ARTICLE TITLE: Computer control versus manual control of systemic
hypertension during cardiac surgery
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 2001, 45(5)
p553-7
AUTHOR(S): Hoeksel SA; Blom JA; Jansen JR; Maessen JG; Schreuder
JJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Cardiovascular
Research Institute, Maastricht University, Maastricht, The
Netherlands.
PUBLICATION TYPE: Journal Article
CONCLUSION: We conclude that, compared with manual control, computer
control of systemic hypertension significantly improved hemodynamic
stability during cardiac surgery.
ARTICLE TITLE: Compliance with postoperative instructions: a
telephone survey of 750 day surgery patients.
COMMENTS: Anaesthesia. 2001 May; 56(5):405-7
ARTICLE SOURCE: Anaesthesia (England), May 2001, 56(5) p481-4
AUTHOR(S): Correa R; Menezes RB; Wong J; Yogendran S; Jenkins K;
Chung F
AUTHOR'S ADDRESS: Coventry School of Anaesthesia, Walsgrave Hospital,
Coventry, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: Patients undergoing day surgical procedures are given
postoperative instructions not to drink alcohol, drive vehicles or
make important decisions for 24 h. They are also advised to have a
responsible adult stay with them at home overnight. Seven hundred and
fifty patients were telephoned at 24 h postoperatively to determine
their compliance with these instructions. Four per cent of patients
drove vehicles, 1.8% consumed alcohol, while one patient made an
important decision. A higher proportion of patients (5%) drove after
general anaesthesia than regional anaesthesia or intravenous sedation
(2.4%). The percentage of patients consuming alcohol was similar in
both groups (1.8% vs. 1.9%). Four per cent of patients had no one
staying with them overnight despite being accompanied out of the
hospital. Patient compliance with instructions to not drink alcohol,
drive or make important decisions may be improved by physician
reinforcement of instructions and patient education.
ARTICLE TITLE: Postoperative instructions: good compliance but is
the advice sound?
COMMENTS: Anaesthesia. 2001 May; 56(5):481-4/21248280
ARTICLE SOURCE: Anaesthesia (England), May 2001, 56(5) p405-7
AUTHOR(S): Smith I
PUBLICATION TYPE: Comment; Editorial
MB: Conclusion that it is better to be safe than sorry
ARTICLE TITLE: Regional anaesthesia for limb surgery--before or
after general anaesthesia. A survey of anaesthetists in the Oxford
region.
ARTICLE SOURCE: Anaesthesia (England), May 2001, 56(5) p450-3
AUTHOR(S): Kadry MA; Rutter SV; Popat MT
AUTHOR'S ADDRESS: Nuffield Department of Anaesthetics, Oxford
Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
miramasr@genie.co.uk.
PUBLICATION TYPE: Journal Article
ABSTRACT: We conducted a postal survey of 221 anaesthetists in the
Oxford region to determine their views and actual clinical practice
regarding regional anaesthesia in adult patients undergoing limb
surgery, when a combined regional and general anaesthetic was
planned. Of the 162 respondents (73.3%), 142 (87.6%) regularly
practised regional blocks for limb surgery in adult patients. For all
the regional anaesthetic techniques in question, more anaesthetists
felt it was safer to perform these blocks before induction of general
anaesthesia than after induction. However, their actual practice
varied markedly from their views, with more anaesthetists performing
these blocks after general anaesthesia. Overall, trainees performed
blocks before induction of general anaesthesia more often than
consultants (p = 0.047).
MB: The registrars were better.
ARTICLE TITLE: Airway fire due to diathermy during tracheostomy in
an intensive care patient.
ARTICLE SOURCE: Anaesthesia (England), May 2001, 56(5) p441-3
AUTHOR(S): Rogers SA; Mills KG; Tufail Z
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, The
Cardiothoracic Centre, Liverpool, UK.
PUBLICATION TYPE: Journal Article; Review; Review of Reported
Cases
ABSTRACT: We describe a case of airway fire in an 83-year-old,
critically ill patient. The fire occurred during a surgical
tracheostomy under general anaesthesia, following ignition of the
tracheal tube by diathermy. After debridement of the burnt tissue and
treatment with intravenous antibiotics and glucocorticoids, the
patient's respiratory function worsened initially. The patient
eventually recovered without long-term sequelae and was discharged
from the intensive care unit. The circumstances of this and other
similar incidents are reviewed, as are the suggested methods for
preventing this frightening occurrence.
MB: The pateint was having 100% oxygen, IPPR + PEEP. The tube was
pulled back before opening the trachea with the diathermy. The tube
burnt.
ARTICLE TITLE: Who discovered circulation of blood?
ARTICLE SOURCE: Ann Intern Med (United States), May 15 2001, 134(10)
p1008-9
AUTHOR(S): Cheng TO
MAJOR SUBJECT HEADING(S): Blood Circulation
MINOR SUBJECT HEADING(S): History of Medicine, Ancient
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: Biography; Historical Article; Letter
MEDLINE INDEXING DATE: 200105
ISSN: 0003-4819
LANGUAGE: English
ARTICLE TITLE: Beta-blockers in congestive heart failure. A
Bayesian meta-analysis.
ARTICLE SOURCE: Ann Intern Med (United States), Apr 3 2001, 134(7)
p550-60
AUTHOR(S): Brophy JM; Joseph L; Rouleau JL
AUTHOR'S ADDRESS: Service de Cardiologie, Centre Hospitalier de
l'Universite de Montreal, Pavillon Notre-Dame, 1560 rue Sherbrooke
Est, Montreal, Quebec H2L 4M1, Canada. jbroph@po-box.mcgill.ca.
PUBLICATION TYPE: Journal Article; Meta-Analysis
ABSTRACT: PURPOSE: Congestive heart failure is an important cause of
patient morbidity and mortality. Although several randomized clinical
trials have compared beta-blockers with placebo for treatment of
congestive heart failure, a meta-analysis quantifying the effect on
mortality and morbidity has not been performed recently. DATA
SOURCES: The MEDLINE, Cochrane, and Web of Science electronic
databases were searched from 1966 to July 2000. References were also
identified from bibliographies of pertinent articles. STUDY
SELECTION: All randomized clinical trials of beta-blockers versus
placebo in chronic stable congestive heart failure were included.
DATA EXTRACTION: A specified protocol was followed to extract data on
patient characteristics, beta-blocker used, overall mortality,
hospitalizations for congestive heart failure, and study quality.
DATA SYNTHESIS: A hierarchical random-effects model was used to
synthesize the results. A total of 22 trials involving 10 135
patients were identified. There were 624 deaths among 4862 patients
randomly assigned to placebo and 444 deaths among 5273 patients
assigned to beta-blocker therapy. In these groups, 754 and 540
patients, respectively, required hospitalization for congestive heart
failure. The probability that beta-blocker therapy reduced total
mortality and hospitalizations for congestive heart failure was
almost 100%. The best estimates of these advantages are 3.8 lives
saved and 4 fewer hospitalizations per 100 patients treated in the
first year after therapy. The probability that these benefits are
clinically significant (>2 lives saved or >2 fewer
hospitalizations per 100 patients treated) is 99%. Both selective and
nonselective agents produced these salutary effects. The results are
robust to any reasonable publication bias. CONCLUSIONS: beta-Blocker
therapy is associated with clinically meaningful reductions in
mortality and morbidity in patients with stable congestive heart
failure and should be routinely offered to all patients similar to
those included in trials.
ARTICLE TITLE: Is it time for a new approach to the initial
treatment of hypertension?
ARTICLE SOURCE: Arch Intern Med (United States), May 14 2001, 161(9)
p1140-4
AUTHOR(S): Moser M
AUTHOR'S ADDRESS: 13 Murray Hill Rd, Scarsdale, NY 10583, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: Epidemiologic review of the calcium channel blocker
drugs. An up-to-date perspective on the proposed hazards.
ARTICLE SOURCE: Arch Intern Med (United States), May 14 2001, 161(9)
p1145-58
AUTHOR(S): Kizer JR; Kimmel SE
AUTHOR'S ADDRESS: MSc, University of Pennsylvania School of Medicine,
717 Blockley Hall, 423 Guardian Dr, Philadelphia, PA 19104-6021, USA.
skimmel@cceb.med.upenn.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: In the setting of soaring popularity, postmarketing studies
of calcium channel blockers came to suggest an increase in a variety
of major adverse end points. The evidence, however, was largely
observational, and large-scale trials capable of addressing the
concerns were wanting. Clinical trials now support the safety and
efficacy of the long-acting dihydropyridines for patients with both
uncomplicated and diabetic hypertension, although conventional
therapies and, in the latter case, angiotensin-converting enzyme
inhibitors have superior proof of benefit. By contrast, short-acting
dihydropyridines should be avoided. In the acute coronary syndromes,
beta-blockers remain the treatment of choice; the evidence for
nondihydropyridines remains inconclusive. Stable angina calls for
beta-blockers as first-line therapy and nondihydropyridines as
second-line therapy, whereas in ventricular dysfunction, safety data
for nondihydropyridines are lacking. Initial reports of cancer,
bleeding, and suicide have been contradicted by subsequent data,
making the associations uncertain or unlikely. Remaining questions
await completion of ongoing trials to better define the indications
for these agents.
ARTICLE TITLE: Management of severe hypokalemia in hospitalized
patients: a study of quality of care based on computerized
databases.
ARTICLE SOURCE: Arch Intern Med (United States), Apr 23 2001, 161(8)
p1089-95
AUTHOR(S): Paltiel O; Salakhov E; Ronen I; Berg D; Israeli A
AUTHOR'S ADDRESS: Department of Social Medicine, PO Box 12000,
Hadassah Medical Center, Jerusalem 91120, Israel.
ora@vms.huji.ac.il.
PUBLICATION TYPE: Evaluation Studies; Journal Article
CONCLUSIONS: The computerized laboratory database is useful in
ascertaining the prevalence of severe hypokalemia and in assessing
shortcomings in its management. Databases can be used to derive valid
and efficient measures of the quality of the clinical management of
electrolyte disorders.
ARTICLE TITLE: Are aneroid sphygmomanometers accurate in hospital
and clinic settings?
ARTICLE SOURCE: Arch Intern Med (United States), Mar 12 2001, 161(5)
p729-31
AUTHOR(S): Canzanello VJ; Jensen PL; Schwartz GL
AUTHOR'S ADDRESS: Division of Hypertension, Mayo Clinic, 200 First St
SW, Rochester, MN 55905, USA. canzanello.vincent@mayo.edu.
PUBLICATION TYPE: Evaluation Studies; Journal Article
Virtually 100% of the values from the aneroid device were within the
4-mm Hg range recommended by the Association for the Advancement of
Medical Instrumentation. CONCLUSION: Aneroid sphygmomanometers
provide accurate pressure measurements when a proper maintenance
protocol is followed.
MB: We still have a Hg policy, ie no aneroids. Are our NIBP
alright?
ARTICLE TITLE: Hungary curbs drug company advertising.
ARTICLE SOURCE: BMJ (England), Apr 21 2001, 322(7292) p947
AUTHOR(S): Kovac C
PUBLICATION TYPE: News
MB: Almost everything is banned. How long before it happens here? The
drug companies seem similar to the tobacco companies.
ARTICLE TITLE: Marketing: Are you being duped?
ARTICLE SOURCE: BMJ (England), May 26 2001, 322(7297) p1312
AUTHOR(S): Jackson T
PUBLICATION TYPE: Journal Article
MB: We are.
ARTICLE TITLE: Industry strongly supports continuing medical
education.
ARTICLE SOURCE: JAMA (United States), Apr 18 2001, 285(15)
p2012-4
AUTHOR(S): Holmer AF
AUTHOR'S ADDRESS: c/o Anne Oman, Pharmaceutical Research and
Manufacturers of America, 1100 15th St, NW, Washington, DC 20005,
USA. aoman@phrma.org.
PUBLICATION TYPE: Journal Article
MB: This & the next article are incompatible.
ARTICLE TITLE: Separating continuing medical education from
pharmaceutical marketing.
ARTICLE SOURCE: JAMA (United States), Apr 18 2001, 285(15)
p2009-12
AUTHOR(S): Relman AS
AUTHOR'S ADDRESS: Department of Medicine, Channing Laboratory,
Harvard Medical School and Brigham and Women's Hospital, 181 Longwood
Ave, Boston, MA 02115, USA. arelman@rics.bwh.harvard.edu.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Antibiotics for acute bronchitis.
ARTICLE SOURCE: BMJ (England), Apr 21 2001, 322(7292) p939-40
AUTHOR(S): Arroll B; Kenealy T
PUBLICATION TYPE: Editorial
MB: Critical of the concept of acute bronchitis. I have always
thought it was vague.
ARTICLE TITLE: Surgeons' attitudes to intraoperative death:
questionnaire survey.
ARTICLE SOURCE: BMJ (England), Apr 14 2001, 322(7291) p896-7
AUTHOR(S): Smith IC; Jones MW
AUTHOR'S ADDRESS: Department of Trauma and Orthopaedics, Ysbyty
Gwynedd, Bangor, Gwynedd LL57 2PW, UK. lasoksmith@aol.com.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Safer discharge from intensive care to hospital
wards. Randomisation is necessary to disentangle intrinsic patient
risk from effects of care
ARTICLE SOURCE: BMJ (England), May 26 2001, 322(7297) p1261-2
AUTHOR(S): McPherson K
AUTHOR'S ADDRESS: London School of Hygiene and Tropical Medicine,
London WC1E 7HT.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Reduction in mortality after inappropriate early
discharge from intensive care unit: logistic regression triage
model
ARTICLE SOURCE: BMJ (England), May 26 2001, 322(7297) p1274
AUTHOR(S): Daly K; Beale R; Chang RW
AUTHOR'S ADDRESS: St Thomas's Hospital, London SE1 7EH.
PUBLICATION TYPE: Journal Article
Conclusions: The discharge mortality of at risk patients may be
reduced by 39% if they remain in intensive care units for another 48
hours. The discharge triage model to identify patients at risk from
too early and inappropriate discharge from intensive care may help
doctors to make the difficult clinical decision of whom to discharge
to make room for a patient requiring urgent admission to the unit. If
confirmed, this study has implications on the provision of
resources.
MB: Sounds like a good idea.
ARTICLE TITLE: An ethical dilemma: Medical errors and medical
culture
ARTICLE SOURCE: BMJ (England), May 19 2001, 322(7296) p1236-40
PUBLICATION TYPE: Journal Article
MB: An error is recalled which occurred to a house officer 15 years
& was covered up. It is not clear if this is an actual case or
fiction as a source for discussion.
ARTICLE TITLE: TV: The execution of Timothy McVeigh: must see
TV?
ARTICLE SOURCE: BMJ (England), May 19 2001, 322(7296) p1254
AUTHOR(S): Derbyshire SW
AUTHOR'S ADDRESS: University of Pittsburgh Medical Center, USA.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Shipman inquiry to investigate 466 deaths [In
Process Citation]
ARTICLE SOURCE: BMJ (England), May 19 2001, 322(7296) p1201B
AUTHOR(S): Dyer C
PUBLICATION TYPE: Journal Article
MB: Wow!
ARTICLE TITLE: Reduction of postoperative mortality and morbidity.
Little information was given on inclusion criteria
ARTICLE SOURCE: BMJ (England), May 12 2001, 322(7295) p1182;
discussion 1182-3
AUTHOR(S): McCulloch TJ; Loadsman JA
PUBLICATION TYPE: Letter
MB: About the meta-analysis of regional anaesthesia on surgical
outcome.
ARTICLE TITLE: New Zealand's new health sector reforms: back to
the future?
ARTICLE SOURCE: BMJ (England), May 12 2001, 322(7295) p1171-4
AUTHOR(S): Devlin N; Maynard A; Mays N
AUTHOR'S ADDRESS: Department of Economics, University of Otago, PO
Box 56, Dunedin, New Zealand.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Study confirms that screening reduces deaths from
breast cancer
ARTICLE SOURCE: BMJ (England), May 12 2001, 322(7295) p1140B
AUTHOR(S): Mayor S
AUTHOR'S ADDRESS: London.
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Newly available treatments for nicotine addiction.
Smokers wanting help with stopping now have effective treatment
options
ARTICLE SOURCE: BMJ (England), May 5 2001, 322(7294) p1076-7
AUTHOR(S): Coleman T; West R
AUTHOR'S ADDRESS: Department of General Practice and Primary Health
Care, Leicester Warwick Medical School, Leicester General Hospital,
Leicester LE5 4PW (tjc3@le.ac.uk).
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: BMJ bans "accidents". Accidents are not
unpredictable
ARTICLE SOURCE: BMJ (England), Jun 2 2001, 322(7298) p1320-1
AUTHOR(S): Davis RM; Pless B
AUTHOR'S ADDRESS: BMJ (rdavis1@hfhs.org).
PUBLICATION TYPE: Journal Article
MB:They are banning the word ie car crash rather than car
accident.
ARTICLE TITLE: Transfusion of blood components and postoperative
infection in patients undergoing cardiac surgery
ARTICLE SOURCE: Chest (United States), May 2001, 119(5) p1461-8
AUTHOR(S): Leal-Noval SR; Rincon-Ferrari MD; Garcia-Curiel A;
Herruzo-Aviles A; Camacho-Larana P; Garnacho-Montero J; Amaya-Villar
R
AUTHOR'S ADDRESS: Critical Care Division (Drs. Leal-Noval,
Rincon-Ferrari, Herruzo-Aviles, Camacho-Larana, Garnacho-Montero, and
Amaya-Villar) and the Microbiology Division (Dr. Garcia-Curiel),
Hospital Universitario "Virgen del Rocio," Seville, Spain.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To investigate the influence of blood
derivatives on the acquisition of severe postoperative infection
(SPI) in patients undergoing heart surgery. SETTING: The
postoperative ICUs of a tertiary-level university hospital. DESIGN: A
cohort study. METHODS: During a 4-year period, 738 patients,
classified as patients with SPIs and patients without SPIs (non-SPI
patients), were included in the study. We studied the influence of 36
variables on the development of SPI in general and individually for
pneumonia, mediastinitis, and/or septicemia. The influence of the
blood derivatives on infections was assessed for RBC concentrates,
RBC and plasma, and RBC and platelets. RESULTS: Seventy patients
(9.4%) were classified as having SPIs, and 668 (90.6%) were
classified as not having SPIs. After multivariate analysis, the
variables associated with SPI (incidence, 9.4%) were reintubation,
sternal dehiscence, mechanical ventilation (MV) for >/= 48 h,
reintervention, neurologic dysfunction, transfusion of >/= 4 U
RBCs, and systemic arterial hypotension. The variables associated
with nosocomial pneumonia (incidence, 5.9%) were reintubation, MV for
>/= 48 h, neurologic dysfunction, transfusion of >/= 4 U blood
components, and arterial hypotension. The variables associated with
mediastinitis (incidence, 2.3%) were reintervention and sternal
dehiscence, and those associated with sepsis (incidence, 1.6%) were
reintubation, time of bypass >/= 110 min, and MV for >/= 48 h.
The mortality rate (patients with SPI, 52.8%; non-SPI patients, 8.2%;
p < 0.001) and mean (+/- SD) length of stay in the ICU (patients
with SPI, 15.8 +/- 12.9 days; non-SPI patients, 4.5 +/- 4.4 days; p
< 0.001) were greater for the infected patients. The transfused
patients also had a greater mortality rate (13.3% vs 8.9%,
respectively; p < 0.001) and a longer mean stay in the ICU (6.1
+/- 7.2 days vs 3.7 +/- 2.8 days, respectively; p < 0.01) than
those not transfused. CONCLUSION: The administration of blood
derivatives, mainly RBCs, was associated in a dose-dependent manner
with the development of SPIs, primarily nosocomial pneumonia.
MB: They were not investigating the influence but the association. It
would not be surprising that those given blood products were the ones
who got infections. It was similar when they associated blood
transfusion with worse outcomes in bowel cancer. When will editors
start rejecting articles attributing causation when only association
is shown? Courts do not allow guilt by association alone.
ARTICLE TITLE: Empiric antibiotic therapy and mortality among
medicare pneumonia inpatients in 10 western states : 1993, 1995, and
1997
ARTICLE SOURCE: Chest (United States), May 2001, 119(5) p1420-6
AUTHOR(S): Houck PM; MacLehose RF; Niederman MS; Lowery JK
AUTHOR'S ADDRESS: Health Care Financing Administration (Drs. Houck
and Lowery, and Mr. MacLehose), Region 10, Seattle, WA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Study objectives: To examine the association of empiric
inpatient antibiotic treatment of community-acquired pneumonia (CAP)
with mortality, and whether this association varies from year to
year. DESIGN: Population-based, retrospective study adjusting for
demographics, comorbidities, and clinical characteristics. SETTING:
Acute-care hospitals in 10 western states. PATIENTS: A group of
10,069 Medicare beneficiaries aged >/= 65 years who were
hospitalized with CAP during fiscal years 1993, 1995, and 1997.
Measurements and results: We examined the risk for mortality during
the 30 days after admission to the hospital. The impact of specific
antibiotic regimens varied greatly from year to year. In 1993,
therapy with a macrolide plus a beta-lactam was associated with
significantly lower mortality than therapy with either a beta-lactam
alone (adjusted odds ratio [AOR], 0.42; 95% confidence
interval [CI], 0.25 to 0.69) or other regimens that did not
include a macrolide, beta-lactam, or fluoroquinolone (AOR, 0.35; 95%
CI, 0.20 to 0.62). Those associations were not observed in 1995 or
1997. Lower mortality was associated with fluoroquinolone monotherapy
compared with beta-lactam monotherapy in 1997 (AOR, 0.27; 95% CI,
0.07 to 0.96) and with macrolide monotherapy compared with other
regimens in 1995 (AOR, 0.24; 95% CI, 0.06 to 0.93), but the number of
patients who received these regimens was small. CONCLUSIONS: The
inclusion of a macrolide or a fluoroquinolone in initial empiric CAP
treatment was associated with improved survival, but this association
varied from year to year, perhaps as a result of a temporal variation
in the incidence of atypical pathogen pneumonia. Improved testing and
surveillance for atypical pathogen pneumonia are needed to guide
empiric therapy.
MB: May be its due to differences in marketing of antibiotics.
ARTICLE TITLE: Pulmonary artery catheterization in the
ICU/critical care unit : indications and contraindications remain
objectively undefined.
ARTICLE SOURCE: Chest (United States), Apr 2001, 119(4) p999-1000
AUTHOR(S): Spodick DH
PUBLICATION TYPE: Editorial
ARTICLE TITLE: Complications of percutaneous tracheostomy.
ARTICLE SOURCE: Chest (United States), Apr 2001, 119(4) p1282-3
AUTHOR(S): Briche T; Le Manach Y; Pats B
AUTHOR'S ADDRESS: Department of Ear, Nose, Throat, Head and Neck
Surgery, Hopital d'Instruction des Armees Percy, Clamart Cedex,
France. t_briche@club-internet.fr.
PUBLICATION TYPE: Journal Article
ABSTRACT: Percutaneous tracheostomy is a technique that, reputedly,
is simple to perform and causes few complications. It is routinely
used in intensive care. We present two patients with tracheal
stenosis. In one patient, we had to perform an anastomotic resection
to cure the patient; in the other patient, we had to place an
endoluminal conformer. To our knowledge, this complication has not
been reported in association with the use of this technique.
ARTICLE TITLE: Propofol vs midazolam for ICU sedation : a Canadian
multicenter randomized trial.
ARTICLE SOURCE: Chest (United States), Apr 2001, 119(4) p1151-9
AUTHOR(S): Hall RI; Sandham D; Cardinal P; Tweeddale M; Moher D; Wang
X; Anis AH
AUTHOR'S ADDRESS: Department of Anesthesia, Queen Elizabeth II Health
Sciences Centre, Halifax, Nova Scotia, Canada. rihall@is.dal.ca;
Collective Name: Study Investigators.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study;
Randomized Controlled Trial
ABSTRACT: STUDY OBJECTIVES: To determine whether sedation with
propofol would lead to shorter times to tracheal extubation and ICU
length of stay than sedation with midazolam. DESIGN: Multicenter,
randomized, open label. SETTING: Four academic tertiary-care ICUs in
Canada. PATIENTS: Critically ill patients requiring continuous
sedation while receiving mechanical ventilation. INTERVENTIONS:
Random allocation by predicted requirement for mechanical ventilation
(short sedation stratum, < 24 h; medium sedation stratum, > or
= 24 and < 72 h; and long sedation stratum, > or = 72 h) to
sedation regimens utilizing propofol or midazolam. MEASUREMENTS AND
RESULTS: Using an intention-to-treat analysis, patients randomized to
receive propofol in the short sedation stratum (propofol, 21
patients; midazolam, 26 patients) and the long sedation stratum
(propofol, 4 patients; midazolam, 10 patients) were extubated earlier
(short sedation stratum: propofol, 5.6 h; midazolam, 11.9 h; long
sedation stratum: propofol, 8.4 h; midazolam, 46.8 h; p < 0.05).
Pooled results showed that patients treated with propofol (n = 46)
were extubated earlier than those treated with midazolam (n = 53)
(6.7 vs 24.7 h, respectively; p < 0.05) following discontinuation
of the sedation but were not discharged from ICU earlier (94.0 vs
63.7 h, respectively; p = 0.26). Propofol-treated patients spent a
larger percentage of time at the target Ramsay sedation level than
midazolam-treated patients (60.2% vs 44.0%, respectively; p <
0.05). Using a treatment-received analysis, propofol sedation either
did not differ from midazolam sedation in time to tracheal extubation
or ICU discharge (sedation duration, < 24 h) or was associated
with earlier tracheal extubation but longer time to ICU discharge
(sedation duration, > or = 24 h, < 72 h, or > or = 72 h).
CONCLUSIONS: The use of propofol sedation allowed for more rapid
tracheal extubation than when midazolam sedation was employed. This
did not result in earlier ICU discharge.
MB: Between 1964 & 1972 before we had an ICU I treated many
patients with prolonged intubation. None were sedated or paralysed.
Their patients did not require sedation. They sedated them.
ARTICLE TITLE: Differential regulation of contractility and nitric
oxide sensitivity in gravid and nongravid myometrium during late
pregnancy in a marsupial
ARTICLE SOURCE: Endocrinology (United States), Jun 2001, 142(6)
p2244-51
AUTHOR(S): Ingram JN; Renfree MB; Shaw G
AUTHOR'S ADDRESS: Department of Zoology, University of Melbourne,
Victoria, 3010, Australia.
PUBLICATION TYPE: Journal Article
ABSTRACT: Marsupials have two anatomically separate uteri; and in
macropodids (kangaroos and wallabies), there is a single ovulation
from alternate ovaries in each cycle. During late pregnancy, the two
uteri are differentially regulated by local hormonal influences from
the corpus luteum, the fetus, and placenta on one side and by the
developing Graafian follicle on the other. In this study, we report
striking differences in contractile behavior of nongravid and gravid
myometrium from the tammar wallaby (Macropus eugenii) in late
pregnancy and immediately post partum. Nongravid myometrium, from the
uterus ipsilateral to a Graafian follicle, was spontaneously active
but unresponsive to the oxytocic peptide mesotocin and the smooth
muscle relaxant nitric oxide. Myometrium from the contralateral,
gravid uterus, which contained a conceptus and was associated with an
active corpus luteum, was not spontaneously active. Gravid myometrium
became increasingly sensitive to mesotocin stimulation as pregnancy
progressed, and nitric oxide induced marked relaxation at all stages
examined, by a guanylyl-cyclase mediated pathway. These results
provide further evidence that the two uteri of marsupials are under
differential control, suggesting that local endocrine and paracrine
influences, derived from the ovaries, the fetus, and placenta, can
regulate concurrent but distinct physiological responses in the
reproductive tracts of these mammals.
MB: A bit of Oz zoology.
ARTICLE TITLE: A case of awareness with sevoflurane and epidural
anesthesia in ovarian tumorectomy
ARTICLE SOURCE: J Clin Anesth (United States), May 2001, 13(3)
p227-9
AUTHOR(S): Miura S; Kashimoto S; Yamaguchi T; Matsukawa T
PUBLICATION TYPE: Journal Article
ABSTRACT: We experienced a case of awareness during ovarian
tumorectomy in a patient who was anesthetized with sevoflurane and
epidural anesthesia. A 74-year-old woman was scheduled for resection
of an ovarian tumor. After epidural catheter insertion, anesthesia
was induced with 60 mg of propofol and 6 mg of vecuronium, and
anesthesia was maintained with epidural anesthesia (1% mepivacaine),
1 to 2% sevoflurane, and 66% nitrous oxide in oxygen. The operative
course was uneventful and the total operation time was 2 hours and 50
minutes. Two days after the operation, we were surprised to learn
that the patient complained of awareness during the surgery.
ARTICLE TITLE: Foot and mouth disease: why not vaccinate?
ARTICLE SOURCE: J R Soc Med (England), Jun 2001, 94(6) p263-4
AUTHOR(S): Beale J
AUTHOR'S ADDRESS: The Priest's House, Sissinghurst Castle, Cranbrook
TN17 2AB, UK.
PUBLICATION TYPE: Journal Article
MB: Its quite complex. It's worth looking at the full text.
ARTICLE TITLE: From the Centers for Disease Control and
Prevention. Trends in screening for colorectal cancer--United States,
1997 and 1999.
ARTICLE SOURCE: JAMA (United States), Mar 28 2001, 285(12)
p1570-1
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: JAMA patient page. Bullying.
ARTICLE SOURCE: JAMA (United States), Apr 25 2001, 285(16) p2156
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Bullying behaviors among US youth: prevalence and
association with psychosocial adjustment.
COMMENTS: JAMA. 2001 Apr 25; 285(16):2131-2/21211683
ARTICLE SOURCE: JAMA (United States), Apr 25 2001, 285(16)
p2094-100
AUTHOR(S): Nansel TR; Overpeck M; Pilla RS; Ruan WJ; Simons-Morton B;
Scheidt P
AUTHOR'S ADDRESS: Division of Epidemiology, Statistics, and
Prevention Research, National Institute of Child Health and Human
Development, 6100 Executive Blvd, Room 7B05, MSC 7510, Bethesda, MD
20892-7510, USA. nanselt@mail.nih.gov.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The prevalence of bullying among US youth is
substantial. Given the concurrent behavioral and emotional
difficulties associated with bullying, as well as the potential
long-term negative outcomes for these youth, the issue of bullying
merits serious attention, both for future research and preventive
intervention.
ARTICLE TITLE: Should patients with heart disease drink
alcohol?
COMMENTS: JAMA. 2001 Apr 18; 285(15):1965-70/21206198; : JAMA. 2001
Apr 18; 285(15):1971-7/21206199
ARTICLE SOURCE: JAMA (United States), Apr 18 2001, 285(15)
p2004-6
AUTHOR(S): Klatsky AL
PUBLICATION TYPE: Comment; Editorial
MB: Not so clear cut.
ARTICLE TITLE: Moderate alcohol consumption and risk of heart
failure among older persons.
COMMENTS: JAMA. 2001 Apr 18; 285(15):2004-6/21206205
ARTICLE SOURCE: JAMA (United States), Apr 18 2001, 285(15)
p1971-7
AUTHOR(S): Abramson JL; Williams SA; Krumholz HM; Vaccarino V
AUTHOR'S ADDRESS: Emory University School of Medicine, Department of
Medicine, Division of Cardiology, 1256 Briarcliff Rd NE, Suite 1
North, Atlanta, GA 30306, USA. jerome@ecor.cardio.emory.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Increasing levels of moderate alcohol consumption are
associated with a decreasing risk of heart failure among older
persons. This association is independent of a number of confounding
factors and does not appear to be entirely mediated by a reduction in
MI risk.
ARTICLE TITLE: Prior alcohol consumption and mortality following
acute myocardial infarction.
COMMENTS: JAMA. 2001 Apr 18; 285(15):2004-6/21206205
ARTICLE SOURCE: JAMA (United States), Apr 18 2001, 285(15)
p1965-70
AUTHOR(S): Mukamal KJ; Maclure M; Muller JE; Sherwood JB; Mittleman
MA
AUTHOR'S ADDRESS: Division of General Medicine and Primary Care, Beth
Israel Deaconess Medical Center, 330 Brookline Ave, LY-303, Boston,
MA 02215, USA. kmukamal@caregroup.harvard.edu.
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: CONTEXT: Studies have found that individuals who consume 1
alcoholic drink every 1 to 2 days have a lower risk of a first acute
myocardial infarction (AMI) than abstainers or heavy drinkers, but
the effect of prior drinking on mortality after AMI is uncertain.
CONCLUSION: Self-reported moderate alcohol consumption in the year
prior to AMI is associated with reduced mortality following
infarction.
ARTICLE TITLE: Predictors of cardiac events after major vascular
surgery: Role of clinical characteristics, dobutamine
echocardiography, and beta-blocker therapy.
ARTICLE SOURCE: JAMA (United States), Apr 11 2001, 285(14)
p1865-73
AUTHOR(S): Boersma E; Poldermans D; Bax JJ; Steyerberg EW; Thomson
IR; Banga JD; van De Ven LL; van Urk H; Roelandt JR
AUTHOR'S ADDRESS: University Hospital Rotterdam, Department of
Surgery, Room H921, Dr Molewaterplein 40, 3015 GD Rotterdam, the
Netherlands. poldermans@hlkd.azr.nl; Collective Name: DECREASE Study
Group (Dutch Echocardiographic Cardiac Risk Evaluation Applying
Stress Echocardiogrpahy).
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: CONTEXT: Patients who undergo major vascular surgery are at
increased risk of perioperative cardiac complications. High-risk
patients can be identified by clinical factors and noninvasive
cardiac testing, such as dobutamine stress echocardiography (DSE);
however, such noninvasive imaging techniques carry significant
disadvantages. A recent study found that perioperative beta-blocker
therapy reduces complication rates in high-risk individuals.
OBJECTIVE: To examine the relationship of clinical characteristics,
DSE results, beta-blocker therapy, and cardiac events in patients
undergoing major vascular surgery. DESIGN AND SETTING: Cohort study
conducted in 1996-1999 in the following 8 centers: Erasmus Medical
Centre and Sint Clara Ziekenhuis, Rotterdam, Twee Steden Ziekenhuis,
Tilburg, Academisch Ziekenhuis Utrecht, Utrecht, and Medisch Centrum
Alkmaar, Alkmaar, the Netherlands; Ziekenhuis Middelheim, Antwerp,
Belgium; and San Gerardo Hospital, Monza, Istituto di Ricovero e Cura
a Carattere Scientifico, San Giovanni Rotondo, Italy. PATIENTS: A
total of 1351 consecutive patients scheduled for major vascular
surgery; DSE was performed in 1097 patients (81%), and 360 (27%)
received beta-blocker therapy. MAIN OUTCOME MEASURE: Cardiac death or
nonfatal myocardial infarction within 30 days after surgery, compared
by clinical characteristics, DSE results, and beta-blocker use.
RESULTS: Forty-five patients (3.3%) had perioperative cardiac death
or nonfatal myocardial infarction. In multivariable analysis,
important clinical determinants of adverse outcome were age 70 years
or older; current or prior angina pectoris; and prior myocardial
infarction, heart failure, or cerebrovascular accident. Eighty-three
percent of patients had less than 3 clinical risk factors. Among this
subgroup, patients receiving beta-blockers had a lower risk of
cardiac complications (0.8% [2/263]) than those not receiving
beta-blockers (2.3% [20/855]), and DSE had minimal additional
prognostic value. In patients with 3 or more risk factors (17%), DSE
provided additional prognostic information, for patients without
stress-induced ischemia had much lower risk of events than those with
stress-induced ischemia (among those receiving beta-blockers, 2.0%
[1/50] vs 10.6% [5/47]). Moreover, patients with
limited stress-induced ischemia (1-4 segments) experienced fewer
cardiac events (2.8% [1/36]) than those with more extensive
ischemia (>/=5 segments, 36% [4/11]). CONCLUSION: The
additional predictive value of DSE is limited in clinically low-risk
patients receiving beta-blockers. In clinical practice, DSE may be
avoided in a large number of patients who can proceed safely for
surgery without delay. In clinically intermediate- and high-risk
patients receiving beta-blockers, DSE may help identify those in whom
surgery can still be performed and those in whom cardiac
revascularization should be considered.
MB: This might just mean that lots more people should be on
beta-blockers.
ARTICLE TITLE: Oregon physicians' attitudes about and experiences
with end-of-life care since passage of the Oregon Death with Dignity
Act.
ARTICLE SOURCE: JAMA (United States), May 9 2001, 285(18) p2363-9
AUTHOR(S): Ganzini L; Nelson HD; Lee MA; Kraemer DF; Schmidt TA;
Delorit MA
AUTHOR'S ADDRESS: Mental Health Division, P31DMH, Portland VA Medical
Center, PO Box 1034, Portland, OR 97207, USA. ganzinil@ohsu.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: Most Oregon physicians who care for terminally ill
patients report that since 1994 they have made efforts to improve
their ability to care for these patients and many have had
conversations with patients about assisted suicide.
ARTICLE TITLE: JAMA patient page. Cholesterol and atherosclerosis
[In Process Citation]
ARTICLE SOURCE: JAMA (United States), May 16 2001, 285(19) p2536
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Morbidity and mortality associated with large-bore
percutaneous venovenous bypass cannulation for 312 orthotopic liver
transplantations
ARTICLE SOURCE: Liver Transpl (United States), Apr 2001, 7(4)
p359-62
AUTHOR(S): Budd JM; Isaac JL; Bennett J; Freeman JW
AUTHOR'S ADDRESS: Featherstone Department of Anaesthetics and
Intensive Care, University Hospital Birmingham NHS Trust, Queen
Elizabeth Hospital, Edgbaston, Birmingham, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: The aim of this study is to establish the incidence of
serious morbidity and mortality associated with the placement of
large-bore (18 to 20 F) percutaneous bypass cannulae for venovenous
bypass (VVBP) during orthotopic liver transplantation (OLT). This
technique has been reported to be rapid, simple, and safe. We
reviewed the case notes of 312 patients who underwent OLT in our
center using this technique. We describe 4 cases of serious morbidity
(incidence, 1.28%) and 1 death (incidence, 0.32%) related directly to
percutaneous placement of the bypass cannula. We conclude that
percutaneous cannula placement for VVBP during OLT has the potential
for life-threatening complications, and this must be considered when
electing to use this technique. When percutaneous cannulae are to be
used, we recommend the use of the right internal jugular vein for
return cannulation and the use of ultrasound guidance, particularly
in those patients in whom cannulation is predictably difficult.
MB: We have had some problems.
ARTICLE TITLE: Cardiac resuscitation.
ARTICLE SOURCE: N Engl J Med (United States), Apr 26 2001, 344(17)
p1304-13
AUTHOR(S): Eisenberg MS; Mengert TJ
AUTHOR'S ADDRESS: Department of Medicine, University of Washington,
Seattle, USA. gingy@u.washington.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: The diagnosis of brain death.
COMMENTS: N Engl J Med. 2001 Apr 19; 344(16):1244-6/21183378
ARTICLE SOURCE: N Engl J Med (United States), Apr 19 2001, 344(16)
p1215-21
AUTHOR(S): Wijdicks EF
AUTHOR'S ADDRESS: Department of Neurology, Mayo Clinic, Rochester,
Minn 55905, USA. Wijde@mayo.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: Brain death--well settled yet still unresolved.
COMMENTS: N Engl J Med. 2001 Apr 19; 344(16):1215-21/21183373
ARTICLE SOURCE: N Engl J Med (United States), Apr 19 2001, 344(16)
p1244-6
AUTHOR(S): Capron AM
PUBLICATION TYPE: Comment; Editorial
MB: It points out a lot of the philosophical muddles which have
resulted form a word with an ordinary language meaning by being
qualified 'death'.
ARTICLE TITLE: Atrial fibrillation.
ARTICLE SOURCE: N Engl J Med (United States), Apr 5 2001, 344(14)
p1067-78
AUTHOR(S): Falk RH
AUTHOR'S ADDRESS: Section of Cardiology, Boston Medical Center, MA
02118, USA. rfalk@bu.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: Expanding indications for beta-blockers in heart
failure
ARTICLE SOURCE: N Engl J Med (United States), May 31 2001, 344(22)
p1711-2
AUTHOR(S): Braunwald E
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Amyotrophic lateral sclerosis
ARTICLE SOURCE: N Engl J Med (United States), May 31 2001, 344(22)
p1688-700
AUTHOR(S): Rowland LP; Shneider NA
AUTHOR'S ADDRESS: Neurological Institute, Columbia-Persbyterian
Medical Center, New York-Presbyterian Hospital, and Columbia
University College of Physicians and Surgeons, NY 10032, USA.
lprl@columbia.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: Is the placebo powerless? An analysis of clinical
trials comparing placebo with no treatment.
COMMENTS: N Engl J Med. 2001 May 24; 344(21):1603-7/21245206; : N
Engl J Med. 2001 May 24; 344(21):1630-2
ARTICLE SOURCE: N Engl J Med (United States), May 24 2001, 344(21)
p1594-602
AUTHOR(S): Hrobjartsson A; Gotzsche PC
AUTHOR'S ADDRESS: Department of Medical Philosophy and Clinical
Theory, University of Copenhagen, Panum Institute, and the Nordic
Cochrane Centre, Rigshospitalet, Denmark.
a.hrobjartsson@cochrane.dk.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
CONCLUSIONS: We found little evidence in general that placebos had
powerful clinical effects. Although placebos had no significant
effects on objective or binary outcomes, they had possible small
benefits in studies with continuous subjective outcomes and for the
treatment of pain. Outside the setting of clinical trials, there is
no justification for the use of placebos.
ARTICLE TITLE: Use of transesophageal echocardiography to guide
cardioversion in patients with atrial fibrillation.
COMMENTS: N Engl J Med. 2001 May 10; 344(19):1468-70
ARTICLE SOURCE: N Engl J Med (United States), May 10 2001, 344(19)
p1411-20
AUTHOR(S): Klein AL; Grimm RA; Murray RD; Apperson-Hansen C; Asinger
RW; Black IW; Davidoff R; Erbel R; Halperin JL; Orsinelli DA; Porter
TR; Stoddard MF
AUTHOR'S ADDRESS: Cleveland Clinic Foundation, Department of
Cardiology, OH 44195, USA. kleina@ccf.org; Collective Name:
Assessment of Cardioversion Using Transesophageal Echocardiography
Investigators.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study;
Randomized Controlled Trial
ABSTRACT: BACKGROUND: The conventional treatment strategy for
patients with atrial fibrillation who are to undergo electrical
cardioversion is to prescribe warfarin for anticoagulation for three
weeks before cardioversion. It has been proposed that if
transesophageal echocardiography reveals no atrial thrombus,
cardioversion may be performed safely after only a short period of
anticoagulant therapy.. RESULTS: There was no significant difference
between the two treatment groups in the rate of embolic events (five
embolic events among 619 patients in the
transesophageal-echocardiography group [0.8 percent]) vs.
three among 603 patients in the conventional-treatment group [0.5
percent], P=0.50). However, the rate of hemorrhagic events was
significantly lower in the transesophageal-echocardiography group (18
events [2.9 percent] vs. 33 events [5.5 percent],
P=0.03). Patients in the transesophageal-echocardiography group also
had a shorter time to cardioversion (mean [+/-SD], 3.0+/-5.6
vs. 30.6+/-10.6 days, P<0.001) and a greater rate of successful
restoration of sinus rhythm (440 patients [71.1 percent] vs.
393 patients [65.2 percent], P=0.03). At eight weeks, there
were no significant differences between the two groups in the rates
of death or maintenance of sinus rhythm or in functional status.
CONCLUSIONS: The use of transesophageal echocardiography to guide the
management of atrial fibrillation may be considered a clinically
effective alternative strategy to conventional therapy for patients
in whom elective cardioversion is planned.
ARTICLE TITLE: Strategies for cardioversion of atrial
fibrillation--time for a change?
COMMENTS: N Engl J Med. 2001 May 10; 344(19):1411-20
ARTICLE SOURCE: N Engl J Med (United States), May 10 2001, 344(19)
p1468-70
AUTHOR(S): Silverman DI; Manning WJ
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Racial disparities in medical care.
COMMENTS: N Engl J Med. 2001 May 10; 344(19):1443-9
ARTICLE SOURCE: N Engl J Med (United States), May 10 2001, 344(19)
p1471-3
AUTHOR(S): Epstein AM; Ayanian JZ
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Racial differences in the response to
drugs--pointers to genetic differences.
COMMENTS: N Engl J Med. 2001 May 3; 344(18):1351-7/21215437; : N Engl
J Med. 2001 May 3; 344(18):1358-65/21215438; : N Engl J Med. 2001 May
3; 344(18):1392-3/21215445
ARTICLE SOURCE: N Engl J Med (United States), May 3 2001, 344(18)
p1394-6
AUTHOR(S): Wood AJ
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Prostate-specific-antigen testing for early
diagnosis of prostate cancer.
ARTICLE SOURCE: N Engl J Med (United States), May 3 2001, 344(18)
p1373-7
AUTHOR(S): Barry MJ
AUTHOR'S ADDRESS: Medical Practices Evaluation Center, Massachusetts
General Hospital, and Department of Medicine, Harvard Medical School,
Boston 02114, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ARTICLE TITLE: 'Balanced analgesia' in the perioperative period:
is there a place for ketamine? [In Process Citation]
ARTICLE SOURCE: Pain (Netherlands), Jun 2001, 92(3) p373-80
AUTHOR(S): De Kock M; Lavand'homme P; Waterloos H
AUTHOR'S ADDRESS: Department of Anesthesiology, University of
Louvain, St. Luc Hospital, Avenue Hippocrate 10-1821, 1200, Brussels,
Belgium.
PUBLICATION TYPE: Journal Article
These observations support the theory that subanesthetic doses of
i.v. ketamine (0.5 mg/kg bolus followed by 0.25 mg/kg per h) given
during anesthesia reduce wound hyperalgesia and are a useful adjuvant
in perioperative balanced analgesia. Moreover, they show that the
systemic route clearly is the preferential route.
ARTICLE TITLE: A prospective, randomized study comparing
percutaneous with surgical tracheostomy in critically ill
patients
ARTICLE SOURCE: Crit Care Med (United States), May 2001, 29(5)
p926-30
AUTHOR(S): Freeman BD; Isabella K; Cobb JP; Boyle WA; Schmieg RE;
Kolleff MH; Lin N; Saak T; Thompson EC; Buchman TG
AUTHOR'S ADDRESS: Department of Surgery, Washington University School
of Medicine, St. Louis, MO, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To determine the relative cost-effectiveness of
percutaneous dilational tracheostomy (PDT) and surgical tracheostomy
(ST) in critically ill patients. DESIGN: Prospective randomized study
CONCLUSIONS: PDT is a cost-effective alternative to ST. The reduction
in patient charges associated with PDT in this study resulted from
the procedure being performed in the intensive care unit, thus
eliminating the need for operating room facilities and personnel. PDT
may become the procedure of choice for electively establishing
tracheostomy in the appropriately selected patient who requires
long-term mechanical ventilation.
ARTICLE TITLE: Sodium bicarbonate and intracellular acidosis: myth
or reality?
ARTICLE SOURCE: Crit Care Med (United States), May 2001, 29(5)
p1088-90
AUTHOR(S): Cuhaci B; Lee J; Ahmed Z
PUBLICATION TYPE: Editorial
ARTICLE TITLE: Will this magic bullet fly true?
ARTICLE SOURCE: Crit Care Med (United States), Apr 2001, 29(4)
p911-3
AUTHOR(S): Sladen RN
PUBLICATION TYPE: Editorial
MB:It is about the uselessness of dopamine and the hope that
penoldofan might fix the kidneys. They have only tried it on dogs and
the results were only suggestive. So I am not expecting any great
advance.
ARTICLE TITLE: Multicenter study of obstetric admissions to 14
intensive care units in southern England [In Process
Citation]
ARTICLE SOURCE: Crit Care Med (United States), Apr 2001, 29(4)
p770-5
AUTHOR(S): Hazelgrove JF; Price C; Pappachan VJ; Smith GB
AUTHOR'S ADDRESS: Department of Intensive Care Medicine, Queen
Alexandra Hospital, Portsmouth, UK.
PUBLICATION TYPE: Journal Article
.CONCLUSIONS: Existing databases can both identify critically ill
obstetrical patients and provide important information about them.
Obstetrical ICU admissions often require minimal intervention and are
associated with low mortality rates. Many might be more appropriately
managed in an a high-dependency environment (HDU). The commonly used
severity of illness scoring systems are good discriminators of
outcome from intensive care admission in this group but may
overestimate mortality rates. Severity of illness scoring systems may
require modification in obstetrical patients to adjust for the normal
physiologic responses to pregnancy.
ARTICLE TITLE: Sepsis-induced adrenal deficiency syndrome
ARTICLE SOURCE: Crit Care Med (United States), Mar 2001, 29(3)
p688-90
AUTHOR(S): Zaloga GP
PUBLICATION TYPE: Editorial
MB: Don't hold your breath. It's all speculation.
ARTICLE TITLE: Improved survival in cancer patients requiring
mechanical ventilatory support: impact of noninvasive mechanical
ventilatory support
ARTICLE SOURCE: Crit Care Med (United States), Mar 2001, 29(3)
p519-25
AUTHOR(S): Azoulay E; Alberti C; Bornstain C; Leleu G; Moreau D;
Recher C; Chevret S; Le Gall JR; Brochard L; Schlemmer B
AUTHOR'S ADDRESS: Medical Intensive Care Unit, Saint Louis University
Hospital and University Paris 7, France.
elie.azoulay@sls.ap-hop-paris.fr.
PUBLICATION TYPE: Journal Article
OBJECTIVE: When a cancer patient becomes critically ill, mechanical
ventilation (MV) is often considered futile. However, recent studies
have found that outcomes of critically ill cancer patients have been
improving over the years and that classic predictors of high
mortality have lost their relevance. DESIGN: We retrospectively
determined outcomes and predictors of 30-day mortality in 237
mechanically-ventilated cancer patients admitted to the intensive
care unit (ICU). CONCLUSION: Our results confirm that mortality has
improved over the past decade in critically ill cancer patients, even
those who require mechanical ventilation (MV), and suggest that this
may be, in part, because of a protective effect of and noninvasive MV
(NIMV).
MB: I have noticed that we have a lot of patients after palliative
surgery for inoperable cancer survive to walk out of hospital on
their feet after <24 hours in ICU on a ventilator
ARTICLE TITLE: Is blood transfusion good for the heart?
COMMENTS: Crit Care Med. 2001 Feb; 29(2):227-34/21142199
ARTICLE SOURCE: Crit Care Med (United States), Feb 2001, 29(2)
p442-4
AUTHOR(S): Surgenor SD; Hampers MJ; Corwin HL
PUBLICATION TYPE: Comment; Editorial; Review; Review, Tutorial
MB: About fiddling with the haemoglobin level in ICU and the
possibility that some with myocardial ischaemia might do better with
a Hb > 7g%.
ARTICLE TITLE: Families looking back: one year after discussion of
withdrawal or withholding of life-sustaining support.
COMMENTS: Crit Care Med. 2001 Jan; 29(1):217-9/21040828
ARTICLE SOURCE: Crit Care Med (United States), Jan 2001, 29(1)
p197-201
AUTHOR(S): Abbott KH; Sago JG; Breen CM; Abernethy AP; Tulsky JA
AUTHOR'S ADDRESS: Program on the Medical Encounter and Palliative
Care, Durham VA Medical Center, NC, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Many families perceived conflict during end-of-life
treatment discussions in the ICU. Conflicts centered on communication
and behavior of staff. Families identified pastoral care and prior
discussion of treatment preferences as sources of psychosocial
support during these discussions. Families sought comfort in the
identification and contact of a "doctor-in-charge." ICU policies such
as family conference rooms and lenient visitation accommodate
families during end-of-life decision-making.
ARTICLE TITLE: Conflict over communication and unprofessional
staff behavior: a common source of dissatisfaction during the
withdrawal of care?
COMMENTS: Crit Care Med. 2001 Jan; 29(1):197-201/21040818
ARTICLE SOURCE: Crit Care Med (United States), Jan 2001, 29(1)
p217-9
AUTHOR(S): McGee DC; Shigemitsu H; Henig NR; Raffin TA
PUBLICATION TYPE: Comment; Editorial
ARTICLE TITLE: Readmission to the intensive care unit after liver
transplantation.
COMMENTS: Crit Care Med. 2001 Jan; 29(1):207-8/21040822
ARTICLE SOURCE: Crit Care Med (United States), Jan 2001, 29(1)
p18-24
AUTHOR(S): Levy MF; Greene L; Ramsay MA; Jennings LW; Ramsay KJ; Meng
J; Hein HA; Goldstein RM; Husberg BS; Gonwa TA; Klintmalm GB
AUTHOR'S ADDRESS: Department of Transplant Services, Baylor
University Medical Center, Dallas, TX 75246-2096, USA.
mf.levy@baylordallas.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: We conclude that the most important means of preventing
ICU readmission in liver transplantation patients is to optimize
cardiopulmonary function and status. Close monitoring of fluid
balance to avoid hypervolemia is essential. Readmitted patients have
a greater resource utilization and have lower survival rates.
ARTICLE TITLE: Whiplash: a review of a commonly misunderstood
injury [In Process Citation]
ARTICLE SOURCE: Am J Med (United States), Jun 1 2001, 110(8)
p651-6
AUTHOR(S): Eck JC; Hodges SD; Humphreys SC
AUTHOR'S ADDRESS: University of Health Sciences (JCE), College of
Osteopathic Medicine, Kansas City, Missouri, USA.
PUBLICATION TYPE: Journal Article
Historically, a soft cervical collar has been used early after the
injury in an attempt to restrict cervical range of motion and limit
the chances of further injury. More recent studies report rest and
restriction of motion to be detrimental and to slow the healing
process.
ARTICLE TITLE: Current role of beta-adrenergic blockers in the
management of chronic heart failure
ARTICLE SOURCE: Am J Med (United States), May 7 2001, 110 Suppl 7A
p81-94
AUTHOR(S): Packer M
AUTHOR'S ADDRESS: Division of Circulatory Physiology and The Heart
Failure Center, Columbia University, College of Physicians and
Surgeons, New York, New York, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Long-term activation of the sympathetic nervous system
exerts adverse biologic effects that are mediated through alpha(1),
beta(1) and beta(2) receptors and that contribute importantly to the
progression of heart failure. As a result, beta blockers are no
longer considered to be contraindicated for use in these patients but
instead now play a critical role in the successful management of
chronic heart failure. Beta blockers have been evaluated in
>15,000 patients with heart failure who have participated in
placebo-controlled trials. The results of these studies indicate
that, like angiotensin-converting enzyme (ACE) inhibitors, long-term
treatment with beta blockers can lessen symptoms and improve clinical
status and can reduce the risk of death as well as the combined risk
of death or hospitalization. The database supporting the use of beta
blockers is now as persuasive (and arguably more persuasive) than the
database supporting the use of ACE inhibitors in heart failure (which
comprises about 7,000 patients). Yet, the benefits of beta blockers
are seen in patients already receiving ACE inhibitors, suggesting
that combined blockade of two neurohormonal systems
(renin-angiotensin system and sympathetic nervous system) can produce
additive effects.
MB: What would have happened if the beta-blockers had been looked at
first.
ARTICLE TITLE: Medical management of mild-to-moderate heart
failure before the advent of beta
ARTICLE SOURCE: Am J Med (United States), May 7 2001, 110 Suppl 7A
p47-62
AUTHOR(S): Abraham WT; Wagoner LE
AUTHOR'S ADDRESS: Division of Cardiovascular Medicine, Gill Heart
Institute, University of Kentucky College of Medicine, (WTA),
Lexington, Kentucky, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Clinical trials of beta blockers in heart failure have
generally required that patients be receiving optimal drug therapy
before randomization to the study medication. Therefore, because beta
blockers are used in addition to conventional drug therapy, review of
the standard drug therapy of mild-to-moderate heart failure before
the advent of beta blockade is essential to understanding the role of
beta blockers in the treatment of heart failure. The conventional
medical management of systolic heart failure includes
angiotensin-converting enzyme (ACE) inhibitors, which should be used
as first-line therapy; diuretics, for the management of body
fluid-volume excess; digoxin; and some other vasodilators. These
therapies have been evaluated in large-scale, randomized, controlled
trials. ACE inhibitors have been shown to significantly attenuate
disease progression and improve outcome (ie, morbidity and mortality)
in patients with mild-to-moderate systolic heart failure.
Controversial or unproven therapies include nonglycoside inotropic
agents, angiotensin II receptor antagonists, antiarrhythmic agents,
anticoagulants, and calcium channel blockers. The pharmacologic
management of diastolic heart failure is largely empirical and is
directed at reducing symptoms. Symptoms caused by increased
ventricular filling pressures may be treated with diuretics and
long-acting nitrates. Some calcium channel blockers and most beta
blockers prolong diastolic filling time by slowing heart rate,
thereby potentially improving the symptoms of diastolic heart
failure. Calcium antagonists, beta blockers, diuretics, and ACE
inhibitors may also promote regression of left ventricular
hypertrophy and thus improve ventricular compliance, possibly
preventing the development of diastolic dysfunction. Because
randomized controlled trials of diastolic heart failure are lacking,
this review focuses on the conventional management of
mild-to-moderate systolic heart failure before the advent of beta
blockade.
ARTICLE TITLE: To err is preventable: medical errors and academic
medicine.
ARTICLE SOURCE: Am J Med (United States), May 2001, 110(7)
p597-603
AUTHOR(S): Meyer G; Lewin DI; Eisenberg J
PUBLICATION TYPE: Journal Article
ARTICLE TITLE: Value of transthoracic echocardiography in the
diagnosis of pulmonary embolism: results of a prospective study in
unselected patients.
ARTICLE SOURCE: Am J Med (United States), May 2001, 110(7)
p528-35
AUTHOR(S): Miniati M; Monti S; Pratali L; Di Ricco G; Marini C;
Formichi B; Prediletto R; Michelassi C; Di Lorenzo M; Tonelli L;
Pistolesi M
AUTHOR'S ADDRESS: Istituto di Fisiologia Clinica del Consiglio
Nazionale delle Ricerche, Pisa, Italy.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In unselected patients with suspected pulmonary embolism
(PE), transthoracic echocardiography fails to identify some 50% of
patients with angiographically proven PE. Although echocardiographic
findings of right ventricular (RV) strain, paired with a high
clinical likelihood, support a diagnosis of PE, the transthoracic
echocardiography has to have a better sensitivity to be used as a
screening test to rule out PE.
ARTICLE TITLE: Clinical context: Current concepts of coronary
heart disease management]
ARTICLE SOURCE: Am J Med (United States), Apr 16 2001, 110(6 Suppl 1)
p3-11
AUTHOR(S): Jacobson TA
AUTHOR'S ADDRESS: Department of Medicine, Emory University School of
Medicine, Atlanta, Georgia, USA.
PUBLICATION TYPE: Journal Article
Optimizing the cost-effectiveness of statin therapy is a particular
concern to managed care organizations in light of the large number of
patients who are now considered candidates for this treatment.
ARTICLE TITLE: Medical therapy for coronary artery disease works,
even (especially) in the real world.
ARTICLE SOURCE: Am J Med (United States), Apr 15 2001, 110(6)
p497-8
AUTHOR(S): Lauer MS
PUBLICATION TYPE: Editorial
MB: Reality (not randomised) benefit of therapy for patients after
acute MI.
ARTICLE TITLE: Clinical trials of beta-blockers in heart failure:
a class review.
ARTICLE SOURCE: Am J Med (United States), Apr 2 2001, 110 Suppl 5A
p7S-10S
AUTHOR(S): Yancy CW
AUTHOR'S ADDRESS: Division of Cardiology, Congestive Heart Failure
Program, The University of Texas Southwestern Medical Center, Dallas,
Texas 75235-9047, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
Owing to slowed disease progression and reduced mortality,
angiotensin-converting enzyme (ACE) inhibitors are indicated in all
patients with heart failure. New data indicate that in appropriate
patients, beta-blocker therapy relieves the symptoms associated with
heart failure, reduces hospitalizations, and improves survival when
added to standard therapy. Questions still remain regarding the ideal
use of beta blockers in heart failure, and ongoing trials will
attempt to clarify those points.
ARTICLE TITLE: A systematic review of randomized trials of disease
management programs in heart failure.
COMMENTS: Am J Med. 2001 Apr 1; 110(5):410-2/21183893
ARTICLE SOURCE: Am J Med (United States), Apr 1 2001, 110(5)
p378-84
AUTHOR(S): McAlister FA; Lawson FM; Teo KK; Armstrong PW
AUTHOR'S ADDRESS: Divisions of General Internal Medicine, University
of Alberta Hospital, Edmonton, Canada.
PUBLICATION TYPE: Journal Article; Meta-Analysis