(5):775-9
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Oct 2002, 84-A(10) p1891-2; discussion 1892-3
AUTHOR(S): Brown AR; Levine WN
PUBLICATION TYPE: Comment; Letter
MB. 3 letters. One from the original authors. The 2 first letters are postulating excuses & are in denial. Bemumoff found lots of disasters after interscalene blocks for postoperative pain by making several phone calls after he'd been consulted for medico-legal purposes. Beware!
(original article - Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology (United States), Dec 2000, 93(6) p1541-4 Benumof, JL.)

ARTICLE TITLE: Changing patterns of pharmacological thromboprophylaxis use by orthopaedic surgeons in New Zealand.
ARTICLE SOURCE: ANZ J Surg (Australia), May 2002, 72(5) p335-8
AUTHOR(S): Walker N; Rodgers A; Gray H
AUTHOR'S ADDRESS: Clinical Trials ResearchUnit, Department of Medicine, University of Auckland, New Zealand.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Orthopaedic surgeons' use of chemoprophylaxis has increased in New Zealand. However, since hospital stays have decreased considerably and most orthopaedic patients are now discharged within a fortnight,prophylaxis may now cover a shorter duration of the at-risk period.
MB. You are supposed to continue anticoagulants for sometime into the postoperative period.
[Predictors of rehospitalization for symptomatic venous thromboembolism after total hip arthroplasty. N Engl J Med (United States), Dec 14 2000, 343(24) p1758-64 White RH; Gettner S; Newman JM; Trauner KB; Romano PS Department of Medicine, University of California, Davis, Sacramento, USA. rhwhite@ucdavis.edu. CONCLUSIONS: In patients who underwent total hip arthroplasty, a body-mass index of 25 or greater was associated with subsequent hospitalization for thromboembolism. Pneumatic compression in patients with a body-mass index of less than 25 and prophylaxis with warfarin after discharge were independently protective against thromboembolism. ]

ARTICLE TITLE: Deep venous thrombosis prophylaxis: are guidelines being followed?
COMMENTS: Comment In: Comment In: RefSource:ANZ J Surg. 2002 May; 72(5):320
ARTICLE SOURCE: ANZ J Surg (Australia), May 2002, 72(5) p331-4
AUTHOR(S): Ahmad HA; Geissler A; MacLellan DG
AUTHOR'S ADDRESS: Alfred Hospital, Melbourne,Victoria, Australia. hairul_ahmad@hotmail.com.
PUBLICATION TYPE: Journal Article
DISCUSSION: Deep Venous Thrombosis is a major problem among hospitalized patients. However, despite its importance, there is a lack of appropriate prophylaxes being instituted. This, together with the poor performance of the participating clinicians in Part 2 of the present study, indicate that there are significant problems in The Canberra Hospital regarding DVT prophylaxes and that steps need to be taken to overcome these problems.

ARTICLE TITLE: Venous thromboembolism prophylaxis: applying evidence-based guidelines.
COMMENTS: Comment On: Comment On: RefSource:ANZ J Surg. 2002 May; 72(5):331-4
ARTICLE SOURCE: ANZ J Surg (Australia), May 2002, 72(5) p320
AUTHOR(S): Fletcher JP
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Objective assessment of a surgical trainee.
COMMENTS: Comment In: Comment In: RefSource:ANZ J Surg. 2002 May; 72(5):319
ARTICLE SOURCE: ANZ J Surg (Australia), May 2002, 72(5) p325-30
AUTHOR(S): Cheung MT; Yau KK
AUTHOR'S ADDRESS: Department of Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong. qehsurg@ha.org.hk.
PUBLICATION TYPE: Journal Article
CONCLUSION: Our proposed method makes use of recently developed statistical methodology for predicting the effect of surgeons' performance,taking into account variations in their case-mix and their patients' fitness.This approach may serve as a very powerful tool for early assessment of a trainee's clinical proficiency, and may also have implications for the future assessment of a surgeon's clinical standard.

ARTICLE TITLE: Do we now have the tools to assess operative skill?
COMMENTS: Comment On: Comment On: RefSource:ANZ J Surg. 2002 May; 72(5):325-30
ARTICLE SOURCE: ANZ J Surg (Australia), May 2002, 72(5) p319
AUTHOR(S): Martin JA
PUBLICATION TYPEComment; Editorial
MB. Its about the difficulties in fixing system problems. Any changes might make the system worse.

ARTICLE TITLE: Australian audit for the endoluminal repair of abdominal aortic aneurysm: the first 12 months.
ARTICLE SOURCE: ANZ J Surg (Australia), Mar 2002, 72(3) p190-5
AUTHOR(S): Boult M; Babidge W; Anderson J; Denton M; Fitridge R; Harris J; Lawrence-Brown M; May J; Myerstt K; Maddern G
AUTHOR'S ADDRESS: Australian Safety and Efficacy Register of New Interventional Procedures - Surgical Royal Australasian College of Surgeons, North Adelaide, South Australia. College.asernip@surgeons.org.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: The Australian Safety and Efficacy Register for New Interventional Procedures - Surgical (ASERNIP-S) was contracted by the Commonwealth Department of Health and Aged Care to audit the procedure of endoluminal repair of abdominal aortic aneurysm. <snip> RESULTS: By December 2000, ASERNIP-S had collected data on approximately 85% of privately performed ELG procedures during the first year of the audit. The early mortality rate was 1.3% in the endoluminal group compared to 2.6% in the open group. The rate of procedural complications was 15% in both groups, but the percentage of systemic complications was higher following the open repair. Aneurysm size and the number of pre-existing conditions had a statistically significant relationship to the variation in the number of complications for ELG patients. <snip>
MB. They located patients from medicare co-payments records. I suppose they then assumed that the public ones were being reported too.

ARTICLE TITLE: II: Should we demand fresh red blood cells for perioperative and critically ill patients?
COMMENTS: Comment On: Comment On: RefSource:Br J Anaesth. 2002 Jan; 88(1):6-9
ARTICLE SOURCE: Br J Anaesth (England), Oct 2002, 89(4) p537-40
AUTHOR(S): McLellan SA; Walsh TS; McClellan DB
PUBLICATION TYPE: Comment; Editorial
MB. They correctly say no as the hypothesised advantage of fresh blood for coagulopahties has not been shown.

ARTICLE TITLE: Phenotyping malignant hyperthermia susceptibility by measuring halothane-induced changes in myoplasmic calcium concentration in cultured human skeletal muscle cells.
ARTICLE SOURCE: Br J Anaesth (England), Oct 2002, 89(4) p571-9
AUTHOR(S): Girard T; Treves S; Censier K; Mueller CR; Zorzato F; Urwyler A
AUTHOR'S ADDRESS: Departments of Anaesthesiology and Research, Kantonsspital/University of Basel, CH-4031 Basel, Switzerland.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Measurements of [Ca(2+)](i) in human skeletal muscle cells can be used to phenotype MH susceptibility; however, we did not observe a specific effect of any mutation in the RYR1 gene on the halothane-induced increase in [Ca(2+)](i).
MB. The text sounds vague. I don't think they are claiming specificity.

ARTICLE TITLE: Pathophysiology and clinical implications of perioperative fluid excess.
ARTICLE SOURCE: Br J Anaesth (England), Oct 2002, 89(4) p622-32
AUTHOR(S): Holte K; Sharrock NE; Kehlet H
AUTHOR'S ADDRESS: Department of Surgical Gastroenterology, Hvidovre University Hospital, DK-2650 Hvidovre, Denmark.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB. There are two paradigms regarding the fluid/endocrine response to trauma. One is that there is a temporary (days) shift of effective extracellular volume (into the traumatised tissue) after trauma. Extra intravenous fluid would be the rational treatment during that period and a reduction immediately after. The other is that there is an endocrine response to trauma causing fluid & electrolyte retention. The rational response would be fluid restriction. This review is biased toward the latter. It pushes 'evidence based' orthodoxy/fashion in suggesting the first paradigm is flawed by lack of evidence. Kehlet, a travelling salesman who has been to Australia, is also associated with the next article about acute pain services which he is pushing in spite of having to record that there is little 'evidence base' for that.
'Evidence base' is a scientific heresy derived from the discarded logical positivism of the 1950s. It was the latest attempt of establishing pure empiricism.
The tone of the review suggests blind studies of recipes. This is naïve & would be almost impossible to do in an ideal manner. Crude recipes attributed to Shires & to Moore might be inappropriate & produce overloading or renal failure respectively. The range of volumes & composition of IV fluids which would result in no cardiovascular damage or renal failure would, in the absence of cardiovascular/renal impairment, not be critical. Post traumatic/operative renal failure was the commonest indication for dialysis before Shires. It's now practically non-existant. Post operative cardiac failure without cardiac disease is uncommon. Post-operative respiratory failure is not due to IV fluids.

ARTICLE TITLE: Does an acute pain service improve postoperative outcome?
ARTICLE SOURCE: Anesth Analg (United States), Nov 2002, 95(5) p1361-72,
AUTHOR(S): Werner MU; Soholm L; Rotboll-Nielsen P; Kehlet H
AUTHOR'S ADDRESS: Acute Pain Service, Department of Anesthesiology 532, Hvidovre University Hospital, 2650 Hvidovre, Denmark. madswerner@medscape.com.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
MB. This group, of which at least one member is a passionate proselytiser for acute pains services (APSs), are getting desperate as there aren't trials showing cost benefits for APSs. They are worried that they could be closed down.

ARTICLE TITLE: Effectiveness of acute postoperative pain management: I. Evidence from published data.
ARTICLE SOURCE: Br J Anaesth (England), Sep 2002, 89(3) p409-23
AUTHOR(S): Dolin SJ; Cashman JN; Bland JM
AUTHOR'S ADDRESS: Pain Clinic, St Richard's Hospital, Chichester PO19 4E, UK.
PUBLICATION TYPEJournal Article; Meta-Analysis; Review; Review, Academic
CONCLUSIONS: These results suggest that the UK Audit Commission (1997) proposed standards of care might be unachievable using current analgesic techniques. The data may be useful in setting standards of care for Acute Pain .
MB. This is what should have been predicted before idealistic ideological standards were set. I realised in the 1960s that I'd have to be there if epidurals were used and that pilot studies indicated 90% satisfaction for nurse-controlled analgesia in the 1980s. Better than 90% success has never been claimed for more complex methods of post-operative analgesia. This review excludes 'satisfaction' because they can't document it. That's hardly a reason to decide to ignore it.
The MASTERS study showed no real benefit & also showed that even under experimental conditions about 50% of the study group did not get the full intended treatment, thus illustrating that acute pain services are impractical. This article shows that they are ineffective.

ARTICLE TITLE: The stuck central venous catheter: beware of potential hazards.
ARTICLE SOURCE: Br J Anaesth (England), Oct 2002, 89(4) p650-2
AUTHOR(S): Mahadeva S; Cohen A; Bellamy M
AUTHOR'S ADDRESS: Intensive Care Unit, St James's Hospital, Beckett Street, Leeds LS9 7TF, UK.
PUBLICATION TYPE: Journal Article
This case report details how one catheter was damaged during the insertion of a second catheter. The problem was discovered when the catheter could not be removed, and was subsequently removed after dissection.

ARTICLE TITLE: Maternal deaths from anaesthesia. An extract from Why mothers die 1997-1999, the Confidential Enquiries into Maternal Deaths in the United Kingdom.
ARTICLE SOURCE: Br J Anaesth (England), Sep 2002, 89(3) p499-508
AUTHOR(S): Thomas TA; Cooper GM
AUTHOR'S ADDRESS: Department of Anaesthesia, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK; Collective Name: Editorial Board of the Confidential Enquiries into Maternal Deaths in the United Kingdom.
PUBLICATION TYPE: Journal Article; Review; Review of Reported Cases
MB. Complex cases.

ARTICLE TITLE: Confidential enquiries into maternal deaths, 1997-1999.
ARTICLE SOURCE: Br J Anaesth (England), Sep 2002, 89(3) p369-72
AUTHOR(S): Cooper GM; Lewis G; Neilson J
PUBLICATION TYPE: Editorial
MB. Worth looking at but as the causes are now vaguer its probably not possible to fix the problems as appeared possible in the past. There are many deaths associated with caesarian which have greatly increased in number and associated with ICU including long periods in ICUs. Causation would be difficult/impossible to deliniate

ARTICLE TITLE: Epidural analgesia and backache: a randomized controlled comparison with intramuscular meperidine for analgesia during labour.
ARTICLE SOURCE: Br J Anaesth (England), Sep 2002, 89(3) p466-72
AUTHOR(S): Loughnan BA; Carli F; Romney M; Dore CJ; Gordon H
AUTHOR'S ADDRESS: Departments of Anaesthesia and Obstetrics and Gynaecology, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Epidural analgesia in labour was not associated with an increase in the prevalence or incidence of backache.

ARTICLE TITLE: Effect of propofol anaesthesia on the event-related potential mismatch negativity and the auditory-evoked potential N1.
ARTICLE SOURCE: Br J Anaesth (England), Sep 2002, 89(3) p382-8
AUTHOR(S): Simpson TP; Manara AR; Kane NM; Barton RL; Rowlands CA; Butler SR
AUTHOR'S ADDRESS: Department of Anaesthesia, Frenchay Hospital, Frenchay Park Road, Bristol BS16 1LE, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Studies on the effects of anaesthesia on event-related potentials and long latency auditory-evoked potentials CONCLUSIONS: Mismatch negativity (MMN) is unlikely to be a clinically useful tool to detect awareness in surgical patients. In contrast, the loss of N1 may identify the transition from consciousness to unconsciousness and deserves further study.
MB. As consciousness is not part of the material world, trying to seek to deduce consciousness form electro-physiological signals is futile.

ARTICLE TITLE: Impaired explicit memory after recovery from propofol/sufentanil anaesthesia is related to changes in the midlatency auditory evoked response.
ARTICLE SOURCE: Br J Anaesth (England), Sep 2002, 89(3) p376-81
AUTHOR(S): Rundshagen I; Schnabel K; Schulte am Esch J
AUTHOR'S ADDRESS: Department of Anaesthesiology, University Hospital Charite, Campus Charite Mitte, Schumannstrasse 20/21, D-10117 Berlin, Germany.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Large intra- and inter-individual variability in the midlatency auditory evoked responses (MLAER) values limited their ability to predict memory responses in individual patients during emergence from propofol/sufentanil anaesthesia.
MB. That means it failed. The title of the article should have been "Impaired explicit memory after recovery from propofol/sufentanil anaesthesia is not related to changes in the midlatency auditory evoked response."

ARTICLE TITLE: Blood transfusion in surgical practice - matching supply to demand.
COMMENTS: Comment On: Comment On: RefSource:Br J Anaesth. 2002 Aug; 89(2):221-5
ARTICLE SOURCE: Br J Anaesth (England), Aug 2002, 89(2) p214-6
AUTHOR(S): Howie JC; Tansey PJ
PUBLICATION TYPE: Comment; Editorial
MB. Anaesthetists have to understand the methods of supplying blood without having to cross match. This has been around for must be nearly 20 years.