MB's Articles of Interest - July 2002

ARTICLE TITLE: Who are the humanitarians?
ARTICLE SOURCE: Am J Orthop (United States), Nov 2001, 30(11) p792
AUTHOR(S): Gould JS
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Athletic stress fractures: part I. History, epidemiology, physiology, risk factors, radiography, diagnosis, and treatment.
ARTICLE SOURCE: Am J Orthop (United States), Nov 2001, 30(11) p798-806
AUTHOR(S): Verma RB; Sherman O
AUTHOR'S ADDRESS: Northshore Long Island Jewish Medical Center, New Hyde Park, New York, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
Part 1 of this article focuses on the history, epidemiology, physiology, risk factors, radiography, diagnosis, and treatment of stress fractures. Part 2 reviews the specifics of stress fractures involving the lower body--the lower extremities, pelvic girdle, and feet and ankles. Part 3 reviews the specifics of stress fractures involving the upper body-shoulder girdle and thoracic region, upper extremities, hands and wrists, and pars interarticularis--and includes a special section on the female athlete. (Parts 2 and 3 will appear in the next issue.).

ARTICLE TITLE: Sudden cardiac death: do we know what we are talking about
ARTICLE SOURCE: Circulation (United States), May 28 2002, 105(21) pE182-2
AUTHOR(S): Angelini P
AUTHOR'S ADDRESS: Texas Heart Institute, Houston, Texas. Cardiovascular Health Branch, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
PUBLICATION TYPE: Journal Article
MB: The diagnosis is usually presumptive, there being no definite evidence.

ARTICLE TITLE: Tea consumption and mortality after acute myocardial infarction
ARTICLE SOURCE: Circulation (United States), May 28 2002, 105(21) p2476-81
AUTHOR(S): Mukamal KJ; Maclure M; Muller JE; Sherwood JB; Mittleman MA
AUTHOR'S ADDRESS: Divisions of General Medicine and Primary Care (K.J.M.) and Cardiology (M.A.M.), Beth Israel Deaconess Medical Center.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Self-reported tea consumption in the year before acute myocardial infarction is associated with lower mortality after infarction.
MB: I would not mind seeing a meta-analysis of the factors associated with differences on diseases & if there were studies designed to establish cause & effect.

ARTICLE TITLE: Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina
ARTICLE SOURCE: Circulation (United States), May 21 2002, 105(20) p2367-72
AUTHOR(S): de Feyter PJ; Serruys PW; Unger F; Beyar R; de Valk V; Milo S; Simon R; Regensburger D; Crean PA; McGovern E; van den Heuvel P; van Cauwelaert C; Penn I; Tyers GF; Lindeboom W
AUTHOR'S ADDRESS: University Hospital Rotterdam, Dijkzigt, Thoraxcenter, Rotterdam, the Netherlands. defeyter@card.azr.nl.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: There was no difference in rates of death, myocardial infarction, and cerebrovascular event at 1 year in patients with unstable angina and multivessel disease treated with either stented angioplasty or bypass surgery compared with patients with stable angina. The rate of repeat revascularization of both unstable and stable angina was significantly higher in patients with stents.

ARTICLE TITLE: Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest.
ARTICLE SOURCE: Circulation (United States), May 14 2002, 105(19) p2270-3
AUTHOR(S): Eftestol T; Sunde K; Steen PA
AUTHOR'S ADDRESS: Stavanger University College, Department of Electrical and Computer Engineering, Stavanger, Norway. trygve.eftestol@tn.his.no.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The interval between discontinuation of chest compressions and delivery of a shock should be kept as short as possible.
MB: I'd have been very surprised if they'd not found that.

ARTICLE TITLE: Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention.
ARTICLE SOURCE: Circulation (United States), May 14 2002, 105(19) p2259-64
AUTHOR(S): Rihal CS; Textor SC; Grill DE; Berger PB; Ting HH; Best PJ; Singh M; Bell MR; Barsness GW; Mathew V; Garratt KN; Holmes DR
AUTHOR'S ADDRESS: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The overall incidence of acute renal failure (ARF after percutaneous coronary intervention (PCI) is low. Diabetic patients with baseline Cr values <2.0 mg/dL are at higher risk than nondiabetic patients, whereas all patients with a serum Cr >2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal.

ARTICLE TITLE: Outcomes of patients with chronic renal insufficiency in the bypass angioplasty revascularization investigation.
ARTICLE SOURCE: Circulation (United States), May 14 2002, 105(19) p2253-8
AUTHOR(S): Szczech LA; Best PJ; Crowley E; Brooks MM; Berger PB; Bittner V; Gersh BJ; Jones R; Califf RM; Ting HH; Whitlow PJ; Detre KM; Holmes D
AUTHOR'S ADDRESS: Duke University Medical Center, Division of Nephrology, Durham, NC 27710, USA. szcze001@mc.duke.edu; Collective Name: Bypass Angioplasty Revascularization Investigation (BARI) Investigators.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Chronic kidney disease (CKD) is associated with an increased risk of recurrent hospitalization, subsequent CABG, and mortality. This increased risk of death is independent of and additive to the risk associated with diabetes.

ARTICLE TITLE: Contemporary medical options for treating patients with heart failure.
ARTICLE SOURCE: Circulation (United States), May 14 2002, 105(19) p2244-6
AUTHOR(S): Konstam MA; Mann DL
AUTHOR'S ADDRESS: Department of Medicine, Division of Cardiology, Tufts-New England Medical Center, and Tufts University School of Medicine, Boston, Mass 02111, USA. MKonstam@Lifespan.org.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Is the oxidative modification hypothesis relevant to human atherosclerosis? Do the antioxidant trials conducted to date refute the hypothesis?
ARTICLE SOURCE: Circulation (United States), Apr 30 2002, 105(17) p2107-11
AUTHOR(S): Steinberg D; Witztum JL
AUTHOR'S ADDRESS: Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, University of California San Diego, La Jolla, Calif 92093-0682, USA. dsteinberg@ucsd.edu.
PUBLICATION TYPE: Journal Article
MB: It appears that the big studies are negative. They have various suggestions including thinking up some new theories but no more trials at present.

ARTICLE TITLE: New therapeutic options in congestive heart failure: Part I.
ARTICLE SOURCE: Circulation (United States), Apr 30 2002, 105(17) p2099-106
AUTHOR(S): McMurray J; Pfeffer MA
AUTHOR'S ADDRESS: Clinical Research Initiative in Heart Failure, University of Glasgow, Scotland.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial y
MB: There is quite a lot of theory but I could not be bothered reading every word. I got the impression that their new theories are not fully coordinated.

ARTICLE TITLE: Cost-effectiveness of the implantable cardioverter-defibrillator versus antiarrhythmic drugs in survivors of serious ventricular tachyarrhythmias: results of the Antiarrhythmics Versus Implantable Defibrillators (AVID) economic analysis substudy.
ARTICLE SOURCE: Circulation (United States), Apr 30 2002, 105(17) p2049-57
AUTHOR(S): Larsen G; Hallstrom A; McAnulty J; Pinski S; Olarte A; Sullivan S; Brodsky M; Powell J; Marchant C; Jennings C; Akiyama T
AUTHOR'S ADDRESS: Cardiology Section, Oregon VA Medical Center, Portland, Ore 97201, USA. greg.larsen@med.va.gov; Collective Name: AVID Investigators.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: The implantable cardioverter-defibrillator (ICD) is moderately cost-effective for secondary prevention of life-threatening ventricular arrhythmias, as judged from prospectively collected data in a randomized clinical trial.
MB: I nearly got a ICD but they could not induce VF.

ARTICLE TITLE: The "unsympathetic" nervous system of heart failure.
COMMENTS: Comment On: Comment On: RefSource:Circulation. 2002 Apr 16; 105(15):1797-803
ARTICLE SOURCE: Circulation (United States), Apr 16 2002, 105(15) p1753-5
AUTHOR(S): Floras JS
PUBLICATION TYPE: Comment; Editorial
MB: More mystique.

ARTICLE TITLE: Metoprolol CR/XL in female patients with heart failure: analysis of the experience in Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF).
COMMENTS: Comment In: Comment In: RefSource:Circulation. 2002 Apr 2; 105(13):1526-8/PMID:11927513
ARTICLE SOURCE: Circulation (United States), Apr 2 2002, 105(13) p1585-91
AUTHOR(S): Ghali JK; Pina IL; Gottlieb SS; Deedwania PC; Wikstrand JC
AUTHOR'S ADDRESS: Cardiac Centers of Louisiana, Shreveport, LA 71103, USA. jkgalt@shreve.net; Collective Name: The MERIT-HF Study Group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: BACKGROUND: Underrepresentation of women in heart failure clinical trials has limited conclusions regarding the effect of various management strategies on survival in women with heart failure and decreased left ventricular ejection fraction (LVEF<snip>. CONCLUSIONS: The beneficial effects of metoprolol controlled-release/extended-release (CR/XL)extend to women with heart failure, including women with clinically stable severe heart failure.

ARTICLE TITLE: Women, heart failure, and heart failure therapies.
COMMENTS: Comment On: Comment On: RefSource:Circulation. 2002 Apr 2; 105(13):1585-91
ARTICLE SOURCE: Circulation (United States), Apr 2 2002, 105(13) p1526-8
AUTHOR(S): Wenger NK
PUBLICATION TYPE: Comment; Editorial
MB: Trials often have fewer women & older people thus limiting the applicability of results.

ARTICLE TITLE: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery---executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery).
ARTICLE SOURCE: Circulation (United States), Mar 12 2002, 105(10) p1257-67
AUTHOR(S): Eagle KA; Berger PB; Calkins H; Chaitman BR; Ewy GA; Fleischmann KE; Fleisher LA; Froehlich JB; Gusberg RJ; Leppo JA; Ryan T; Schlant RC; Winters WL; Gibbons RJ; Antman EM; Alpert JS; Faxon DP; Fuster V; Gregoratos G; Jacobs AK; Hiratzka LF; Russell RO; Smith SC
AUTHOR'S ADDRESS: Collective Name: American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery).
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline

ARTICLE TITLE: Tolerability of beta-blocker initiation and titration in the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF).
ARTICLE SOURCE: Circulation (United States), Mar 12 2002, 105(10) p1182-8
AUTHOR(S): Gottlieb SS; Fisher ML; Kjekshus J; Deedwania P; Gullestad L; Vitovec J; Wikstrand J
AUTHOR'S ADDRESS: University of Maryland School of Medicine, Baltimore, MD 21201, USA. sgottlie@medicine.umaryland.edu; Collective Name: The MERIT-HF Investigators.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
ABSTRACT: BACKGROUND: beta-Blockade improves survival when administered over a long period of time to patients with heart failure. However, the time course of any possible deterioration during the titration phase has not been reported. METHODS AND RESULTS: We looked at evidence of clinical deterioration in the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF) by analyzing events and symptoms during the first 90 days. During titration, the Kaplan-Meier curves for the combined end point of all-cause mortality/all-cause hospitalization were similar in all patients randomized, with no significant difference in favor of placebo at any visit or in any of the analyzed subgroups (New York Heart Association class II, III/IV, or III/IV with ejection fraction <0.25, heart rate less-than-or-equal 76 bpm, and systolic blood pressure less-than-or-equal 120 mm Hg). The curves started to diverge in favor of beta-blockade after 60 days. Low heart rate was the main factor that limited titration. In New York Heart Association class III/IV, 5.9% of the patients receiving placebo discontinued study medicine during the first 90 days compared with 8.1% of those receiving metoprolol CR/XL (P=0.037 unadjusted, P=NS adjusted); corresponding figures in those with New York Heart Association class III/IV and ejection fraction <0.25 were 7.1% and 8.0% (P=NS). From day 90 until the end of the study, more patients in the placebo group discontinued study medicine in all subgroups. There was no change in diuretic or ACE inhibitor dosing with beta-blocker titration. Most patients reported no change in symptoms of breathlessness or fatigue during the titration phase. CONCLUSIONS: When carefully titrated, metoprolol CR/XL can be given safely to the overwhelming majority of patients with stable mild to moderate heart failure, with minimal side effects or deterioration.
MB: They started me suddenly on 150mg metoprolol /day but then I did not have cardiac failure - whatever that means.

ARTICLE TITLE: The impact of three years' ethics teaching, in an integrated medical curriculum, on students' proposed behaviour on meeting ethical dilemmas
ARTICLE SOURCE: Med Educ (England), May 2002, 36(5) p489-97
AUTHOR(S): Goldie J; Schwartz L; McConnachie A; Morrison J
AUTHOR'S ADDRESS: Department of General Practice, University of Glasgow, UK.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: While small group ethics teaching can be effective in developing students' normative identification with the profession of medicine, its effectiveness is dependent on the amount of small group teaching provided. The lack of formal assessment in years 2 and 3 is also felt to contribute to the lack of impact. This information will inform future curriculum development.
MB: I don't think they show that they have succeeded. How could they? The impact is on the result of answers to a series of question. The subjects would learn what were the 'consensus' answers should be.

ARTICLE TITLE: External examining--a challenge for new curricula?
ARTICLE SOURCE: Med Educ (England), Apr 2002, 36(4) p308-9
AUTHOR(S): Morrison J; Watt G
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Cardiopulmonary resuscitation training for undergraduate medical students: a five-year study.
ARTICLE SOURCE: Med Educ (England), Mar 2002, 36(3) p296-8
AUTHOR(S): Graham CA; Scollon D
AUTHOR'S ADDRESS: Accident & Emergency Medicine, Southern General Hospital, Glasgow, UK. ColinGraham@bigfoot.com.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: There has been a sustained improvement in CPR training at this institution since 1993. Improvements in the training of specific advanced life support techniques does not lead to improved overall confidence in using these skills on qualification. Advanced life support training requires further expansion.

ARTICLE TITLE: Is there a problem with the problems in problem-based learning?
ARTICLE SOURCE: Med Educ (England), Mar 2002, 36(3) p279-81
AUTHOR(S): Finucane P; Nair B
AUTHOR'S ADDRESS: Flinders University, Adelaide, South Australia, Australia.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To determine the balance between acute and chronic medical problems in the PBL cases at 2 Australian medical schools. METHODS: Analysis of 162 PBL cases. RESULTS: Cases concentrate on acute problems in young people and neglect chronic disease in the old. CONCLUSION: This imbalance may contribute to negative attitudes towards elderly patients and people with chronic disease.
MB: How silly can you get?

ARTICLE TITLE: Does a rural educational experience influence students' likelihood of rural practice? Impact of student background and gender.
ARTICLE SOURCE: Med Educ (England), Mar 2002, 36(3) p241-7
AUTHOR(S): Woloschuk W; Tarrant M
AUTHOR'S ADDRESS: Undergraduate Medical Education, Faculty of Medicine, University of Calgary, Alberta, Canada. woloschu@ucalgary.ca.
PUBLICATION TYPE: Journal Article
ABSTRACT: CONTEXT: The family medicine clerkship at the University of Calgary is a 4-week mandatory rotation in the final year of a 3-year programme. Students are given the opportunity to experience rural practice by training at 1 of several rural practices. OBJECTIVE: To determine whether exposure to a rural educational experience changes students' likelihood of doing a rural locum or rural practice and whether student background and gender are related to these practice plans. METHOD: Clinical clerks from the Classes of 1996-2000, who trained at rural sites, responded to questionnaire items both before and after the rural educational experience. Responses to the questionnaire items and discipline of postgraduate training served as dependent variables. Student background and gender were independent variables. RESULTS: As a result of the rural educational experience all students were more likely to do a rural locum. Compared to their urban-raised peers, students from rural backgrounds reported a significantly greater likelihood of doing a rural locum and practising in a rural community, irrespective of gender or participating in a rural educational experience. There was no relationship between background and career choice. CONCLUSION: A rural educational experience at the undergraduate level increases the stated likelihood of students participating in rural locums and helps to solidify existing rural affiliations. Students with rural backgrounds have a more favourable attitude toward rural practice. This pre-post study provides further support for the preferential admission to medical school of students with rural backgrounds to help alleviate the rural physician shortage.
MB: The exposure could have the opposite effect. Students would know how to answer the questionnaire.

ARTICLE TITLE: Internationalization of undergraduate medical studies: promoting clinical tourism or academic development?
ARTICLE SOURCE: Med Educ (England), Dec 2001, 35(12) p1162-3
AUTHOR(S): Majoor GD
AUTHOR'S ADDRESS: International Educational Programmes, Faculty of Medicine, Maastricht University, The Netherlands. g.majoor@bibfdg.unimaas.nl.
PUBLICATION TYPE: Journal Article
MB: The author is a bit precious. We have lots of overseas students, residents & registrars who come here firstly as tourists. Most benefit from the medical experience which the author does not seem to think is universal. He thinks that the only universal part is anatomy & physiology. I think he has lost the plot.

ARTICLE TITLE: Learning to look: developing clinical observational skills at an art museum.
ARTICLE SOURCE: Med Educ (England), Dec 2001, 35(12) p1157-61
AUTHOR(S): Bardes CL; Gillers D; Herman AE
AUTHOR'S ADDRESS: Weill Cornell Medical College, New York, NY 10021, USA. clbardes@med.cornell.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: CONTEXT: Clinical diagnosis involves the observation, description, and interpretation of visual information. These skills are also the special province of the visual arts. We describe an educational collaboration between a medical school and an art museum, designed for the purpose of developing student skills in observation, description, and interpretation. OBJECTIVES: In the programme, medical students first examine painted portraits, under the tutelage of art educators and medical school faculty. Then, the students examine photographs of patients' faces and apply the same skills. CONCLUSION: This programme, well-received by students and faculty, appeared to help the students not only in improving their empirical skills in observation, but also in developing increased awareness of emotional and character expression in the human face.
MB: Karl Popper asked his students sitting a class to look & then describe what they had seen. It did not work because they had to decide what they would look at. In this class they would get them to guess the emotion on a portrait without the portrait doing anything. I suppose it could have been of some value in getting them to appreciate art. When in NY I find the daily tour/tutorials at the NY Metropolitan Museum useful too. This experiment was at the Frick collection. Everyone enjoyed themselves & the students seemed to be better in working out emotional states from faces, I suppose rather than by talking to the patients.
In diagnosing you have to have (internally) directed observation.

ARTICLE TITLE: The demise of a planned randomised controlled trial in an urban Aboriginal medical service.
COMMENTS: Comment In: Comment In: RefSource:Med J Aust. 2002 Mar 18; 176(6):248-9
ARTICLE SOURCE: Med J Aust (Australia), Mar 18 2002, 176(6) p273-6
AUTHOR(S): Sibthorpe BM; Bailie RS; Brady MA; Ball SA; Sumner-Dodd P; Hall WD
AUTHOR'S ADDRESS: National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT. beverly.sibthorpe@anu.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: To fill a gap in knowledge about the effectiveness of brief intervention for hazardous alcohol use among Indigenous Australians, we attempted to implement a randomised controlled trial in an urban Aboriginal Medical Service (AMS) as a joint AMS-university partnership. Because of low numbers of potential participants being screened, the RCT was abandoned in favour of a two-part "demonstration project". Only 16 clients were recruited for follow-up in six-months, and the trial was terminated. Clinic, patient, Aboriginal health worker, and GP factors, interacting with study design factors, all contributed to our inability to implement the trial as designed. The key points to emerge from the study are that alcohol misuse is a difficult issue to manage in an Indigenous primary health care setting; RCTs involving inevitably complex study protocols may not be acceptable or sufficiently adaptable to make them viable in busy, Indigenous primary health care settings; and "gold-standard" RCT-derived evidence for the effectiveness of many public health interventions in Indigenous primary health care settings may never be available, and decisions about appropriate interventions will often have to be based on qualitative assessment of appropriateness and evidence from other populations and other settings.

ARTICLE TITLE: Hard lessons from a randomised controlled trial.
COMMENTS: Comment On: Comment On: RefSource:Med J Aust. 2002 Mar 18; 176(6):273-6
ARTICLE SOURCE: Med J Aust (Australia), Mar 18 2002, 176(6) p248-9
AUTHOR(S): Jamrozik K
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Is it worth screening women over 70 for breast cancer--or indeed any women?
COMMENTS: Comment On: Comment On: RefSource:Med J Aust. 2001 Sep 3; 175(5):270-1; Comment On: Comment On: RefSource:Med J Aust. 2002 Mar 18; 176(6):266-71ARTICLE SOURCE: Med J Aust (Australia), Mar 18 2002, 176(6) p247-8
AUTHOR(S): Rodger A
PUBLICATION TYPE: Comment; Editorial
MB: It appears that the objective answer is 'no'.

ARTICLE TITLE: Medical harm and the consequences of error for doctors.
ARTICLE SOURCE: Med J Aust (Australia), Mar 4 2002, 176(5) p222-5
AUTHOR(S): McNeill PM; Walton M
AUTHOR'S ADDRESS: School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney. paul.mcneill@unsw.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: Mistakes in medicine, particularly when patients have suffered harm as a result, are of ethical concern as breaching a fundamental injunction in medicine: "first do not harm". To minimise the chances of a recurrence, an effective response to harm must take into account both the concerns of patients who have been harmed and the concerns of doctors who may fear extreme outcomes if a mistake is admitted. There is an apparent conflict between a need to respond to errors non-punitively, on the one hand, and ethical and legal requirements for accountability and compensation for anyone harmed, on the other. There is also confusion between arguments for a "blame-free" culture in the healthcare system and the need to attribute responsibility in some cases. Important elements in an ethical response to mistakes include disclosure to the patient and family; taking appropriate clinical steps to mitigate any harm that may result from a mistake; identifying the process leading to harm; and responding in an appropriate and humane manner to minimise the likelihood of any recurrence.
MB: The problem is so endemic that only a revolution will be able to fix it quickly. It is amazing that evolution seems to work over about 20 years. Presumably good intentions gradually fix the systemic problems.

ARTICLE TITLE: Postoperative serious adverse events in a teaching hospital: a prospective study.
ARTICLE SOURCE: Med J Aust (Australia), Mar 4 2002, 176(5) p216-8
AUTHOR(S): Bellomo R; Goldsmith D; Russell S; Uchino S
AUTHOR'S ADDRESS: Department of Intensive Care, Austin and Repatriation Medical Centre, Heidelberg, VIC. Rinaldo.Bellomo@armc.org.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: serious adverse events (SAEs) among are common and result in high mortality, especially in older surgical inpatients and those having unscheduled surgery. These findings raise important issues of optimal perioperative management in tertiary hospitals.

ARTICLE TITLE: Sedation for endoscopy: the safe use of propofol by general practitioner sedationists.
COMMENTS: Comment In: Comment In: RefSource:Med J Aust. 2002 Feb 18; 176(4):147
ARTICLE SOURCE: Med J Aust (Australia), Feb 18 2002, 176(4) p158-61
AUTHOR(S): Clarke AC; Chiragakis L; Hillman LC; Kaye GL
AUTHOR'S ADDRESS: Mugga Wara & Brindabella Endoscopy Centres, Canberra, ACT. tony-clarke@bigpond.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To determine the incidence of adverse events related to an endoscopy sedation regimen that included propofol, delivered by general practitioner (GP) sedationists. DESIGN: Audit of reports of sedation-related adverse events in patients undergoing endoscopy. A sample of 1000 patients' medical records was also reviewed to determine the drugs and dosages used and the proportion of sedations delivered by GPs. SETTING AND PARTICIPANTS: All patients undergoing gastroscopy and/or colonoscopy from January 1996 to December 2000 in two private endoscopy centres in Canberra. Sedation was provided by GPs or a specialist anaesthetist, in most cases using a drug regimen that included propofol. MAIN OUTCOME MEASURES: Incidences of respiratory arrest, airway obstruction, hypoxia requiring intervention, hypotension, and death; number of interventions to correct these events, including extra airway management, bag-mask ventilation, intravenous fluid infusion, endotracheal intubation and the use of reversal agents, and admission to hospital. RESULTS: 28,472 procedures were performed in the five years. There were 185 sedation-related adverse events (6.5/1000 procedures; 95% CI, 5.6-7.4): 107 for airway or ventilation problems (3.8/1000) and 77 hypotensive episodes (2.7/1000). Respiratory-related adverse events were more common in patients managed by GPs than anaesthetists, but this was not significant (P = 0.1). Interventions were recorded in 234 patients (8.2/1000; 95% CI, 7.2-9.3): 123 to maintain ventilation, and 111 intravenous infusions. GPs were more likely than anaesthetists to intervene to manage respiratory-related adverse events (P = 0.03). Four patients required transfer or admission to hospital. No patients required endotracheal intubation, and there were no deaths. CONCLUSIONS: The GP sedationists encountered a low incidence of adverse events, which they managed effectively. It appears that appropriately selected and trained GPs can safely use propofol for sedation during endoscopy.
MB: This is a special clinic with regular GPs and saving of higher risk patients for the specialist anaesthetists.

ARTICLE TITLE: Sedation for endoscopy.
COMMENTS: Comment On: Comment On: RefSource:Med J Aust. 2002 Feb 18; 176(4):158-61
ARTICLE SOURCE: Med J Aust (Australia), Feb 18 2002, 176(4) p147
AUTHOR(S): Knoblanche GE
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Sudden cardiac death in the young.
ARTICLE SOURCE: Med J Aust (Australia), Feb 18 2002, 176(4) p148-9
AUTHOR(S): Semsarian C; Maron BJ
PUBLICATION TYPE: Editorial

ARTICLE TITLE: When is diabetes really diabetes?
COMMENTS: Comment On: Comment On: RefSource:Med J Aust. 2002 Feb 4; 176(3):104-7
ARTICLE SOURCE: Med J Aust (Australia), Feb 4 2002, 176(3) p97-8
AUTHOR(S): Colagiuri S
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Declarations made by graduating medical students in Australia and New Zealand.
COMMENTS: Comment In: Comment In: RefSource:Med J Aust. 2002 Feb 4; 176(3):99/PMID:11936324
ARTICLE SOURCE: Med J Aust (Australia), Feb 4 2002, 176(3) p123-5
AUTHOR(S): McNeill PM; Dowton SB
AUTHOR'S ADDRESS: School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney. paul.mcneill@unsw.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To survey the use of declarations of ethical commitment made by graduating medical students in Australia and New Zealand. METHODS: Information, obtained by email and telephone, from faculty officers of all faculties of medicine (or medicine and health sciences) in Australia and New Zealand. RESULTS: Declarations are made by graduating medical students at seven of 12 Australasian faculties of medicine. To date, declarations have been based on the Declaration of Geneva or the Hippocratic Oath or have been formulated by academic staff or the students themselves. In six of the seven universities, declarations are made as part of a special declaration ceremony (usually combined with a prize-giving ceremony). One university includes a declaration as part of the official graduation ceremony. DISCUSSION: We discuss the relative merits of a declaration selected for students by staff members and a declaration written anew by each group of graduating students.

ARTICLE TITLE: What's wrong with the dead body? Use of the human cadaver in medical education.
ARTICLE SOURCE: Med J Aust (Australia), Jan 21 2002, 176(2) p74-6
AUTHOR(S): Parker LM
AUTHOR'S ADDRESS: Department of Infectious Disease, University of Sydney, NSW. lmparker@optusnet.com.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: A 2000 survey of Australian medical schools showed that use of anatomical dissection and autopsies for teaching has declined. Opinions vary between schools as to the effect on teaching of anatomy and pathology. However, exposure to the dissected human body may have benefits beyond this teaching, including inculcating the trait of "detached concern", teaching about medical fallibility and uncertainty, and raising issues of death and dying.

ARTICLE TITLE: Anaesthesia.
ARTICLE SOURCE: Med J Aust (Australia), Jan 7 2002, 176(1) p6
AUTHOR(S): Kerridge RK
AUTHOR'S ADDRESS: Department of Anaesthetics, John Hunter Hospital, Newcastle, NSW, 2310. mdrkk@cc.newcastle.edu.au.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Intensive care medicine.
ARTICLE SOURCE: Med J Aust (Australia), Jan 7 2002, 176(1) p24
AUTHOR(S): Bell AJ; Turner AJ
AUTHOR'S ADDRESS: Department of Critical Care Medicine, Royal Hobart Hospital, Hobart, TAS. anthony.bell@dchs.tas.gov.au.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Mixed signals in heart failure: cancer rules.
ARTICLE SOURCE: J Clin Invest (United States), Apr 2002, 109(7) p849-55
AUTHOR(S): Hoshijima M; Chien KR
AUTHOR'S ADDRESS: University of California, San Diego (UCSD) Institute of Molecular Medicine, UCSD-Salk Program in Molecular Medicine, La Jolla, California 92093, USA.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: The influence of gender of the surgeon on surgical procedure preference for breast cancer.
ARTICLE SOURCE: Am Surg (United States), Apr 2002, 68(4) p398-400
AUTHOR(S): Weinberg E; Woods S; Grannan K; Hendy MP
AUTHOR'S ADDRESS: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA.
PUBLICATION TYPE Journal Article
ABSTRACT: There are few data in the literature with regard to the influence of surgeon gender and the treatment of breast cancer. In this retrospective review we propose to test the hypothesis that male surgeons are just as likely as female surgeons to provide breast-conservative treatment. From 1990 through 1997 2271 women with breast cancer in Cincinnati, Ohio were operated on by surgeons within the TriHealth Corporation. We compared the performance rate of breast conservation therapy (BCT) with the rate of mastectomy in early-stage breast cancer patients between male and female surgeons. Male surgeons were significantly more likely to provide their patients with breast-conserving treatment than their female colleagues for stages 0 and IIb (P < 0.05). Although male surgeons performed more BCT than female surgeons for stages I and IIa the difference was not statistically significant. For the three stages combined there was a 30 per cent greater chance of a patient receiving breast-conserving treatment if she went to a male surgeon (P < 0.05). We conclude that in our institution male surgeons are no more likely to select mastectomy than their female colleagues and there appears to be an increased use of BCT by male surgeons.
MB: This need not be a cause & effect relationship.

ARTICLE TITLE: Continuing experience with liver resection and vena cava reconstruction using cardiopulmonary bypass and hypothermic circulatory arrest.
ARTICLE SOURCE: Am Surg (United States), Apr 2002, 68(4) p359-63; discussion 364
AUTHOR(S): Sener SF; Winchester DJ; Votapka TV; McGuire MS; O'Connor B; Szokol JW
AUTHOR'S ADDRESS: Division of General Surgery of the Department of Surgery, Evanston Northwestern Healthcare, Illinois, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: When the suprahepatic vena cava or the hepatic vein confluence with the inferior vena cava (IVC) is obscured by tumor or a clot in the IVC extends above the liver, cross-clamping the IVC during liver or retroperitoneal resection is hazardous. This report describes a 10-year experience with ten patients who had liver (seven) or retroperitoneal (three) resections with vena cava reconstruction using cardiopulmonary bypass and hypothermic circulatory arrest. There were no perioperative deaths. Morbidity consisted of prolonged bile leak (one), pulmonary embolism (one), and stroke (one). Control of the liver was secured in six of seven patients who had a liver resection. There were three significant advantages to this technique. First, the median sternotomy provided superior exposure to the suprahepatic IVC. Second, the bypass technique avoided the risks of hemodynamic instability and prevented air embolism and sudden uncontrolled hemorrhage incurred by resection or IVC cross-clamping. Third, hypothermia provided a method of protection for residual liver function especially in the face of chronic liver disease induced by infection or chemotherapy.

ARTICLE TITLE: Venous thromboembolism prophylaxis: applying evidence-based guidelines
ARTICLE SOURCE: ANZ J Surg (Australia), May 2002, 72(5) p320
AUTHOR(S): Fletcher JP
PUBLICATION TYPE: Status: In-Process
Editorial

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 and Departmentof Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: A survey conducted in 1992 found that New Zealand orthopaedicsurgeons relied on non-pharmacological methods of deep vein thrombosisprevention in most arthroplasty patients and almost all hip fracturepatients. This survey was repeated in 1999 to ascertain whetherthis pattern of use had changed. METHODS: All orthopaedic consultants in New Zealand who performed hipor knee surgery in 1999 were asked to complete a one-page postalquestionnaire, asking for information regarding: the frequency withwhich chemoprophylaxis was employed in patients undergoing surgeryfor hip fracture, hip arthroplasty, or knee arthroplasty; the drugregimes used; the factors that influenced the choice of chemoprophylaxis; and the factors that limited chemoprophylaxis use in orthopaedicpractice. RESULTS: Between 1992 and 1999, the proportion of patients given chemoprophylaxisincreased from 3% to 25% for patients with hipfracture, and from 32% to 57% for elective arthroplastypatients. The proportion of surgeons using low molecular weightheparin increased over the 7-year period from 55% to 76%,while aspirin use remained stable at 7% and standard heparinand warfarin decreased to less than 5%. There was a shiftaway from starting chemoprophylaxis preoperatively towards continuinguntil discharge, rather than until the patient was mobile. Opinionson indications and contraindications for chemoprophylaxis had notchanged substantially during the 7-year period. CONCLUSIONS: Orthopaedic surgeons' use of chemoprophylaxis has increasedin New Zealand. However, since hospital stays have decreased considerablyand most orthopaedic patients are now discharged within a fortnight,prophylaxis may now cover a shorter duration of the at-risk period.

ARTICLE TITLE: Deep venous thrombosis prophylaxis: Are guidelines being followed?
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, Department ofSurgery, Canberra Hospital, Australian Capital Territory, Australia.
PUBLICATION TYPE: Journal Article
DISCUSSION: Deep Venous Thrombosis is a major problem among hospitalizedpatients. However, despite its importance, there is a lack of appropriateprophylaxes being instituted. This, together with the poor performanceof the participating clinicians in Part 2 of the present study,indicate that there are significant problems in The Canberra Hospitalregarding DVT prophylaxes and that steps need to be taken to overcomethese problems.

ARTICLE TITLE: Is a chest radiograph a satisfactory test for the correct position of a central line?
ARTICLE SOURCE: ANZ J Surg (Australia), Apr 2002, 72(4) p312-3
AUTHOR(S): Hani MB; Smith RC
AUTHOR'S ADDRESS: The University of Sydney, Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.

ARTICLE TITLE: Effectiveness of intra-operative wound infiltration with long-acting local anaesthetic
ARTICLE SOURCE: ANZ J Surg (Australia), Jan 2002, 72(1) p18-20
AUTHOR(S): Kuan YM; Smith S; Miles C; Grigg M
AUTHOR'S ADDRESS: Department of Surgery, Monash University, Box Hill Hospital, Melbourne, Victoria, Australia.
PUBLICATION TYPE: Journal Article
Conclusion: Intraoperative wound infiltration with bupivacaine is widely employed as a method of minimizing postoperative pain. This study was unable to demonstrate a benefit of employing the technique in terms of a reduction in the patient's perception of pain. By having each patient act as their own control, we have avoided one of the major deficiencies of previous studies, namely, interpatient variability in assessment and perception of pain.

ARTICLE TITLE: Art macabre: is anatomy necessary?
ARTICLE SOURCE: ANZ J Surg (Australia), Dec 2001, 71(12) p782-3; discussion 783-4
AUTHOR(S): Jones K
PUBLICATION TYPE: Letter

ARTICLE TITLE: Psychiatry, postmodernism and postnormal science.
ARTICLE SOURCE: J R Soc Med (England), Apr 2002, 95(4) p207-10
AUTHOR(S): Laugharne R; Laugharne J
AUTHOR'S ADDRESS: Department of Mental Health, School of Postgraduate Medicine and Health Sciences, University of Exeter, Wonford House Hospital, Dryden Road, Exeter EX2 5AF, UK. r.laugharne@exeter.ac.uk.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The limits of psychiatry.
ARTICLE SOURCE: BMJ (England), Apr 13 2002, 324(7342) p900-4
AUTHOR(S): Double D
AUTHOR'S ADDRESS: Norfolk Mental Health Care NHS Trust, Carrobreck, Norwich NR6 5BE. dbdouble@dbdouble.co.uk.
PUBLICATION TYPE: Journal Article
MB: I don't think psychiatry ever made it to the modern period.

ARTICLE TITLE: Catheter-related epidural abscesses - Don't wait for neurological deficits
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 2002, 46(5) p611-5
AUTHOR(S): Royakkers AA; Willigers H; Van Der Ven AJ; Wilmink J; Durieux M; Van Kleef M
AUTHOR'S ADDRESS: Departments of Anesthesiology, Micro-Biology and Radiology, University Hospital Maastricht, Maastricht, the Netherlands.
PUBLICATION TYPE: Journal Article
ABSTRACT: Epidural abscess is a rare but serious complication of epidural anesthesia for peri- and postoperative analgesia. It is feared because of possible persistent neurological deficits. Epidural abscess presents mostly with a classic triad of symptoms: back pain, fever and variable neurological signs and symptoms. When neurologic signs or symptoms develop, MRI scanning is the diagnostic procedure of choice. The therapy of choice is intravenous antibiotics for more than 4 weeks with or without a laminectomy or drainage. In the present paper we describe three patients with epidural abscesses presented during a time period of 1 year in our hospital. In each case, patients developed local signs of infection and systemic signs, but no neurological symptoms. Based on these cases and a review of the literature, we propose that MRI scanning should be strongly considered when patients present with systemic and local signs, even in the absence of neurological deficits.

ARTICLE TITLE: Bicarbonate attenuates intracellular acidosis
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 2002, 46(5) p579-84
AUTHOR(S): Nielsen HB; Hein L; Svendsen LB; Secher NH; Quistorff B
AUTHOR'S ADDRESS: NMR Center, the Panum Institute and the Copenhagen Muscle Research Center, Department of Anaesthesia, Rigshospitalet, University of Copenhagen, Denmark.
PUBLICATION TYPE: Journal Article
CONCLUSION: During exercise-induced metabolic acidosis, intravenous administration of bicarbonate increased the buffering capacity of blood and attenuated the decrease in intracellular muscle pH, although there was a small increase in the arterial carbon dioxide pressure.
MB: This appears to be a misguided experiment. I am not sure how they measured intrecellur pH but it was affected less than they expected. Intracellar pH had a vogue about 35 years ago. It's likely even less important than blood pH in itself.

ARTICLE TITLE: Monitoring arterial blood pressure during whole body hyperthermia
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), May 2002, 46(5) p561-6
AUTHOR(S): Kerner T; Deja M; Ahlers O; Hildebrandt B; Dieing A; Riess H; Wust P; Gerlach H
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care Medicine, Department of Hematology and Oncology, Department of Radiology, Charite Medical Center, Virchow Hospital, Humboldt University, Berlin.
PUBLICATION TYPE: Journal Article
CONCLUSION: The mean arterial pressure and not the systolic and/or diastolic pressure should guide hemodynamic management during during whole body hyperthermia (WBH). The sphygmomanometric technique is not recommended for use during hyperthermia.
MB: This is part of treatment for malignancies. We did it several times in the early 1970s are I was sent to see it in Edinburgh where they put the patients into a bath of wax at melting point 45C. The temperature was raised to 45C for some hours. This produced obvious quite violent cardiac action. I don't think we would have used an arterial line then but one obviously would now.
We did not persist with the method. In Edinburgh the criteria that there had been improvement was that the patient enjoyed porridge the next morning.

ARTICLE TITLE: Intraoperative awareness: detected by the structured Brice interview?
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Apr 2002, 46(4) p345-9
AUTHOR(S): Enlund M; Hassan HG
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care, Uppsala University Hospital, Sweden.
PUBLICATION TYPE: Status: In-Process
METHODS: The Brice interview (A structured interview designed of minimisepseudo-memories.BJA 1970;42:535.)was used prospectively in 5216 patients given a propofol/opioid anesthetic for day-case or short-stay surgery. Neuromuscular blocks were used only for surgical needs, not routinely. DISCUSSION: We were unable to detect intraoperative awareness. The anesthetic regimen, including minimal use of muscle relaxants, might be beneficial for awareness prevention. Alternatively, the diagnostic power, the timing of the Brice interview, or the number of interviews performed may be questioned.

ARTICLE TITLE: Victims of awareness.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Mar 2002, 46(3) p229-31
AUTHOR(S): Lennmarken C; Bildfors K; Enlund G; Samuelsson P; Sandin R
AUTHOR'S ADDRESS: Department of Anesthesia and Intensive Care, Vrinnevisjukhuset, Norrkoping, Sweden. Claes.Lennmarken@lio.se.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Intraoperative awareness with explicit recall may be followed by long-lasting mental symptoms. However, the average risk for developing mental sequelae after awareness, and the average severity and the duration of symptoms has not previously been illustrated in a consecutive series of awareness cases. METHODS: Nine patients among 18 consecutive, prospectively identified cases of intraoperative awareness with recall could be located after approximately 2 years and agreed to an interview about possible persisting problems. RESULTS: Four of the nine interviewed patients were still severely disabled due to psychiatric/psychological sequelae. All of these patients had experienced anxiety during the period of awareness, but only one had complained about pain. Another three patients had less severe, transient mental symptoms, although they could cope with these in daily life. Two patients denied any sequelae from their awareness episode. CONCLUSIONS: Up to 3 weeks after their unsuccessful anesthetic, repeated information and discussions had been offered. Despite the fact that all patients at that time claimed to be satisfied with this management, and eventually considered no further contacts necessary, this was obviously inaccurate. Therefore, professional psychiatric assessment, treatment and long-term follow-up should constitute standard practice for all patients who have experienced intraoperative awareness.

ARTICLE TITLE: Awareness during general anaesthesia: a review of 81 cases from the Anaesthetic Incident Monitoring Study
ARTICLE SOURCE: Anaesthesia (England), Jun 2002, 57(6) p549-56
AUTHOR(S): Bergman IJ; Kluger MT; Short TG
AUTHOR'S ADDRESS: Department of Anaesthesia, Auckland Hospital, Auckland, New Zealand Department of Anaesthesia, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, New Zealand.
PUBLICATION TYPE: Status: In-Process
Journal Article
ABSTRACT: Because of recent studies suggesting that awareness is still a major issue in anaesthetic practice, we reviewed 8372 incidents reported to the Anaesthetic Incident Monitoring Study. There were 81 cases in which peri-operative recall was consistent with awareness. There were 50 cases of definite awareness and 31 cases with a high probability of awareness. In 13 of the 81 incidents, the patients appeared to receive adequate doses of anaesthetic drugs. Where the cause could be determined, awareness was mainly due to drug error resulting in inadvertent paralysis of an awake patient (n = 32) and failure of delivery of volatile anaesthetic (n = 16). Less common causes included prolonged attempts at intubation of the trachea (n = 5), deliberate withdrawal of volatile anaesthetic (n = 4) or muscle relaxant apnoea with inadequate administration of hypnotic (n = 3). An objective central nervous system depth of anaesthesia monitor may have prevented 42 of these incidents and an improved drug administration system may have prevented 32. On the basis of these reports, we have developed guidelines that may have prevented the majority of these incidents.

ARTICLE TITLE: Perioperative medicine - a new sub-speciality, or a multi-disciplinary strategy to improve perioperative management and outcome?
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Feb 2002, 46(2) p121-2
AUTHOR(S): Dahl JB; Kehlet H
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Incidence and severity of postoperative nausea and vomiting are similar after metoclopramide 20 mg and ondansetron 8 mg given by the end of laparoscopic cholecystectomies.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 2002, 46(1) p109-13
AUTHOR(S): Quaynor H; Raeder JC
AUTHOR'S ADDRESS: Department of Anesthesia, Kongsberg Hospital, Ullevaal University Hospital, Oslo, Norway. hen-qua@frisurf.no.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Metoclopramide 20 mg i.v. given at the end of laparoscopic cholecystectomy resulted in a similar incidence of PONV compared with ondansetron 8 mg. The patients receiving metoclopramide had less pain than the patients receiving ondansetron.

ARTICLE TITLE: Intravenous fluids warming by mattress is simple and efficient during pediatric surgery.
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 2002, 46(1) p80-4
AUTHOR(S): Serour F; Weissenberg M; Boaz M; Ezri T; Gorenstein A
AUTHOR'S ADDRESS: Division of Pediatric Surgery, Department of Anesthesiology, The Edith Wolfson Medical Center, Holon, Israel. serour@wolfson.health.gov.il.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: The increase in CT was more pronounced in patients where fluids were warmed under the warming mattress (Group M) than in those with fluids warmed by a coil warming device (Group T). The elevation in CT seen in Group M is associated with an increase in infusion fluid temperature at the line just before the i.v. cannula. Both methods of fluid warming (by placing the i.v. tubing under warming mattress and by using a fluid warming system) effectively preserved normothermia during abdominal surgery in children.
MB:I don't think this was a very well controlled study.

ARTICLE TITLE: Priestley, the furious free thinker of the enlightenment, and Scheele, the taciturn apothecary of Uppsala.
COMMENTS: Comment In: Comment In: RefSource:Acta Anaesthesiol Scand. 2002 Jan; 46(1):1/PMID:11903064
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 2002, 46(1) p2-9
AUTHOR(S): Severinghaus JW
AUTHOR'S ADDRESS: Cardiovascular Research Institute, University of California, San Francisco, CA 94143, USA. jwseps@attbi.com.
PUBLICATION TYPE: Biography; Historical Article; Journal Article

ARTICLE TITLE: Phlogiston--fire air--oxygen. The fascinating story of an 18th century discovery.
COMMENTS: Comment On: Comment On: RefSource:Acta Anaesthesiol Scand. 2002 Jan; 46(1):2-9/PMID:11903065
ARTICLE SOURCE: Acta Anaesthesiol Scand (Denmark), Jan 2002, 46(1) p1
AUTHOR(S): Lindahl SG
AUTHOR'S ADDRESS: Chair Nobel Committee for Physiology or Medicine, Karolinska Hospital and Institute, Stockholm, Sweden.
PUBLICATION TYPE: Comment; Editorial; Historical Article

ARTICLE TITLE: Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry).
ARTICLE SOURCE: Am J Cardiol (United States), Apr 1 2002, 89(7) p791-6
AUTHOR(S): Goldberg RJ; Steg PG; Sadiq I; Granger CB; Jackson EA; Budaj A; Brieger D; Avezum A; Goodman S
AUTHOR'S ADDRESS: University of Massachusetts Medical School, Worcester, Massachusetts, USA. Goldberr@ummhc.org.
PUBLICATION TYPE: Journal Article
ABSTRACT: Our primary study aim was to examine extent of, and factors associated with, delay in seeking medical care in a large multinational registry of patients with acute myocardial infarction (AMI) and unstable angina pectoris. A secondary goal was to examine the relation between duration of prehospital delay and receipt and timing of coronary reperfusion strategies. Investigators from 14 countries are participating in the Global Registry of Acute Coronary Events (GRACE) project. The study sample consisted of 3,693 patients with ST-segment elevation AMI, 2,935 with non-ST-segment elevation AMI, and 3,954 patients with unstable angina hospitalized between 1999 and 2001. The average and median delay times were longest in patients with non-ST-segment elevation AMI (6.1 and 3.0 hours, respectively) followed by patients with unstable angina (5.6 and 3.0 hours) and those with ST-segment elevation AMI (4.7 and 2.3 hours). Approximately 41% of patients with ST-segment elevation AMI presented to the 94 study hospitals within 2 hours of the onset of acute coronary symptoms; this compared with approximately one third of patients with non-ST-segment elevation AMI and unstable angina. Several demographic and clinical characteristics were associated with prehospital delay. In patients with ST-segment elevation AMI, duration of prehospital delay was inversely related to the receipt of thrombolytic therapy, but was inconsistently related to the use of percutaneous coronary interventions. The results of this study demonstrate that a large proportion of patients continue to exhibit prolonged delay in seeking medical care after the onset of acute coronary symptoms and remain in need of targeted educational efforts to reduce extent of delay.

ARTICLE TITLE: The difference between a mentor and a teacher.
ARTICLE SOURCE: Am J Cardiol (United States), Apr 15 2002, 89(8) p1004-5
AUTHOR(S): Hollingsworth JH
AUTHOR'S ADDRESS: University of Virginia School of Medicine, Roanoke, Virginia, USA. jhayden@roanoke.infi.net.
PUBLICATION TYPE: Journal Article
MB: About the author having a boss who wrote a letter to the family of his patients who had died. He did the same and was surprised that if he saw them again they reminded him of it.

ARTICLE TITLE: The rational use of computed tomography scans in the diagnosis of appendicitis
ARTICLE SOURCE: Am J Surg (United States), May 2002, 183(5) p547-50
AUTHOR(S): Morris KT; Kavanagh M; Hansen P; Whiteford MH; Deveney K; Standage B
AUTHOR'S ADDRESS: Department of Surgery, Oregon Health Sciences University, and Department of Surgery, Legacy Health Systems, 1130 NW 22nd, Suite 300, 97210, Portland, OR, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Ordering CT scans to evaluate for appendicitis prior to surgical evaluation is of limited value.

ARTICLE TITLE: Acid-base physiology: the 'traditional' and the 'modern' approaches.
ARTICLE SOURCE: Anaesthesia (England), Apr 2002, 57(4) p348-56
AUTHOR(S): Sirker AA; Rhodes A; Grounds RM; Bennett ED
AUTHOR'S ADDRESS: Department of Intensive Care, St. Georges Hospital, London SW17 OQT, UK.
PUBLICATION TYPE: Status: Completed
Journal Article; Review; Review, Tutorial
ABSTRACT: The interpretation and understanding of acid-base dysfunction has recently been revisited. The 'traditional' approach developed from the pioneering work of Henderson and Hasselbalch and is still the most widely used in clinical practice. There are a number of problems identified with this approach, however. The 'modern' approach derives from Stewart's work in physical chemistry. In this review we describe the origins of the traditional approach and discusses related concepts. We then describe Stewart's approach, including how it is derived and how it may be used to classify acid-base derangements. The applications of Stewart's approach to clinical scenarios in intensive care is then discussed briefly before we examine some published clinical studies based on his work.
MB: There is massive confusion in what they call the 'traditional ' as well as the Stewart approach. The traditional is what is used in most places ie that of Henderson & Hasselbalch although it was added to a bit by Astrup & Co. Most students reject both as they are inconsistent with standard chemistry. The article is a mass of equations. It would be enough to put anyone off.
See http://www.usyd.edu.au/su/anaes/lectures/acidbase_mjb/acidbase.html for a more intuitive approach.

ARTICLE TITLE: Propofol effective concentration 50 and its relationship to bispectral index.
ARTICLE SOURCE: Anaesthesia (England), Mar 2002, 57(3) p242-8
AUTHOR(S): Irwin MG; Hui TW; Milne SE; Kenny GN
AUTHOR'S ADDRESS: Department of Anaesthesiology, University of Hong Kong, Room 424, K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. mgirwin@hkucc.hku.hk.
PUBLICATION TYPE: Journal Article
ABSTRACT: Sixty unpremedicated healthy adult patients were studied during induction of anaesthesia with intravenous propofol delivered by a 'Diprifusor' target-controlled infusion. Bispectral index (BIS) and spectral edge frequency (SEF95) were measured concurrently with the predicted blood and effect site propofol concentrations. Logistic regression was used to calculate the predicted propofol blood and effect site concentrations required to produce unconsciousness and no response to a noxious stimulus in 50% and 95% of patients and to correlate BIS with these end-points. The Diprifusor TCI software produces anaesthesia at consistent target concentrations. Bispectral index correlates well with clinical end-points and may be useful during propofol anaesthesia.
MB: I would not have thought that effective concentration 95 would be a good target.

ARTICLE TITLE: Personality testing and profiling for anaesthetic job recruitment: attitudes of anaesthetic specialists/consultants in New Zealand and Scotland.
ARTICLE SOURCE: Anaesthesia (England), Feb 2002, 57(2) p116-22
AUTHOR(S): Kluger MT; Watson D; Laidlaw TM; Fletcher T
AUTHOR'S ADDRESS: Department of Anaesthesia, North Shore Hospital, Auckland, New Zealand. klugerm@uhl.co.nz.
PUBLICATION TYPE: Journal Article
ABSTRACT: Specialist/consultant anaesthetists based in New Zealand and Scotland were sent a reply paid postal questionnaire asking about their attitudes to personality testing and personality types in the recruitment process for registrars and specialists. The questionnaire consisted of nine Likert-style questions and 14 visual analogue questions. The overall response rate was 65% (523/808). The responses to all the questions were broadly similar in the two countries. Personality testing was deemed of use in recruiting trainees and specialists, with a slightly greater proportion considering personality traits more important than academic achievement. An overwhelming majority believed the presence of an adverse personality trait would influence an appointment process, but few believed that the personality makeup of anaesthetists influenced the way in which they react to stressful situations. A slight majority considered the interview process a poor predictor of personality. New Zealand anaesthetists rated independence, orderliness, compassion, empathy, reflectiveness and patience higher than did anaesthetists in Scotland. In contrast, anaesthetists in Scotland rated pragmatism, as opposed to perfection, as a more important characteristic than did the New Zealand specialists. Personality assessment, although not effective as the sole tool for candidate selection, may have a role in the process of anaesthetic job recruitment and warrants further investigation.
MB: If you ask a silly question....

ARTICLE TITLE: Predicting difficult intubation--worthwhile exercise or pointless ritual?
ARTICLE SOURCE: Anaesthesia (England), Feb 2002, 57(2) p105-9
AUTHOR(S): Yentis SM
PUBLICATION TYPE: Editorial; Review; Review, Tutorial
MB: Pointless except to make you aware that you can't predict difficult intubation & probably anything else.

ARTICLE TITLE: Burnout and self-reported patient care in an internal medicine residency program.
COMMENTS: Comment In: Comment In: RefSource:Ann Intern Med. 2002 Mar 5; 136(5):391-3/PMID:11874312; Summary For Patients In: Summary For Patients In: RefSource:Ann Intern Med. 2002 Mar 5; 136(5):I29/PMID:11874329
ARTICLE SOURCE: Ann Intern Med (United States), Mar 5 2002, 136(5) p358-67
AUTHOR(S): Shanafelt TD; Bradley KA; Wipf JE; Back AL
AUTHOR'S ADDRESS: University of Washington, Veterans Affairs Northwest Health Services Research and Development Center of Excellence, and Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA. .
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Burnout is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment. Little is known about burnout in residents or its relationship to patient care.<snip> CONCLUSION: Burnout was common among resident physicians and was associated with self-reported suboptimal patient care practices.

ARTICLE TITLE: Who is sicker: patients - or residents? Residents' distress and the care of patients.
COMMENTS: Comment On: Comment On: RefSource:Ann Intern Med. 2002 Mar 5; 136(5):358-67
ARTICLE SOURCE: Ann Intern Med (United States), Mar 5 2002, 136(5) p391-3
AUTHOR(S): Clever LH
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Acupuncture: theory, efficacy, and practice.
ARTICLE SOURCE: Ann Intern Med (United States), Mar 5 2002, 136(5) p374-83
AUTHOR(S): Kaptchuk TJ
AUTHOR'S ADDRESS: Division of Research and Education in Complementary and Integrative Medical Therapies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
PUBLICATION TYPE: Historical Article; Journal Article; Review; Review, Academic
ABSTRACT: Traditionally, acupuncture is embedded in naturalistic theories that are compatible with Confucianism and Taoism. Such ideas as yin-yang, qi, dampness, and wind represent East Asian conceptual frameworks that emphasize the reliability of ordinary, human sensory awareness. Many physicians who practice acupuncture reject such prescientific notions. Numerous randomized, controlled trials and more than 25 systematic reviews and meta-analyses have evaluated the clinical efficacy of acupuncture. Evidence from these trials indicates that acupuncture is effective for emesis developing after surgery or chemotherapy in adults and for nausea associated with pregnancy. Good evidence exists that acupuncture is also effective for relieving dental pain. For such conditions as chronic pain, back pain, and headache, the data are equivocal or contradictory. Clinical research on acupuncture poses unique methodologic challenges. Properly performed acupuncture seems to be a safe procedure. Basic-science research provides evidence that begins to offer plausible mechanisms for the presumed physiologic effects of acupuncture. Multiple research approaches have shown that acupuncture activates endogenous opioid mechanisms. Recent data, obtained by using functional magnetic resonance imaging, suggest that acupuncture has regionally specific, quantifiable effects on relevant brain structures. Acupuncture may stimulate gene expression of neuropeptides. The training and provision of acupuncture care in the United States are rapidly expanding.

ARTICLE TITLE: Short-term Acupuncture Therapy Is of No Benefit in Patients With Moderate Persistent Asthma
ARTICLE SOURCE: Chest (United States), May 2002, 121(5) p1396-400
AUTHOR(S): Shapira MY; Berkman N; Ben-David G; Avital A; Bardach E; Breuer R
AUTHOR'S ADDRESS: Department of Bone Marrow Transplantation (Dr. Shapira) and the Institute of Pulmonology (Drs. Berkman, Avital, Breuer, and Ben-David, and Ms Bardach), Hadassah University Hospital, Jerusalem, Israel.
PUBLICATION TYPE: Journal Article
CONCLUSION: In patients with moderate persistent asthma, a short course of acupuncture treatment resulted in no change in lung functions, bronchial hyperreactivity, or patient symptoms.

ARTICLE TITLE: Acupuncture for asthma: fact or fiction?
ARTICLE SOURCE: Chest (United States), May 2002, 121(5) p1387-8
AUTHOR(S): Varon J; Fromm RE; Marik PE
AUTHOR'S ADDRESS: Dr. Varon and Dr. Fromm are Associate Professors of Medicine, Baylor College of Medicine, and Dr. Marik is Professor of Medicine, University of Pittsburgh Medical Center.
PUBLICATION TYPE Journal Article

ARTICLE TITLE: Hospital readmission after coronary artery bypass grafting: are women doing worse?
ARTICLE SOURCE: Ann Thorac Surg (United States), May 2002, 73(5) p1380-6
AUTHOR(S): Steuer J; Blomqvist P; Granath F; Rydh B; Ekbom A; de Faire U; Stahle E
AUTHOR'S ADDRESS: Department of Thoracic and Cardiovascular Surgery, University Hospital, Uppsala, Sweden.
PUBLICATION TYPE: Status: In-Process
Journal Article
CONCLUSIONS: This study showed an acceptable risk of readmission after coronary artery bypass grafting. Women more often had risk factors related to readmission. However, given identical disease severity, the risk was similar in men and women.

ARTICLE TITLE: Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology
ARTICLE SOURCE: Arch Intern Med (United States), May 27 2002, 162(10) p1182-9
AUTHOR(S): Tsai AW; Cushman M; Rosamond WD; Heckbert SR; Polak JF; Folsom AR
AUTHOR'S ADDRESS: Division of Epidemiology, School of Public Health, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55454. folsom@epi.umn.edu.
PUBLICATION TYPE: Status: In-Process
Journal Article
CONCLUSIONS: Our data showing no relationship of some arterial risk factors with venous thromboembolism (VTE) corroborate the view that the etiology of VTE differs from atherosclerotic cardiovascular disease. In addition, the findings suggest a hypothesis that avoidance of obesity and diabetes or vigilance in prophylaxis in patients with those conditions may prevent some venous thromboses.

ARTICLE TITLE: The "Hassle Factor": what motivates physicians to manipulate reimbursement rules?
ARTICLE SOURCE: Arch Intern Med (United States), May 27 2002, 162(10) p1134-9
AUTHOR(S): Werner RM; Alexander GC; Fagerlin A; Ubel PA
AUTHOR'S ADDRESS: Division of General Internal Medicine, University of Pennsylvania, Blockley Hall, 12th Floor, 423 Guardian Dr, Philadelphia, PA 19104. rwerner@wharton.upenn.edu.
PUBLICATION TYPE: Status: In-Process
Journal Article
ABSTRACT: BACKGROUND: Some physicians are willing to misrepresent clinical information to insurance companies to circumvent appeals processes CONCLUSIONS: Physicians are more willing to sanction deception when the appeals process is longer, the likelihood of a successful appeal is lower, and the health condition is more severe. Changes in the difficulty of appeals processes may ease the tensions physicians face regarding patient advocacy and honesty.

ARTICLE TITLE: Benefits of beta-blocker therapy for heart failure: weighing the evidence.
ARTICLE SOURCE: Arch Intern Med (United States), Mar 25 2002, 162(6) p641-8
AUTHOR(S): Goldstein S
AUTHOR'S ADDRESS: Division of Cardiovascular Medicine, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA. sgoldst1@hfhs.org.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Our understanding of factors contributing to the progression of heart failure has advanced dramatically over the past 2 decades. We have also gained considerable insight into the pharmacology of beta-adrenergic receptor blockers (beta-blockers). Based on this knowledge, we can now appreciate the potential of these drugs for the treatment of heart failure. Several beta-blockers have been shown to be clinically effective in the treatment of heart failure. Critical evaluation of the evidence from basic research studies, as well as clinical trials in patients with heart failure, helps to delineate the theoretical and clinical benefits of beta-blockers.

ARTICLE TITLE: Conflicts of interest: science, money, and health.
ARTICLE SOURCE: Arch Intern Med (United States), Mar 25 2002, 162(6) p635-7
AUTHOR(S): Alpert JS; Furman S; Smaha L
AUTHOR'S ADDRESS: Department of Medicine, University of Arizona Health Sciences Center, 1501 Campbell Ave, Tucson, AZ 85724, USA. jalpert@u.arizona.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The association of sex and payer status on management and subsequent survival in acute myocardial infarction.
ARTICLE SOURCE: Arch Intern Med (United States), Mar 11 2002, 162(5) p587-93
AUTHOR(S): Canto JG; Rogers WJ; Chandra NC; French WJ; Barron HV; Frederick PD; Maynard C; Every NR
AUTHOR'S ADDRESS: Department of Medicine, University of Alabama Medical Center, Birmingham, USA; Collective Name: National Registry of Myocardial Infarction 2 Investigators.
PUBLICATION TYPE: Journal Article
METHODS: Baseline and clinical presenting characteristics, utilization of hospital resources, and subsequent clinical outcome were ascertained among 327 040 women and men enrolled in a national registry of myocardial infarction from June 1, 1994, to January 31, 1997. CONCLUSION: In this large registry, we did not observe significant variations among payer classes in management and mortality among women and men after acute myocardial infarction.

ARTICLE TITLE: Quality of life after acute myocardial infarction among patients treated at sites with and without on-site availability of angiography.
ARTICLE SOURCE: Arch Intern Med (United States), Mar 11 2002, 162(5) p553-9
AUTHOR(S): Pilote L; Lauzon C; Huynh T; Dion D; Roux R; Racine N; Carignan S; Diodati JG; Levesque C; Charbonneau F; Pouliot J; Joseph L; Eisenberg MJ
AUTHOR'S ADDRESS: McGill University Health Centre, Montreal, Quebec, Canada. louise.pilote@musica.mcgill.ca.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: In the early post- acute myocardial infarction (AMI) period, the quality of life (QOL) of patients admitted at sites with angiography was higher than that of patients admitted at sites without angiography. However, by 1 year, the QOL and functional status of patients was similar in both groups. Differences in QOL were greatest when differences in treatment were greatest, lending support to a positive albeit small association between an early invasive approach to post-AMI care and improved QOL.

ARTICLE TITLE: Do subspecialists working outside of their specialty provide less efficient and lower-quality care to hospitalized patients than do primary care physicians?
ARTICLE SOURCE: Arch Intern Med (United States), Mar 11 2002, 162(5) p527-32
AUTHOR(S): Weingarten SR; Lloyd L; Chiou CF; Braunstein GD
AUTHOR'S ADDRESS: Department of Health Services Research, Zynx Health, Inc, Cedars-Sinai Health System, 9100 Wilshire Blvd, Suite 655E, Beverly Hills, CA 90212, USA. weingarten@zynx.com.
PUBLICATION TYPE: Journal Article; Multicenter Study
CONCLUSIONS: Subspecialists commonly care for patients outside of their subspecialty, despite the fact that their patients may have longer lengths of stay than those cared for by subspecialists practicing within their specialty or by general internists. In addition, such patients may have slightly higher mortality rates than those cared for by subspecialists practicing within their subspecialty.

ARTICLE TITLE: Psychological factors in heart failure: a review of the literature.
ARTICLE SOURCE: Arch Intern Med (United States), Mar 11 2002, 162(5) p509-16
AUTHOR(S): MacMahon KM; Lip GY
AUTHOR'S ADDRESS: University Department of Medicine, City Hospital, Dudley Road, Birmingham B18 7QH, England.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Congestive heart failure (CHF) is the end stage of many diseases of the heart and a major cause of morbidity and mortality. The incidence of CHF is increasing steadily as treatment for its coronary antecedents, such as myocardial infarction, advances. Treatment of CHF generally relies on a battery of pharmacological interventions, alongside exercise and diet regimens. It is only in recent years that the psychological impact of heart failure has been explored, which is reflected by the absence of standardized psychological assessment for patients with CHF. In this article, we review studies that have addressed the effects of depression, anxiety, coping style, and level of social support in CHF. From the available evidence, it appears that patients generally experience moderate levels of depression, but not greatly heightened anxiety. Level of social support and style of coping with the disease are, however, important prognostic factors. It is difficult to draw definitive conclusions owing to the paucity of literature. Further work examining this issue is needed if the psychological issues of heart failure are not to be neglected.

ARTICLE TITLE: The changing face of hypertension: is systolic blood pressure the final answer?
COMMENTS: Comment On: Comment On: RefSource:Arch Intern Med. 2002 Mar 11; 162(5):577-81
ARTICLE SOURCE: Arch Intern Med (United States), Mar 11 2002, 162(5) p506-8
AUTHOR(S): Deedwania PC
PUBLICATION TYPE: Comment; Editorial
MB: Apparently it is.

ARTICLE TITLE: Autologous transfusion.
ARTICLE SOURCE: BMJ (England), Mar 30 2002, 324(7340) p772-5
AUTHOR(S): Vanderlinde ES; Heal JM; Blumberg N
AUTHOR'S ADDRESS: Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA.
PUBLICATION TYPE Journal Article; Review; Review Literature

ARTICLE TITLE: German doctors face investigation in drugs scandal.
ARTICLE SOURCE: BMJ (England), Mar 23 2002, 324(7339) p693
AUTHOR(S): Tuffs A
PUBLICATION TYPE: News
MB: 3500 German doctors are being investigated for being involved in Drug Company favours.

ARTICLE TITLE: After Bristol: putting patients at the centre.
ARTICLE SOURCE: BMJ (England), Mar 16 2002, 324(7338) p648-51
AUTHOR(S): Coulter A
AUTHOR'S ADDRESS: Picker Institute Europe, Oxford OX1 1RX. angela.coulter@pickereurope.ac.uk.
PUBLICATION TYPE: Journal Article
MB: There are 198 recommendations. I can't imagine they will be implemented.

ARTICLE TITLE: Woman may face death penalty in postnatal depression case.
ARTICLE SOURCE: BMJ (England), Mar 16 2002, 324(7338) p634
AUTHOR(S): Charatan F; Eaton F; Eaton L
PUBLICATION TYPE: News
MB: Mother killed her 5 children in Texas.

ARTICLE TITLE: Deprofessionalising doctors?
COMMENTS: Comment In: Comment In: RefSource:BMJ. 2002 May 4; 324
ARTICLE SOURCE: BMJ (England), Mar 16 2002, 324(7338) p627-8
AUTHOR(S): Pereira Gray D
PUBLICATION TYPE: Editorial
MB: This is pretty scary. They are having an NHS Reform Bill which is proposing a committee of lay people responsible to Parliament over the GMC. The author thinks it could be like the Ecclesiastic Committee they had since 1919 presumably to supervise the established Church (of England). They want to direct post-graduate education too.

ARTICLE TITLE: NHS settles claim of patients treated with LSD.
ARTICLE SOURCE: BMJ (England), Mar 2 2002, 324(7336) p501
AUTHOR(S): Dyer C
PUBLICATION TYPE: News
MB: There are some surgeons here who were given LSD as interns while doing a psychiarty term.

ARTICLE TITLE: Randomised controlled trials for homoeopathy.
COMMENTS: Comment On: Comment On: RefSource:BMJ. 2002 Mar 2; 324(7336):520
ARTICLE SOURCE: BMJ (England), Mar 2 2002, 324(7336) p498-9
AUTHOR(S): Feder G; Katz T
PUBLICATION TYPE: Comment; Editorial
MB: There is a meta-analysis in that issue. The authors don't think that a big real definitive trial could be justified as a priority.

ARTICLE TITLE: ABC of clinical electrocardiography: Acute myocardial infarction-Part I.
ARTICLE SOURCE: BMJ (England), Apr 6 2002, 324(7341) p831-4
AUTHOR(S): Morris F; Brady WJ
AUTHOR'S ADDRESS: Department of Emergency Medicine, Northern General Hospital, Sheffield, UK.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: ABC of clinical electrocardiography: Myocardial ischaemia.
ARTICLE SOURCE: BMJ (England), Apr 27 2002, 324(7344) p1023-6
AUTHOR(S): Channer K; Morris F
AUTHOR'S ADDRESS: Royal Hallamshire Hospital, Sheffield.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: ABC of clinical electrocardiography. Conditions affecting the right side of the heart
ARTICLE SOURCE: BMJ (England), May 18 2002, 324(7347) p1201-4
AUTHOR(S): Harrigan RA; Jones K
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Driving and arrhythmias.
ARTICLE SOURCE: BMJ (England), Apr 20 2002, 324(7343) p927-8
AUTHOR(S): Binns H; Camm J
PUBLICATION TYPE: Editorial

ARTICLE TITLE: How whistleblowing cost one doctor 550000 pounds
ARTICLE SOURCE: BMJ (England), May 25 2002, 324(7348) p1240
AUTHOR(S): Sheldon T
PUBLICATION TYPE: News

ARTICLE TITLE: In-hospital deaths as fraction of all deaths within 30 days of hospital admission for surgery: analysis of routine statistics.
ARTICLE SOURCE: BMJ (England), May 4 2002, 324(7345) p1069-70
AUTHOR(S): Goldacre MJ; Griffith M; Gill L; Mackintosh A
AUTHOR'S ADDRESS: Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Oxford OX3 7LF. michael.goldacre@dphpc.ox.ac.uk.
PUBLICATION TYPE: Journal Article
MB: They don't stay in hospital long enough to be counted.

ARTICLE TITLE: Ventilator-associated pneumonia and surgical patients
ARTICLE SOURCE: Chest (United States), May 2002, 121(5) p1390-1
AUTHOR(S): Spain DA
AUTHOR'S ADDRESS: Dr. Spain is Chief of Trauma/Surgical Clinical Care, Department of Surgery.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Amiodarone vs. sotalol as prophylaxis against atrial fibrillation/flutter after heart surgery: a meta-analysis.
ARTICLE SOURCE: Chest (United States), Apr 2002, 121(4) p1203-10
AUTHOR(S): Wurdeman RL; Mooss AN; Mohiuddin SM; Lenz TL
AUTHOR'S ADDRESS: Creighton University School of Pharmacy and Allied Health Professions, Omaha, NE, USA. rwurdem@cardiac.creighton.edu.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSIONS: This data would suggest that either drug could be used in a prophylactic regimen to reduce the incidence of atrial fibrillation and flutter (AFF) following heart surgery.

ARTICLE TITLE: Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy.
ARTICLE SOURCE: Chest (United States), Apr 2002, 121(4) p1149-54
AUTHOR(S): Antonelli M; Conti G; Rocco M; Arcangeli A; Cavaliere F; Proietti R; Meduri GU
AUTHOR'S ADDRESS: Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Rome, Italy. max.antonelli@flashnet.it.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
<snip>PATIENTS AND METHODS: Twenty-six patients with PaO(2)/FIO(2) ratios < or = 200 who required bronchoscopic BAL for suspected nosocomial pneumonia were entered into the study. Thirteen patients were randomized during FOB to receive NPPV, and 13 patients were randomized to receive conventional oxygen supplementation by Venturi mask. The primary end points were changes in the PaO(2)/FIO(2) ratio during FOB and within 60 min of terminating the procedure. <snip>CONCLUSION: In patients with severe hypoxemia, noninvasive positive-pressure ventilation (NPPV) is superior to conventional oxygen supplementation in preventing gas-exchange deterioration during fiberoptic bronchoscopy (FOB) with better hemodynamic tolerance.
MB: I would think so.

ARTICLE TITLE: Stair climbing test predicts cardiopulmonary complications after lung resection.
ARTICLE SOURCE: Chest (United States), Apr 2002, 121(4) p1106-10
AUTHOR(S): Brunelli A; Al Refai M; Monteverde M; Borri A; Salati M; Fianchini A
AUTHOR'S ADDRESS: Department of Thoracic Surgery, University of Ancona, Ancona, Italy. alexit_2000@yahoo.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: STUDY OBJECTIVE: To evaluate the capability of the stair climbing test to predict cardiopulmonary complications after lung resection for lung cancer. <snip> CONCLUSIONS: The stair climbing test is a safe and economical exercise test, and it was the best predictor of cardiopulmonary complications after lung resection.

ARTICLE TITLE: Silver-coated endotracheal tubes associated with reduced bacterial burden in the lungs of mechanically ventilated dogs.
COMMENTS: Comment In: Comment In: RefSource:Chest. 2002 Mar; 121(3):682-3
ARTICLE SOURCE: Chest (United States), Mar 2002, 121(3) p863-70
AUTHOR(S): Olson ME; Harmon BG; Kollef MH
AUTHOR'S ADDRESS: Department of Microbiology and Infectious Diseases, Animal Resources Center, The University of Calgary, Alberta, Canada.
PUBLICATION TYPE: Evaluation Studies; Journal Article
CONCLUSION: These results suggest that the silver coating of endotracheal tubes may delay the onset of and decrease the severity of lung colonization by aerobic bacteria. Based on these results, clinical studies are planned to determine the safety and clinical efficacy of silver-coated endotracheal tubes in patients requiring mechanical ventilation in the ICU setting.

ARTICLE TITLE: Is a silver coating a silver lining?
COMMENTS: Comment On: Comment On: RefSource:Chest. 2002 Mar; 121(3):863-70
ARTICLE SOURCE: Chest (United States), Mar 2002, 121(3) p682-3
AUTHOR(S): Balk RA
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Prevention of ventilator-associated pneumonia: selecting interventions that make a difference.
COMMENTS: Comment On: Comment On: RefSource:Chest. 2002 Mar; 121(3):858-62/PMID:11888973
ARTICLE SOURCE: Chest (United States), Mar 2002, 121(3) p679-81
AUTHOR(S): Iregui M; Kollef MH
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Bispectral index-guided sedation with dexmedetomidine in intensive care: a prospective, randomized, double blind, placebo-controlled phase II study
ARTICLE SOURCE: Crit Care Med (United States), May 2002, 30(5) p1007-14
AUTHOR(S): Triltsch AE; Welte M; von Homeyer P; Grosse J; Genahr A; Moshirzadeh M; Sidiropoulos A; Konertz W; Kox WJ; Spies CD
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, Benjamin Franklin Medical Center, Free University of Berlin, Germany.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Dexmedetomidine reduced propofol requirements and improved hemodynamic stability during bispectral index-guided intensive care unit sedation.

ARTICLE TITLE: Lessons from everyday lives: A moral justification for acute care research*
ARTICLE SOURCE: Crit Care Med (United States), May 2002, 30(5) p1146-51
AUTHOR(S): McRae AD; Weijer C
AUTHOR'S ADDRESS: Department of Bioethics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
PUBLICATION TYPE: Status: In-Process
Journal Article
ABSTRACT: Progress in emergency and critical care requires that clinical research be performed on patients who are incapable of granting consent for research participation. Analyses of the ethics of such research have left some questions incompletely answered. Why should we be permitted to expose vulnerable patients to research risks without their consent? In particular, how do we justify research interventions that have no potential benefit for participants (nontherapeutic interventions)? This article presents a moral justification for nontherapeutic interventions in emergency research. By relying on a framework for assessing research risks, and by drawing on the example of pediatric research, this justification is founded in how institutional review boards, and society in general, analyze risk. Our justification for emergency research also suggests additional protections for emergency research participants, including a stringent threshold for research risk, that still permit important research to proceed.

ARTICLE TITLE: Therapeutic sedation: has its time come?
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Apr; 30(4):904-7
ARTICLE SOURCE: Crit Care Med (United States), Apr 2002, 30(4) p949-52
AUTHOR(S): Marik PE; Zaloga GP
PUBLICATION TYPE: Comment; Editorial .

ARTICLE TITLE: Medication errors: problems identified, but what is the solution?
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Apr; 30(4):846-50/PMID:11940757
ARTICLE SOURCE: Crit Care Med (United States), Apr 2002, 30(4) p944-5
AUTHOR(S): Olsen KM
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Early extubation after pediatric heart surgery: the future?
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Apr; 30(4):787-91
ARTICLE SOURCE: Crit Care Med (United States), Apr 2002, 30(4) p940-1
AUTHOR(S): Robinson A
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Very early extubation in children after cardiac surgery.
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Apr; 30(4):940-1
ARTICLE SOURCE: Crit Care Med (United States), Apr 2002, 30(4) p787-91
AUTHOR(S): Kloth RL; Baum VC
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA.
CONCLUSIONS: Successful early extubation of even young children is possible and easily accomplished in most children undergoing cardiopulmonary bypass, even with complex procedures, but advantages of extubation in the operating room vs. immediate ICU extubation remain unclear. Transient mild-to-moderate mixed acidosis is common and requires no treatment. Full implementation requires acceptance by surgical and ICU staffs.
MB: In 1960 all cardiac surgery patients were extubated at the end of surgery. It was then found that some did better if left intubated. The patients then were all probably more impaired than now.

ARTICLE TITLE: Understanding sepsis: promise, caution, and accolades to a mentor's mentor.
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Mar; 30(3):617-22/PMID:11990925
ARTICLE SOURCE: Crit Care Med (United States), Mar 2002, 30(3) p717-8
AUTHOR(S): Deutschman CS
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Definition of sepsis: not quite time to dump SIRS?
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Mar; 30(3):529-35/PMID:11990910
ARTICLE SOURCE: Crit Care Med (United States), Mar 2002, 30(3) p706-8
AUTHOR(S): Marik PE
PUBLICATION TYPE: Comment; Editorial
MB: I think that we could discard the concept after reading that editorial. They sometimes grew pathogens. There were sometimes variations in PCT & CRP. There seems to be a lot of un-intelligible biochemistry which suggest therapy which does not work. I went to a seminar in Berlin a few years ago & the had a symposium to honour Dr Bone who had done many studies but they'd all failed.

ARTICLE TITLE: Randomized, controlled clinical trials in sepsis: has methodological quality improved over time?
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Feb; 30(2):487-8
ARTICLE SOURCE: Crit Care Med (United States), Feb 2002, 30(2) p461-72
AUTHOR(S): Graf J; Doig GS; Cook DJ; Vincent JL; Sibbald WJ
AUTHOR'S ADDRESS: Medical Clinic I, Department of Cardiology, University Hospital Aachen, Aachen, Germany. jgraf@gmx.de.
PUBLICATION TYPE: Journal Article; Meta-Analysis; Review; Review, Tutorial
CONCLUSION: The methodological limitations identified in this article can help to target further improvement in trial design to enhance the validity of findings from future randomized clinical trials of sepsis.
MB: I don't think it's very sensible to look on 'sepsis' as a single entity especially as it is looked on as a syndrome rather than a pathological entity. Cancer had a pathological definition & there are multiple kinds of that. It appears that sepsis & SIRS do not have to include an infective oganism.

ARTICLE TITLE: Cardiac tamponade in an orthotopic liver recipient with pulmonary hypertension.
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Mar; 30(3):721-3
ARTICLE SOURCE: Crit Care Med (United States), Mar 2002, 30(3) p699-701
AUTHOR(S): Akinci SB; Gaine SP; Post W; Merrit WT; Tan HP; Winters B
AUTHOR'S ADDRESS: Department of Anesthesiology & Reanimation, Hacettepe University, Ankara, Turkey.
PUBLICATION TYPE: Journal Article
CONCLUSION: Pulmonary hypertension may decrease the predictive accuracy of echocardiographic clues for cardiac tamponade. Pericardiocentesis should be considered with clinical suspicion of cardiac tamponade without classic echocardiographic evidence in portopulmonary hypertension.

ARTICLE TITLE: Acute severe asthma: differences in therapies and outcomes among pediatric intensive care units.
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Mar; 30(3):713-4
ARTICLE SOURCE: Crit Care Med (United States), Mar 2002, 30(3) p581-5
AUTHOR(S): Roberts JS; Bratton SL; Brogan TV
AUTHOR'S ADDRESS: Department of Pediatrics, University of Washington School of Medicine, Children's Hospital, Seattle, USA.
PUBLICATION TYPE: Journal Article; Multicenter Study
ABSTRACT: OBJECTIVE: To determine differences in therapies and outcomes among pediatric intensive care units for patients with acute severe asthma. DESIGN: Retrospective cohort study. SETTING: Eleven pediatric intensive care units participating in the Pediatric Intensive Care Evaluations. PATIENTS: Patients were 1528 children with a primary diagnosis of asthma. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We studied severity of illness, length of stay, and use of invasive interventions. The patients at the centers had similar median physiologic measures of illness and Pediatric Risk of Mortality III scores. The patients received a wide range of invasive interventions depending on institution, including mechanical ventilation (3% to 47%), arterial catheter placement (4% to 46%), central venous catheter (2% to 51%), and determination of a blood gas (24% to 70%). At institutions where mechanical ventilation was used more commonly (>20%, high use), intensive care and hospital stays were longer for asthmatic patients regardless of mechanical ventilation requirement compared with centers with lower use of mechanical ventilation. The status of "high-use center" was an independent predictor for intensive care stay (p = .005) and hospital length of stay (p = .017) as well as duration of mechanical ventilation (p = .014) after adjustment for age, degree of hypercarbia, maximal respiratory rate, use of an arterial catheter, and Pediatric Risk of Mortality III scores among ventilated children. CONCLUSIONS: We found that use of invasive interventions including mechanical ventilation and vascular monitoring varied greatly by institution. Centers with higher use of mechanical ventilation had longer median intensive care stay and hospital stays. Pediatric asthma management for acute severe asthma may be improved by clear elucidation of the institutional practices where fewer invasive interventions were used to achieve better outcomes.
MB: Those ventilating more patients could have had more severe patients.

ARTICLE TITLE: Noninvasive ventilation in acute respiratory failure - a meta-analysis update.
ARTICLE SOURCE: Crit Care Med (United States), Mar 2002, 30(3) p555-62
AUTHOR(S): Peter JV; Moran JL; Phillips-Hughes J; Warn D
AUTHOR'S ADDRESS: Intensive Care Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSION: Substantial reductions in mortality and the need for subsequent invasive mechanical ventilation (MV) were associated with noninvasive ventilation (NIV ) in acute respiratory failure, especially in the chronic obstructive pulmonary disease (COPD) subgroup. Hospital length of stay was variably affected. Heterogeneity of treatment effects was observed.

ARTICLE TITLE: Severe status asthmaticus: management with permissive hypercapnia and inhalation anesthesia.
ARTICLE SOURCE: Crit Care Med (United States), Feb 2002, 30(2) p477-80
AUTHOR(S): Mutlu GM; Factor P; Schwartz DE; Sznajder JI
AUTHOR'S ADDRESS: Pulmonary and Critical Care Medicine, Evanston Northwestern Healthcare, Evanston, IL 60611, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Mechanical ventilation in severe status asthmaticus can be challenging. Permissive hypercapnia is a relatively safe strategy in the ventilatory management of asthma. High levels of hypercapnia and associated severe acidosis are well tolerated in the absence of contraindications (i.e., preexisting intracranial hypertension). Inhalation anesthesia may be useful in the treatment of refractory cases of asthma but should be used carefully because it may be hazardous owing to poor flow capabilities of most anesthesia ventilators.

ARTICLE TITLE: Brain death assessment using instant spectral analysis of heart rate variability.
ARTICLE SOURCE: Crit Care Med (United States), Feb 2002, 30(2) p306-10
AUTHOR(S): Baillard C; Vivien B; Mansier P; Mangin L; Jasson S; Riou B; Swynghedauw B
AUTHOR'S ADDRESS: U127-INSERM, Lariboisiere Hospital, Paris, France.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: This study provides a novel approach to confirmation of the cessation of brainstem function. Validation of the technique and a broader patient sample is needed to establish a role for clinical application.
MB: Brain death is a vague enough concept. I don't think we can take any notice of these people.

ARTICLE TITLE: Jugular versus subclavian central venous catheter insertion: search for the better approach.
COMMENTS: Comment On: Comment On: RefSource:Crit Care Med. 2002 Feb; 30(2):454-60
ARTICLE SOURCE: Crit Care Med (United States), Feb 2002, 30(2) p486-7
AUTHOR(S): Vinod KP
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Complications of central venous catheters: internal jugular versus subclavian access - a systematic review.
COMMENTS: Comment In: Comment In: RefSource:Crit Care Med. 2002 Feb; 30(2):486-7
ARTICLE SOURCE: Crit Care Med (United States), Feb 2002, 30(2) p454-60
AUTHOR(S): Ruesch S; Walder B; Tramer MR
AUTHOR'S ADDRESS: Division of Anaesthesiology, Department Anaesthesiology, Pharmacology, and Surgical Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.
PUBLICATION TYPE: Journal Article; Meta-Analysis; Review; Review, Tutorial
ABSTRACT: OBJECTIVE: To test whether complications happen more often with the internal jugular or the subclavian central venous approach. DATA SOURCE: Systematic search (MEDLINE, Cochrane Library, EMBASE, bibliographies) up to June 30, 2000, with no language restriction. <snip> CONCLUSIONS: There are more arterial punctures but less catheter malpositions with the internal jugular compared with the subclavian access. There is no evidence of any difference in the incidence of hemato- or pneumothorax and vessel occlusion. Data on bloodstream infection are scarce. These data are from nonrandomized studies; selection bias cannot be ruled out. In terms of risk, the data most likely represent a best case scenario. For rational decision-making, randomized trials are needed.

ARTICLE TITLE: Head position for facilitating the superior vena caval placement of catheters during right subclavian approach in children.
ARTICLE SOURCE: Crit Care Med (United States), Feb 2002, 30(2) p297-9
AUTHOR(S): Jung CW; Bahk JH; Kim MW; Lee KH; Ko H
AUTHOR'S ADDRESS: Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: In infants, tilting the head toward the catheterization side can reduce the incidence of catheter malposition during the right subclavian approach.

ARTICLE TITLE: Education, ethics, and end-of-life decisions in the intensive care unit.
ARTICLE SOURCE: Crit Care Med (United States), Feb 2002, 30(2) p290-6
AUTHOR(S): Stevens L; Cook D; Guyatt G; Griffith L; Walter S; McMullin J
AUTHOR'S ADDRESS: Department of Medicine, McMaster University, Hamilton, ON, Canada.
PUBLICATION TYPE Journal Article; Multicenter Study
CONCLUSIONS: Experiential, case-based, patient-centered curricula are associated with resident confidence in withdrawal of life support decisions in the intensive care unit.

ARTICLE TITLE: Anaesthetic management and outcome in right-lobe living liver-donor surgery
ARTICLE SOURCE: Eur J Anaesthesiol (England), Feb 2002, 19(2) p93-8
AUTHOR(S): Cammu G; Troisi R; Cuomo O; de Hemptinne B; Di Florio E; Mortier E
AUTHOR'S ADDRESS: Ghent University Hospital, Department of Anaesthesia, Belgium. Guy.Cammu@olvz-aalst.be.
PUBLICATION TYPE: Status: In-Process
Journal Article
CONCLUSIONS: The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.

ARTICLE TITLE: Postoperative residual curarization with cisatracurium and rocuronium infusions.
ARTICLE SOURCE: Eur J Anaesthesiol (England), Feb 2002, 19(2) p129-34
AUTHOR(S): Cammu G; de Baerdemaeker L; den Blauwen N; de Mey JC; Struys M; Mortier E
AUTHOR'S ADDRESS: Ghent University Hospital, Department of Anaesthesia, Belgium. Guy.Cammu@olvz-aalst.be.
PUBLICATION TYPE: Status: In-Process
Journal Article
CONCLUSIONS: Patients receiving a cisatracurium or rocuronium infusion have a high incidence of postoperative residual curarization when the block is not antagonized. When 'reversal' is not attempted, cisatracurium seems to be safer than rocuronium.
MB: That is consistent with what I have seen of infusion of NM blockers. Cisatracurium self destructs so one would expect it to disappear more reliabialy.

ARTICLE TITLE: Meta-analysis of randomised controlled trials of the effectiveness of antiarrhythmic agents at promoting sinus rhythm in patients with atrial fibrillation
ARTICLE SOURCE: Heart (England), Jun 2002, 87(6) p535-43
AUTHOR(S): Nichol G; McAlister F; Pham B; Laupacis A; Shea B; Green M; Tang A; Wells G
AUTHOR'S ADDRESS: Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa Hospital, Ottawa, Ontario, Canada. grahamnichol@earthlink.net.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To conduct a meta-analysis of randomised controlled trials to estimate the effectiveness of antiarrhythmic drugs at promoting sinus rhythm in patients with atrial fibrillation<snip> RESULTS: 91 articles met a priori criteria for inclusion in the analysis. <snip>CONCLUSIONS: Class IA, IC(na channel blockers eg procaine amide), and III (prolonger repolarisation eg amioderone) drugs are associated with increased sinus rhythm at follow up compared with placebo. It is unclear whether any antiarrhythmic drug class is associated with increased or decreased mortality.
MB: That's a bit depressing.

ARTICLE TITLE: Myocardial dysfunction in sepsis: no role for NO?
ARTICLE SOURCE: Heart (England), Jun 2002, 87(6) p507-9
AUTHOR(S): Belcher E; Mitchell J; Evans T
AUTHOR'S ADDRESS: Unit of Critical Care, Imperial College School of Medicine, Royal Brompton Hospital, London SW3 6NP, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effects of obstructive sleep apnea (OSA), inhalational anesthesia, and fentanyl on the airway and ventilation of children
ARTICLE SOURCE: J Appl Physiol (United States), May 2002, 92(5) p1987-94
AUTHOR(S): Waters KA; McBrien F; Stewart P; Hinder M; Wharton S
AUTHOR'S ADDRESS: Department of Sleep Medicine, The Children's Hospital at Westmead, NSW 2145, Australia. kaw@mail.med.usyd.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: To assess effects of anesthesia and opioids, we studied 13 children with obstructive sleep apnea (OSA, age 4.0 +/- 2.2 yr, mean +/- SD) and 24 age-matched control subjects (5.8 +/- 4.0 yr). Apnea indexes of children with OSA were 29.4 +/- 18 h-1, median 30 h-1. Under inhalational anesthetic, closing pressure at the mask was 2.2 +/- 6.9 vs. -14.7 +/- 7.8 cmH2O, OSA vs. control (P < 0.001). After intubation, spontaneous ventilation was 115.5 +/- 56.9 vs. 158.7 +/- 81.6 ml x kg-1 small middle dot min-1, OSA vs. control (P = 0.02), despite elevated PCO2 (49.3 vs. 42.1 Torr, OSA vs. control, P < 0.001). Minute ventilation fell after fentanyl (0.5 microg/kg iv), with central apnea in 6 of 13 OSA cases vs. 1 of 23 control subjects (P < 0.001). Consistent with the finding of reduced spontaneous ventilation, apnea was most likely when end-tidal CO2 exceeded 50 Torr during spontaneous breathing under anesthetic. Thus children with OSA had depressed spontaneous ventilation under anesthesia, and opioids precipitated apnea in almost 50% of children with OSA who were intubated but breathing spontaneously under inhalational anesthesia.
MB: It appears they think that with sleep apnoea the sensitivity to CO2 is diminished. That would not be surprising but there might have been other factors.

ARTICLE TITLE: Con: Right-sided double-lumen endotracheal tubes should not be routinely used in thoracic surgery
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2002, 16(2) p249-52
AUTHOR(S): Cohen E
AUTHOR'S ADDRESS: Department of Anesthesiology, Thoracic Anesthesia, Mount Sinai School of Medicine, New York, NY.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Pro: Right-sided double-lumen endotracheal tubes should be routinely used in thoracic surgery
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2002, 16(2) p246-8
AUTHOR(S): Campos JH; Gomez MN
AUTHOR'S ADDRESS: Department of Anesthesia, University of Iowa College of Medicine, Iowa City, IA.
PUBLICATION TYPE: Journal Article
MB: I can't imagine why it might be suggested that should be used for anything bar a left pneumonectomy. Has it not always been thus?

ARTICLE TITLE: Venial and mortal sins: The problems of confounding and bias
ARTICLE SOURCE: J Cardiothorac Vasc Anesth (United States), Apr 2002, 16(2) p137-8
AUTHOR(S): Mangano CM
AUTHOR'S ADDRESS: Department of Anesthesia, Stanford University School of Medicine, Stanford, CA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Complications associated with the prophylactic use of methylprednisolone during surgical stabilization after spinal cord injury.
ARTICLE SOURCE: J Neurosurg (United States), Apr 2002, 96(3 Suppl) p267-72
AUTHOR(S): Molano Mdel R; Broton JG; Bean JA; Calancie B
AUTHOR'S ADDRESS: The Miami Project to Cure Paralysis and Department of Neurological Surgery, University of Miami School of Medicine, Florida, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data.
ARTICLE SOURCE: J Neurosurg (United States), Mar 2002, 96(3) p571-9
AUTHOR(S): Scheufler KM; Zentner J
AUTHOR'S ADDRESS: Department of Neurosurgery, University of Freiburg, Germany. scheufle@nz11.ukl.uni-freiburg.de.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Controversies in cardiothoracic surgery: Is it ethical to advertise surgical results to increase referrals
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), May 2002, 123(5) p839-41
AUTHOR(S): McKneally MF
AUTHOR'S ADDRESS: Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
PUBLICATION TYPE: Journal Article
MB: May be. What if you gave the money to charity? If the advertising was honest its better to have operations in fewer places.

ARTICLE TITLE: Psychological sequelae of the September 11 terrorist attacks in New York City.
ARTICLE SOURCE: N Engl J Med (United States), Mar 28 2002, 346(13) p982-7
AUTHOR(S): Galea S; Ahern J; Resnick H; Kilpatrick D; Bucuvalas M; Gold J; Vlahov D
AUTHOR'S ADDRESS: Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY 10029-5283, USA. sgalea@nyam.org.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: There was a substantial burden of acute post-traumatic stress disorder (PTSD) and depression in Manhattan after the September 11 attacks. Experiences involving exposure to the attacks were predictors of current PTSD, and losses as a result of the events were predictors of current depression. In the aftermath of terrorist attacks, there may be substantial psychological morbidity in the population.

ARTICLE TITLE: Psychiatric effects of terrorist attacks are underestimated.
ARTICLE SOURCE: BMJ (England), May 4 2002, 324(7345) p1058
AUTHOR(S): Charatan F
PUBLICATION TYPE: News

ARTICLE TITLE: Reperfusion therapy in acute myocardial infarction.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Mar 28; 346(13):957-66
ARTICLE SOURCE: N Engl J Med (United States), Mar 28 2002, 346(13) p954-5
AUTHOR(S): Lange RA; Hillis LD
AUTHOR'S ADDRESS: University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Treatment of primary pulmonary hypertension -- the next generation.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Mar 21; 346(12):896-903
ARTICLE SOURCE: N Engl J Med (United States), Mar 21 2002, 346(12) p933-5
AUTHOR(S): Newman JH
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation.
ARTICLE SOURCE: N Engl J Med (United States), Mar 21 2002, 346(12) p884-90
AUTHOR(S): Dorian P; Cass D; Schwartz B; Cooper R; Gelaznikas R; Barr A
AUTHOR'S ADDRESS: Departments of Medicine and Emergency Medicine, St. Michael's Hospital, Toronto. dorianp@smh.toronto.on.ca.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: As compared with lidocaine, amiodarone leads to substantially higher rates of survival to hospital admission in patients with shock-resistant out-of-hospital ventricular fibrillation.
MB: Mine had to have amiodarone. It reverted 9 times before the amiodarone & then I was right.

ARTICLE TITLE: Clinical investigation of smallpox in 1767.
ARTICLE SOURCE: N Engl J Med (United States), Apr 25 2002, 346(17) p1326-8
AUTHOR(S): Boylston AW
AUTHOR'S ADDRESS: University of Leeds, Leeds LS9 7TF, United Kingdom.
PUBLICATION TYPEBiography; Historical Article; Journal Article

ARTICLE TITLE: Hospital volume and surgical mortality in the United States.
ARTICLE SOURCE: N Engl J Med (United States), Apr 11 2002, 346(15) p1128-37
AUTHOR(S): Birkmeyer JD; Siewers AE; Finlayson EV; Stukel TA; Lucas FL; Batista I; Welch HG; Wennberg DE
AUTHOR'S ADDRESS: Veterans Affairs Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA. john.birkmeyer@dartmouth.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In the absence of other information about the quality of surgery at the hospitals near them, Medicare patients undergoing selected cardiovascular or cancer procedures can significantly reduce their risk of operative death by selecting a high-volume hospital.
MB: That sounds very sensible to me.

ARTICLE TITLE: Cervical cancer and the elusive male factor.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Apr 11; 346(15):1105-12
ARTICLE SOURCE: N Engl J Med (United States), Apr 11 2002, 346(15) p1160-1
AUTHOR(S): Adami HO; Trichopoulos D
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The ethics of partial-liver donation.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 Apr 4; 346(14):1074-82
ARTICLE SOURCE: N Engl J Med (United States), Apr 4 2002, 346(14) p1038
AUTHOR(S): Surman OS
AUTHOR'S ADDRESS: Massachusetts General Hospital, Boston, MA 02114.
PUBLICATION TYPE: Comment; Journal Article
MB: They mention the recent death in NY from this operation.

ARTICLE TITLE: Physician-assisted death - a last resort?
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 May 23; 346(21):1638-44
ARTICLE SOURCE: N Engl J Med (United States), May 23 2002, 346(21) p1663-5
AUTHOR(S): Ganzini L; Block S
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Euthanasia and physician-assisted suicide among patients with amyotrophic lateral sclerosis in the Netherlands.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 May 23; 346(21):1663-5
ARTICLE SOURCE: N Engl J Med (United States), May 23 2002, 346(21) p1638-44
AUTHOR(S): Veldink JH; Wokke JH; van der Wal G; Vianney de Jong JM; van den Berg LH
AUTHOR'S ADDRESS: Department of Neurology, University Medical Center, Utrecht, the Netherlands.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: In the Netherlands, we found that one in five patients with Amyotrophic lateral sclerosis (ALS) died as a result of euthanasia or physician-assisted suicide.

ARTICLE TITLE: Specialists, technology, and newborns - too much of a good thing.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 May 16; 346(20):1538-44
ARTICLE SOURCE: N Engl J Med (United States), May 16 2002, 346(20) p1574-5
AUTHOR(S): Grumbach K
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Physicians and addiction.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 May 16; 346(20):1529-37ARTICLE SOURCE: N Engl J Med (United States), May 16 2002, 346(20) p1510-1
AUTHOR(S): Verghese A
AUTHOR'S ADDRESS: Texas Tech Health Sciences Center, El Paso, TX 79905, USA.
PUBLICATION TYPE: Comment; Journal Article
MB: About addicted doctors.

ARTICLE TITLE: Participation in research and access to experimental treatments by HIV-infected patients.
COMMENTS: Comment In: Comment In: RefSource:N Engl J Med. 2002 May 2; 346(18):1400-2
ARTICLE SOURCE: N Engl J Med (United States), May 2 2002, 346(18) p1373-82
AUTHOR(S): Gifford AL; Cunningham WE; Heslin KC; Andersen RM; Nakazono T; Lieu DK; Shapiro MF; Bozzette SA
AUTHOR'S ADDRESS: Center for Research in Patient-Oriented Care and the Quality Enhancement Research Initiative in HIV, Veterans Affairs San Diego Healthcare System, and the University of California, San Diego, California 92161, USA. agifford@ucsd.edu; Collective Name: HIV Cost and Services Utilization Study Consortium.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Among patients with HIV infection, participation in research trials and access to experimental treatment is influenced by race or ethnic group and type of health insurance.

ARTICLE TITLE: Beta-blockers for stable heart failure.
COMMENTS: Comment On: Comment On: RefSource:N Engl J Med. 2002 May 2; 346(18):1357-65
ARTICLE SOURCE: N Engl J Med (United States), May 2 2002, 346(18) p1346-7
AUTHOR(S): Stevenson LW
AUTHOR'S ADDRESS: Brigham and Women's Hospital, Boston, MA 02115, USA.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Vascular injury in Australia.
ARTICLE SOURCE: Surg Clin North Am (United States), Feb 2002, 82(1) p211-9
AUTHOR(S): Sugrue M; Caldwell EM; Damours SK; Crozier JA; Deane SA
AUTHOR'S ADDRESS: Trauma Department, Liverpool Hospital, University of New South Wales, Sydney, Australia. michael.sugrue@swsahs.nsw.gov.au.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Endovascular management of carotid and basilar artery occlusion secondary to trauma of the thoracic aorta: case report.
ARTICLE SOURCE: J Trauma (United States), Apr 2002, 52(4) p775-9
AUTHOR(S): Hayashi Y; Futami K; Hamada Y; Soma M; Munemoto S; Shimizu H; Yamashita J
AUTHOR'S ADDRESS: Department of Neurosurgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan. yahayashi@ns.m.kanazawa-u.ac.jp.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.
ARTICLE SOURCE: J Trauma (United States), Apr 2002, 52(4) p727-32; discussion 732
AUTHOR(S): Tanaka H; Yukioka T; Yamaguti Y; Shimizu S; Goto H; Matsuda H; Shimazaki S
AUTHOR'S ADDRESS: Department of Traumatology and Critical Care Medicine, Kyorin University, Tokyo, Japan. htanaka@gol.com.
PUBLICATION TYPE: Status: Completed
Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: This study proved that in severe flail chest patients, surgical stabilization using Judet struts has beneficial effects with respect to less ventilatory support, lower incidence of pneumonia, shorter trauma intensive care unit stay, and reduced medical cost than internal fixation. Moreover, surgical stabilization with Judet struts improved percent forced vital capacity from the early phase after surgical fixation. Also, patients with surgical stabilization could return to their previous employment quicker than those with internal pneumatic stabilization, even in those with the same severity of flail chest. We therefore concluded that surgical stabilization with Judet struts may be preferably applied to patients with severe flail chest who need ventilator support.
MB: Its not one or the other. I recall before internal pneumatic stabilisation (IPPR) when these cases were disasters. The first one to have IPPR at St V Hosp in Sydney 1958 was ventilated by us interns manually for a week or 2.

ARTICLE TITLE: Hypoxia is not the sole cause of lactate production during shock.
ARTICLE SOURCE: J Trauma (United States), Mar 2002, 52(3) p415-9
AUTHOR(S): Luchette FA; Jenkins WA; Friend LA; Su C; Fischer JE; James JH
AUTHOR'S ADDRESS: Department of Surgery, University of Cincinnati College of Medicine, and Shriners Hospital for Children, Shriners Burns Hospital, Cincinnati, Ohio, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: Increased Na+-K+ATPase activity during epinephrine treatment or hemorrhage contributes to muscle lactate production. Hypoxia is not necessarily the sole cause of hyperlactatemia during and after hemorrhagic shock.
MB: This is in rats. Exogenous lactate from bank blood is probably a big factor in human resuscitation. This will be slow to recover if hyopvolaemia can't be corrected quickly and if hypothermia occurs.

ARTICLE TITLE: Blood culturing practices in a trauma intensive care unit: does concurrent antibiotic use make a difference?
ARTICLE SOURCE: J Trauma (United States), Mar 2002, 52(3) p463-8
AUTHOR(S): Schermer CR; Sanchez DP; Qualls CR; Demarest GB; Albrecht RM; Fry DE
AUTHOR'S ADDRESS: Department of Surgery, University of New Mexico Health Sciences Center, Albuquerque, New Mexico 87131, USA. cschermer@salud.unm.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: Concurrent antimicrobial administration does not alter blood culture yield. Prophylactic administration alters the type of organism cultured. Little new information is gained from repetitive culturing.