MB's Articles of Interest - June 2000

 

ARTICLE TITLE: Patient-controlled analgesia in postoperative cardiac surgery.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Oct 1999, 27(5) p464-70
AUTHOR(S): Tsang J; Brush B
AUTHOR'S ADDRESS: Intensive Care Unit, Vancouver General Hospital, Vancouver, B.C., Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: The purpose of this study was to assess, in the early postoperative period of cardiac surgery, the efficacy of patient-controlled analgesia (PCA) versus nurse-administered intravenous morphine followed by oral acetaminophen with or without codeine <snip> statistically different. It was concluded that there was no significant advantage in using PCA routinely in the early postoperative period after cardiac surgery. Furthermore, repetition of PCA instructions was often required during the study period.

ARTICLE TITLE: Intraoperative and postoperative analgesic efficacy and adverse effects of intrathecal opioids in patients undergoing cesarean section with spinal anesthesia: a qualitative and quantitative systematic review of randomized controlled trials.
ARTICLE SOURCE: Anesthesiology (United States), Dec 1999, 91(6) p1919-27
AUTHOR(S): Dahl JB; Jeppesen IS; Jorgensen H; Wetterslev J; Moiniche S
AUTHOR'S ADDRESS: Department of Anaesthesiology, Herlev University Hospital, Denmark. jbdahl@dadlnet.dk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (29 references); REVIEW, TUTORIAL

ARTICLE TITLE: Airway injury during anesthesia: a closed claims analysis.
ARTICLE SOURCE: Anesthesiology (United States), Dec 1999, 91(6) p1703-11
AUTHOR(S): Domino KB; Posner KL; Caplan RA; Cheney FW
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195-6540, USA. kdomino@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Patients in whom tracheal intubation has been difficult should be observed for and told to watch for the development of symptoms and signs of retropharyngeal abscess, mediastinitis, or both.

ARTICLE TITLE: Does epidural anesthesia have general anesthetic effects? A prospective, randomized, double-blind, placebo-controlled trial.
ARTICLE SOURCE: Anesthesiology (United States), Dec 1999, 91(6) p1687-92
AUTHOR(S): Hodgson PS; Liu SS; Gras TW
AUTHOR'S ADDRESS: Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington 98111, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Lidocaine epidural anesthesia reduced the MAC of sevoflurane by approximately 50%. This MAC sparing is most likely caused by indirect central effects of spinal deafferentation and not to systemic effects of lidocaine or direct neural blockade. Thus, lower concentrations of volatile agents than those based on standard MAC values may be adequate during combined epidural-general anesthesia.
MB. It is not surprising as they used patient movement to decide on 'MAC' dosage.

ARTICLE TITLE: Beneficial effects from beta-adrenergic blockade in elderly patients undergoing noncardiac surgery.
ARTICLE SOURCE: Anesthesiology (United States), Dec 1999, 91(6) p1674-86
AUTHOR(S): Zaugg M; Tagliente T; Lucchinetti E; Jacobs E; Krol M; Bodian C; Reich DL; Silverstein JH
AUTHOR'S ADDRESS: Department of Anesthesiology, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: Beta-blockade does not reduce the neuroendocrine stress response, suggesting that this mechanism is not responsible for the previously reported improved cardiovascular outcome. However, it confers several advantages, including decreased analgesic requirements, faster recovery from anesthesia, and improved hemodynamic stability. The release of cardiac troponin I suggests the occurrence of perioperative myocardial damage in this elderly population, which appears to be independent of the neuroendocrine stress response.
MB. Maybe everyone should be on beta blockers and ACE inhibitors whether or not they are having an operation.

ARTICLE TITLE: Effects of crystalloid and colloid preload on blood volume in the parturient undergoing spinal anesthesia for elective Cesarean section [see comments]
COMMENTS: Comment in: Anesthesiology 1999 Dec; 91(6):1565-7
ARTICLE SOURCE: Anesthesiology (United States), Dec 1999, 91(6) p1571-6
AUTHOR(S): Ueyama H; He YL; Tanigami H; Mashimo T; Yoshiya I
AUTHOR'S ADDRESS: Department of Anesthesiology, Osaka University Medical School, Japan. ueyama@hp-op.med.osaka-u.ac.jp.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: The role of crystalloid preloading to prevent hypotension associated with spinal anesthesia in parturients during cesarean section has been challenged. Direct measurement of blood volume should provide insight regarding the volume-expanding effects. The aim of the current study was to clarify the effects of volume preload with either crystalloid or colloid solution on the changes in blood volume of parturients undergoing spinal anesthesia for cesarean section. METHODS: Thirty-six healthy parturients scheduled for elective cesarean section during spinal anesthesia were allocated randomly to one of three groups receiving 1.5 l lactated Ringer's solution (LR; n = 12), 0.5 l hydroxyethylstarch solution, 6% (0.5 l HES; n = 12), and 1.0 l hydroxyethylstarch solution, 6% (1.0 l HES; n = 12), respectively. Blood volume and cardiac output were measured before and after volume preloading with indocyanine green (ICG), and the indocyanine green blood concentrations were monitored by noninvasive pulse spectrophotometry. RESULTS: After volume preload, the blood volume significantly increased in all three groups (P < 0.01). The volume of infused solution remaining in the vascular space in the LR, 0.5-l HES, and 1.0-l HES groups were 0.43+/-0.20 l, 0.54+/-0.14 l, and 1.03+/-0.21 l, respectively, corresponding to 28% of lactated Ringer's solution and 100% of hydroxyethylstarch solution infused. Significant increases in cardiac output were observed in the 0.5-l and 1.0-l HES groups (P < 0.01). A significant correlation between the percentage increase in blood volume and that of cardiac output was observed by volume preloading (r2 = 0.838; P < 0.001). The incidence of hypotension was 75% for the LR group, 58% for the 0.5-l HES group, and 17% for the 1.0-l HES group, respectively. CONCLUSIONS: The incidence of hypotension developed in the 1.0-l HES group was significantly lower than that in the LR and 0.5-l HES groups, showing that greater volume expansion results in less hypotension. This result indicates that the augmentation of blood volume with preloading, regardless of the fluid used, must be large enough to result in a significant increase in cardiac output for effective prevention of hypotension.
MB. Why not give GAs. They were alright. It is apparent for UK obstetric mortality studies that the obstetric anaesthetic have become deskilled. If they are convinced that regional essential and that hypotension is important then real monitoring during any loading would be required. The study should have at least measured CVP. If a SG catheter had been used more modern methods of measuring cardiac output could have been combined with mixed venous saturation etc.

ARTICLE TITLE: Spinal hypotension associated with Cesarean section: will preload ever work? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 Dec; 91(6):1571-6
ARTICLE SOURCE: Anesthesiology (United States), Dec 1999, 91(6) p1565-7
AUTHOR(S): Rout C; Rocke DA
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. They despair of finding a rational solution to the previous articles. If they learnt to give GAs without aspiration it might help. When I did caesarian anaesthetics I always thought the whole thing was easy including the intubation. I introduced endothracheal anaesthesia in my great institution. I was a junior registrar then. I often intubated the patients already in the lithotomy in an old-fashioned labour ward bed lying across the bed above the patient's head. It was a breeze.

ARTICLE TITLE: Assessment of the patient with cardiac disease: an anesthesiologist's paradigm.
ARTICLE SOURCE: Anesthesiology (United States), Nov 1999, 91(5) p1521-6
AUTHOR(S): Mangano DT
AUTHOR'S ADDRESS: San Francisco Veterans Affairs Medical Center, California 94121, USA. dennis_mangano@quickmail.ucsf.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (18 references); REVIEW, TUTORIAL

ARTICLE TITLE: Supplemental oxygen reduces the incidence of postoperative nausea and vomiting.
ARTICLE SOURCE: Anesthesiology (United States), Nov 1999, 91(5) p1246-52
AUTHOR(S): Greif R; Laciny S; Rapf B; Hickle RS; Sessler DI
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative Care, University of California-San Francisco, 94143-0648, USA. sessler@anesthesia.ucsf.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Supplemental oxygen reduced the incidence of postoperative nausea or vomiting nearly twofold after colorectal surgery. The mechanism by which oxygen administration reduces the incidence of these postoperative sequelae remains unknown but may be related to subtle intestinal ischemia. Because oxygen is inexpensive and essentially risk-free, supplemental oxygen appears to be an effective method of reducing postoperative nausea and vomiting.
MB. This contains some authors of the group which claimed that hypothermia increases wound infection. That was not confirmed. This claim would require confirmation too.
I must declare an interest. I am very interested in preventing hypothermia during the operative period but do not use forced heated air to achieve normothermia

ARTICLE TITLE: Perflubron emulsion delays blood transfusions in orthopedic surgery. European Perflubron Emulsion Study Group [see comments]
COMMENTS: Comment in: Anesthesiology 1999 Nov; 91(5):1185-7
ARTICLE SOURCE: Anesthesiology (United States), Nov 1999, 91(5) p1195-208
AUTHOR(S): Spahn DR; van Brempt R; Theilmeier G; Reibold JP; Welte M; Heinzerling H; Birck KM; Keipert PE; Messmer K; Heinzerling H; Birck KM; Keipert PE; Messmer K
AUTHOR'S ADDRESS: Department of Anesthesiology, University Hospital Zurich, Switzerland. donat.spahn@ifa.usz.ch.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Perflubron emulsion (1.8 g/kg) combined with 100% oxygen ventilation is more effective than autologous blood or colloid infusion in reversing physiologic transfusion triggers.

ARTICLE TITLE: Perfluorochemical "blood substitutes" [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 Nov; 91(5):1195-208
ARTICLE SOURCE: Anesthesiology (United States), Nov 1999, 91(5) p1185-7
AUTHOR(S): Tremper KK
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Barbiturates and the brain [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 Nov; 91(5):1329-41
ARTICLE SOURCE: Anesthesiology (United States), Nov 1999, 91(5) p1190-2
AUTHOR(S): Pearce RA
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Risk factors of delayed extubation, prolonged length of stay in the intensive care unit, and mortality in patients undergoing coronary artery bypass graft with fast-track cardiac anesthesia: a new cardiac risk score [see comments]
COMMENTS: Comment in: Anesthesiology 1999 Oct; 91(4):911-5
ARTICLE SOURCE: Anesthesiology (United States), Oct 1999, 91(4) p936-44
AUTHOR(S): Wong DT; Cheng DC; Kustra R; Tibshirani R; Karski J; Carroll-Munro J; Sandler A
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Risk factors of delayed extubation, prolonged intensive care unit (ICU) length of stay (LOS), and mortality have not been studied for patients administered fast-track cardiac anesthesia (FTCA). The authors' goals were to determine risk factors of outcomes and cardiac risk scores (CRS) for CABG patients undergoing FTCA. METHODS: Consecutive CABG patients undergoing FTCA were prospectively studied. Outcome variables were delayed extubation > 10 h, prolonged ICU LOS > 48 h, and mortality. Univariate analyses were performed followed by multiple logistic regression to derive risk factors of the three outcomes. Simplified integer-based CRS were derived from logistic models. Bootstrap validation was performed to assess and compare the predictive abilities of CRS and logistic models for the three outcomes. RESULTS: The authors studied 885 patients. Twenty-five percent had delayed extubation, 17% had prolonged ICU LOS, and 2.6% died. Risk factors of delayed extubation were increased age, female gender, postoperative use of intraaortic balloon pump, inotropes, bleeding, and atrial arrhythmia. Risk factors of prolonged ICU LOS were those of delayed extubation plus preoperative myocardial infarction and postoperative renal insufficiency. Risk factors of mortality were female gender, emergency surgery, and poor left ventricular function. CRSs were modeled for the three outcomes. The area under the receiver operating characteristic curve for the CRS-logistic models was not significantly different: 0.707/0.702 for delayed extubation, 0.851/0.855 for prolonged ICU LOS, and 0.657/0.699 for mortality. CONCLUSION: In CABG patients undergoing FTCA, the authors derived and validated risk factors of delayed extubation, prolonged ICU LOS, and mortality. Furthermore, they developed a simplified CRS system with similar predictive abilities as the logistic models.
:

ARTICLE TITLE: Fast tracking into the new millennium: an evolving paradigm [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1999 Oct; 91(4):936-44
ARTICLE SOURCE: Anesthesiology (United States), Oct 1999, 91(4) p911-5
AUTHOR(S): London MJ; Shroyer AL; Grover FL
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. How come the FDA did not have to approve fast tracking. I can recall when EVERY patient was fast tracked. That is ALL patients were extubated at the end of ALL operations. Extubation by 10 hours is pretty slow. I think I could give them some lessons in rapid recovery.

ARTICLE TITLE: Anticoagulation monitoring during cardiac surgery: a review of current and emerging techniques.
ARTICLE SOURCE: Anesthesiology (United States), Oct 1999, 91(4) p1122-51
AUTHOR(S): Despotis GJ; Gravlee G; Filos K; Levy J
AUTHOR'S ADDRESS: Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110, USA. despotig@notes.wustl.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (326 references); REVIEW, TUTORIAL
ABSTRACT: The literature does not consistently support the importance of anticoagulation monitoring techniques during CPB. This is best reflected by studies that have evaluated the impact of the ACT method on blood loss and transfusion outcomes. Inconsistent findings from studies that evaluated the impact of ACT monitoring may be related to either suboptimal study design (i.e., retrospective, unblinded, nonrandomized) or possibly the diagnostic inprecision of the ACT method used in these studies. There are a small number of well-controlled studies, some of which suggest that bleeding and transfusion outcomes can be improved by refining heparin monitoring techniques, either by sustaining better anticoagulation during CPB or by optimizing protamine doses (i.e., when empiric protocols result in excessive protamine doses). More well-controlled studies are needed to better define the importance of anticoagulation management during CPB.
MB. That means real tests done by haematologists.

ARTICLE TITLE: Developments in cardioprotection: "polarized" arrest as an alternative to "depolarized" arrest.
ARTICLE SOURCE: Ann Thorac Surg (United States), Nov 1999, 68(5) p1960-6
AUTHOR(S): Chambers DJ; Hearse DJ
AUTHOR'S ADDRESS: Department of Cardiac Surgical Research/Cardiothoracic Surgery, The Rayne Institute, St. Thomas' Hospital, London, England. david.chambers@kcl.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (48 references); REVIEW, TUTORIAL
ABSTRACT: During cardiac surgery or cardiac transplantation, the heart is subjected to varying periods of global ischemia. The heart must be protected during this ischemic period to avoid additional injury, and techniques have been developed that delay ischemic injury and minimize reperfusion injury. Almost universally, this involves using a hyperkalemic cardioplegic solution and these solutions have become the gold standard for myocardial protection for more than 20 years. Despite the extensive and continued research aimed at improving these basic hyperkalemic cardioplegic solutions, patients undergoing surgery almost invariably experience some degree of postoperative dysfunction. It is likely that this relates to the depolarizing nature of hyperkalemic solutions, which results in ionic imbalance caused by continuing transmembrane fluxes and the consequent maintenance of high energy phosphate metabolism, even during hypothermic ischemia. A potentially beneficial alternative to hyperkalemic cardioplegia is to arrest the heart in a "hyperpolarized" or "polarized" state, which maintains the membrane potential of the arrested myocardium at or near to the resting membrane potential. At these potentials, transmembrane fluxes will be minimized and there should be little metabolic demand, resulting in improved myocardial protection. Recent studies have explored these alternative concepts for myocardial protection. The use of compounds such as adenosine or potassium channel openers, which are thought to induce hyperpolarized arrest, have demonstrated improved protection after normothermic, or short periods of hypothermic, ischemia when compared to hyperkalemic (depolarized) arrest. Similarly, studies from our own laboratory, in which the sodium channel blocker, tetrodotoxin, was used to induce polarized arrest (demonstrated by direct measurement of membrane potential during ischemia) was also shown to provide better recovery of function after 5 hours of long-term hypothermic (7.5 degrees C) storage. These promising initial studies need to be consolidated before experimental promise becomes clinical reality.

ARTICLE TITLE: Cost-effectiveness of minimally invasive coronary artery bypass surgery.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 1999, 68(4) p1562-6
AUTHOR(S): Arom KV; Emery RW; Flavin TF; Petersen RJ
AUTHOR'S ADDRESS: Minneapolis Heart Institute, Minnesota 55407, USA. karom@csa-heart.com.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Off pump procedures currently reflect acute episode-of-care cost savings over conventional coronary artery bypass (CCAB).

ARTICLE TITLE: Should patients be normothermic in the immediate postoperative period? [comment]
COMMENTS: Comment on: Ann Thorac Surg 1999 Oct; 68(4):1452-3
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 1999, 68(4) p1454-5
AUTHOR(S): Jones T; Roy RC
AUTHOR'S ADDRESS: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1009, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Outcomes '99. Conference on cardiac and vascular surgery: neurobehavioral assessment, physiological monitoring and cerebral protective strategies. Key West, Florida, USA. May 26-30, 1999. Proceedings and abstracts.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 1999, 68(4) p1445-69
PUBLICATION TYPE: CONGRESSES; OVERALL

ARTICLE TITLE: Public reporting of surgical mortality: a survey of New York State cardiothoracic surgeons.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 1999, 68(4) p1195-200; discussion 1201-2
AUTHOR(S): Burack JH; Impellizzeri P; Homel P; Cunningham JN Jr
AUTHOR'S ADDRESS: Division of Cardiothoracic Surgery, State University of New York, Health Science Center at Brooklyn, 11203, USA. ejsd@erols.com.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The public disclosure of surgical results may be based on imperfect data and appears to have resulted in denial of surgical treatment to high-risk patients.

ARTICLE TITLE: A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit.
ARTICLE SOURCE: Arch Intern Med (United States), Oct 25 1999, 159(19) p2273-8
AUTHOR(S): Harris WS; Gowda M; Kolb JW; Strychacz CP; Vacek JL; Jones PG; Forker A; O'Keefe JH; McCallister BD
AUTHOR'S ADDRESS: Mid America Heart Institute, Saint Luke's Hospital, Kansas City, MO, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: CONTEXT: Intercessory prayer (praying for others) has been a common response to sickness for millennia, but it has received little scientific attention. The positive findings of a previous controlled trial of intercessory prayer have yet to be replicated. OBJECTIVE: To determine whether remote, intercessory prayer for hospitalized, cardiac patients will reduce overall adverse events and length of stay. DESIGN: Randomized, controlled, double-blind, prospective, parallel-group trial. SETTING: Private, university-associated hospital. PATIENTS: Nine hundred ninety consecutive patients who were newly admitted to the coronary care unit (CCU). INTERVENTION: At the time of admission, patients were randomized to receive remote, intercessory prayer (prayer group) or not (usual care group). The first names of patients in the prayer group were given to a team of outside intercessors who prayed for them daily for 4 weeks. Patients were unaware that they were being prayed for, and the intercessors did not know and never met the patients. MAIN OUTCOME MEASURES: The medical course from CCU admission to hospital discharge was summarized in a CCU course score derived from blinded, retrospective chart review. RESULTS: Compared with the usual care group (n = 524), the prayer group (n = 466) had lower mean +/- SEM weighted (6.35 +/- 0.26 vs 7.13 +/- 0.27; P=.04) and unweighted (2.7 +/- 0.1 vs 3.0 +/- 0.1; P=.04) CCU course scores. Lengths of CCU and hospital stays were not different. CONCLUSIONS: Remote, intercessory prayer was associated with lower CCU course scores. This result suggests that prayer may be an effective adjunct to standard medical care.
MB. How will it be paid for?

ARTICLE TITLE: Reliability of self-reported blood pressure measurements.
ARTICLE SOURCE: Arch Intern Med (United States), Dec 13-27 1999, 159(22) p2689-93
AUTHOR(S): Johnson KA; Partsch DJ; Rippole LL; McVey DM
AUTHOR'S ADDRESS: HealthAmerica of Pennsylvania, Inc, and Department of Pharmaceutical Sciences, University of Pittsburgh, PA, USA. johnsonka@msx.upmc.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Most self-reported BP and HR readings were identical to electronically stored measurements. However, erroneous reporting occurred significantly more often in cases of uncontrolled BP and HR, which may misguide physicians in the optimal treatment of their patients with hypertension.

ARTICLE TITLE: Association between alcohol consumption and mortality, myocardial infarction, and stroke in 25 year follow up of 49 618 young Swedish men.
ARTICLE SOURCE: BMJ (England), Sep 25 1999, 319(7213) p821-2
AUTHOR(S): Romelsjo A; Leifman A
AUTHOR'S ADDRESS: Karolinska Institutet, Department of Public Health Sciences, Centre for Alcohol and Drug Prevention, Novum, S-141 57 Huddinge, Sweden. anders.romelsjo@smd.sll.se.
MAJOR SUBJECT HEADING(S): Alcohol Drinking [mortality]; Cerebrovascular Accident [mortality]; Myocardial Infarction [mortality]
MINOR SUBJECT HEADING(S): Follow-Up Studies; Incidence; Middle Age; Sweden [epidemiology]
INDEXING CHECK TAG(S): Human; Male; Support, Non-U.S. Gov't
PUBLICATION TYPE: JOURNAL ARTICLE
MEDLINE INDEXING DATE: 200001
ISSN: 0959-8138
LANGUAGE: English

ARTICLE TITLE: AMA sets up "union" for employed doctors [news]
ARTICLE SOURCE: BMJ (England), Sep 25 1999, 319(7213) p806
AUTHOR(S): Gottlieb S
PUBLICATION TYPE: NEWS
MB. The Australian Salaried Medical Officers Federation does it here. I was a member for years. Our AMA is also a union and employs "industrial officers"> I have had to use the services of both.

ARTICLE TITLE: Israel wants to abolish private medicine in public hospitals [news]
ARTICLE SOURCE: BMJ (England), Sep 25 1999, 319(7213) p803
AUTHOR(S): Siegel-Itzkovich J
PUBLICATION TYPE: NEWS
That is one way of lowering the overall quality in both sectors.

ARTICLE TITLE: Should cases of permanent vegetative state still go to court?. Britain should follow other countries and keep the courts for cases of dispute [editorial; comment]
COMMENTS: Comment on: BMJ 1999 Sep 25; 319(7213):841-4
ARTICLE SOURCE: BMJ (England), Sep 25 1999, 319(7213) p796-7
AUTHOR(S): Jennett B
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Commentary: Competencies for informed shared decision making.
ARTICLE SOURCE: BMJ (England), Sep 18 1999, 319(7212) p770
AUTHOR(S): Greenhalgh
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Five year follow up of patients at high cardiovascular risk who took part in randomised controlled trial of health promotion.
ARTICLE SOURCE: BMJ (England), Sep 11 1999, 319(7211) p687-8
AUTHOR(S): Cupples ME; McKnight A
AUTHOR'S ADDRESS: Department of General Practice, Queen's University, Belfast BT9 7HR. m.cupples@qub.ac.uk.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL

ARTICLE TITLE: ACE inhibitor reduces cardiovascular events by 22% [news]
ARTICLE SOURCE: BMJ (England), Sep 11 1999, 319(7211) p661
AUTHOR(S): Mayor S
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Commentary: all women should have a choice [comment]
COMMENTS: Comment on: BMJ 1999 Nov 27; 319(7222):1397-402
ARTICLE SOURCE: BMJ (England), Nov 27 1999, 319(7222) p1401
AUTHOR(S): Griffin A
MAJOR SUBJECT HEADING(S): Cesarean Section [psychology]
MINOR SUBJECT HEADING(S): Cesarean Section [statistics & numerical data]; Great Britain; Pregnancy; Socioeconomic Factors
INDEXING CHECK TAG(S): Female; Human

ARTICLE TITLE: Commentary: increase in cesarean sections may reflect medical control not women's choice [comment]
COMMENTS: Comment on: BMJ 1999 Nov 27; 319(7222):1397-402
ARTICLE SOURCE: BMJ (England), Nov 27 1999, 319(7222) p1401-2
AUTHOR(S): Castro A
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Rates and implications of caesarean sections in Latin America: ecological study [see comments]
COMMENTS: Comment in: BMJ 1999 Nov 27; 319(7222):1401; Comment in: BMJ 1999 Nov 27; 319(7222):1401-2; Comment in: BMJ 1999 Nov 27; 319(7222):1402
ARTICLE SOURCE: BMJ (England), Nov 27 1999, 319(7222) p1397-400
AUTHOR(S): Belizan JM; Althabe F; Barros FC; Alexander S
AUTHOR'S ADDRESS: Latin American Centre for Perinatology, Pan American Health Organisation, World Health Organisation, Hospital de Clinicas s/n, 11000 Montevideo, Uruguay. belizanj@clap.ops-oms.org.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The reported figures represent an unnecessary increased risk for young women and their babies. From the economic perspective, this is a burden to health systems that work with limited budgets.

ARTICLE TITLE: Meeting the demand for donor organs in the US. It's time for bold public policy, such as mandated choice or presumed consent [editorial]
ARTICLE SOURCE: BMJ (England), Nov 27 1999, 319(7222) p1382-3
AUTHOR(S): Davis RM
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Big US health insurer gives doctors final say in treatment [news]
ARTICLE SOURCE: BMJ (England), Nov 20 1999, 319(7221) p1323
AUTHOR(S): Charatan F
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Revalidation in Australia and New Zealand: approach of Royal Australasian College of Physicians [see comments]
COMMENTS: Comment in: BMJ 1999 Oct 30; 319(7218):1145-6
ARTICLE SOURCE: BMJ (England), Oct 30 1999, 319(7218) p1185-8
AUTHOR(S): Newble D; Paget N; McLaren B
AUTHOR'S ADDRESS: Department of Medical Education, University of Sheffield, Northern General Hospital, Sheffield S5 7AU.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (5 references); REVIEW, TUTORIAL

ARTICLE TITLE: Revalidation is the answer [editorial; comment]
COMMENTS: Comment on: BMJ 1999 Oct 30; 319(7218):1180-3; Comment on: BMJ 1999 Oct 30; 319(7218):1183-5; Comment on: BMJ 1999 Oct 30; 319(7218):1185-8; Comment on: BMJ 1999 Oct 30; 319(7218):1188-90; Comment on: BMJ 1999 Oct 30; 319(7218):1191-2
ARTICLE SOURCE: BMJ (England), Oct 30 1999, 319(7218) p1145-6
AUTHOR(S): Buckley G
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: NICE to rule on influenza flu drug zanamivir [news]
ARTICLE SOURCE: BMJ (England), Oct 9 1999, 319(7215) p937
AUTHOR(S): Yamey G
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Time to register randomised trials. The case is now unanswerable [editorial]
ARTICLE SOURCE: BMJ (England), Oct 2 1999, 319(7214) p865-6
AUTHOR(S): Horton R; Smith R
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: When are the seeds of postoperative pressure sores sown?. Often during surgery [editorial]
ARTICLE SOURCE: BMJ (England), Oct 2 1999, 319(7214) p863-4
AUTHOR(S): Bliss M; Simini B
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Moderate alcohol intake and lower risk of coronary heart disease: meta-analysis of effects on lipids and haemostatic factors.
ARTICLE SOURCE: BMJ (England), Dec 11 1999, 319(7224) p1523-8
AUTHOR(S): Rimm EB; Williams P; Fosher K; Criqui M; Stampfer MJ
AUTHOR'S ADDRESS: Department of Nutrition, Harvard School of Public Health, Boston, MA 02115, USA. eric.rimm@channing.harvard.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
RESULTS: 61 data records were abstracted from 42 eligible studies with information on change in biological markers of risk of coronary heart disease. An experimental dose of 30 g of ethanol a day increased concentrations of high density lipoprotein cholesterol by 3.99 mg/dl (95% confidence interval 3.25 to 4.73), apolipoprotein A I by 8.82 mg/dl (7.79 to 9.86), and triglyceride by 5.69 mg/dl (2.49 to 8.89). Several haemostatic factors related to a thrombolytic profile were modestly affected by alcohol. On the basis of published associations between these biomarkers and risk of coronary heart disease 30 g of alcohol a day would cause an estimated reduction of 24.7% in risk of coronary heart disease. CONCLUSIONS: Alcohol intake is causally related to lower risk of coronary heart disease through changes in lipids and haemostatic factors.

ARTICLE TITLE: Medical errors kill almost 100000 Americans a year [news]
ARTICLE SOURCE: BMJ (England), Dec 11 1999, 319(7224) p1519
AUTHOR(S): Charatan F
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Vaccination policies: individual rights v community health. We can't afford to be half hearted about vaccination programmes [editorial; comment]
COMMENTS: Comment on: BMJ 1999 Dec 4; 319(7223):1462-7
ARTICLE SOURCE: BMJ (England), Dec 4 1999, 319(7223) p1448-9
AUTHOR(S): King S
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Treatment of sleep apnea: unmet needs [editorial; comment]
COMMENTS: Comment on: Chest 1999 Dec; 116(6):1511-8
ARTICLE SOURCE: Chest (United States), Dec 1999, 116(6) p1501-3
AUTHOR(S): Lavie P
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Impact of blood transfusions on inflammatory mediator release in patients undergoing cardiac surgery [see comments]
COMMENTS: Comment in: Chest 1999 Nov; 116(5):1149-50
ARTICLE SOURCE: Chest (United States), Nov 1999, 116(5) p1233-9
AUTHOR(S): Fransen E; Maessen J; Dentener M; Senden N; Buurman W
AUTHOR'S ADDRESS: Department of Cardiopulmonary Surgery, University Hospital Maastricht, Maastricht, Netherlands.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: STUDY OBJECTIVES: This study was conducted to investigate whether intraoperative blood transfusions affect the release of proinflammatory mediators in patients undergoing cardiac surgery. Therefore, we measured plasma levels of bactericidal permeability increasing protein (BPI) as a marker of neutrophil activation, interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP), and C-reactive protein (CRP). In addition, these mediators, except CRP, were also measured in packed red cell units (PCs) administered to these patients. DESIGN: Prospective study. SETTING: Cardiopulmonary surgery department in a university hospital. PATIENTS: One hundred fourteen consecutive patients undergoing cardiac surgery. INTERVENTIONS: Blood samples were taken at induction of anesthesia, at the start of aortic cross-clamping, at aortic unclamping, and at 0.5, 4, 8, and 18 h thereafter. RESULTS: Thirty-six patients received PC intraoperatively. BPI levels in patients who received transfusions were significantly higher at 0.5 and 4 h after aortic unclamping than in patients without transfusions (p < 0.05), and increased with the number of PC administered. IL-6 levels at 0.5, 4, and 18 h after aortic unclamping were also significantly higher in patients who received transfusions (p < 0.01). BPI was found in all units of packed red cells tested at concentrations up to 15 times preoperative plasma levels in patients. However, PC IL-6 could be detected in none of the samples. Plasma levels of LBP and CRP were similar in both patient groups. LBP was found in very low concentrations in all PC. Patients who received intraoperative transfusions had a worse postoperative performance. CONCLUSIONS: Intraoperative PC transfusions do contribute to the inflammatory response after cardiac surgery both by enhancing part of the response and by directly changing plasma concentrations of inflammatory mediators. Furthermore, these data show that intraoperative PC transfusion is associated with a worse postoperative performance.
MB. The result could be due to the reason the blood was transfused

ARTICLE TITLE: Blood transfusion: first, do no harm! [editorial; comment]
COMMENTS: Comment on: Chest 1999 Nov; 116(5):1233-9
ARTICLE SOURCE: Chest (United States), Nov 1999, 116(5) p1149-50
AUTHOR(S): Corwin HL
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (19 references); REVIEW, TUTORIAL
MEDLINE INDEXING DATE: 200002

ARTICLE TITLE: Do no harm [editorial; comment]
COMMENTS: Comment on: Chest 1999 Nov; 116(5):1218-23
ARTICLE SOURCE: Chest (United States), Nov 1999, 116(5) p1147-8
AUTHOR(S): Barst RJ
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (7 references); REVIEW, TUTORIAL

ARTICLE TITLE: Asthma hospitalizations and mortality in Chicago: an epidemiologic overview.
ARTICLE SOURCE: Chest (United States), Oct 1999, 116(4 Suppl 1) p135S-141S
AUTHOR(S): Thomas SD; Whitman S
AUTHOR'S ADDRESS: Epidemiology Program, City of Chicago Department of Public Health, IL 60604, USA. sandrathomas@worldnet.att.net.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: STUDY OBJECTIVES: To characterize the patterns and correlates of asthma hospitalizations and mortality in Chicago. DESIGN: Cross-sectional analysis of discharge data for 1996 and mortality time trend data for the period from 1990 to 1997. SETTING: The city of Chicago, IL, with Cook County, IL, and US data employed for comparisons. POPULATION STUDIED: People who were hospitalized with a primary diagnosis of asthma and people whose underlying cause of death was asthma. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The 1996 asthma hospitalization rate for Chicago was 42.8 per 10,000, more than twice as high as suburban Chicago or US rates. Medicaid patients were overrepresented. Length of stay was longer for older patients and Medicaid patients. Age-adjusted asthma mortality in Chicago was 4.7 times higher in non-Hispanic blacks than in non-Hispanic whites. The black/white asthma mortality ratio is 2.5:1 for the nation overall. Asthma mortality rates for Hispanics in Chicago were between those of non-Hispanic whites and blacks but have almost doubled during this decade. CONCLUSIONS: The rising asthma mortality and high asthma hospitalization rates in Chicago constitute a significant public health problem. Comorbidities more common in urban environments, such as substance abuse, may play a unique role in determining the distribution of adverse outcomes within Chicago's population. Asthma hospitalizations and deaths may vary in their risk profiles, and this should be taken into account when developing research and intervention strategies.

ARTICLE TITLE: Asthma: we need to do better! [editorial; comment]
COMMENTS: Comment on: Chest 1999 Dec; 116(6):1638-45
ARTICLE SOURCE: Chest (United States), Dec 1999, 116(6) p1509-10
AUTHOR(S): Poponick J
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: The dull-edged sword of inhaled corticosteroids [editorial]
ARTICLE SOURCE: Chest (United States), Oct 1999, 116(4) p854-6
AUTHOR(S): Harding SM
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Diagnosing heart failure by the Valsalva maneuver : Isn't It finally time? [editorial; comment]
COMMENTS: Comment on: Chest 1999 Oct; 116(4):861-7
ARTICLE SOURCE: Chest (United States), Oct 1999, 116(4) p851-3
AUTHOR(S): Zema MJ
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Shared decision making in a publicly funded health care system. Policies exist to reduce the risk of conflict between individual and society [editorial]
ARTICLE SOURCE: BMJ (England), Sep 18 1999, 319(7212) p725-6
AUTHOR(S): Sculpher MJ; Watt I; Gafni A
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Paternalism or partnership? Patients have grown up-and there's no going back [editorial; comment]
COMMENTS: Comment on: BMJ 1999 Sep 18; 319(7212):731-4; Comment on: BMJ 1999 Sep 18; 319(7212):738-43; Comment on: BMJ 1999 Sep 18; 319(7212):753-6; Comment on: BMJ 1999 Sep 18; 319(7212):764-6; Comment on: BMJ 1999 Sep 18; 319(7212):766-71
ARTICLE SOURCE: BMJ (England), Sep 18 1999, 319(7212) p719-20
AUTHOR(S): Coulter A
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: New noninvasive test alternative to Allen's test: snuff-box technique.
ARTICLE SOURCE: J Thorac Cardiovasc Surg (United States), Oct 1999, 118(4) p756-8
AUTHOR(S): Kochi K; Sueda T; Orihashi K; Matsuura Y
AUTHOR'S ADDRESS: First Department of Surgery, Hiroshima University School of Medicine, Hiroshima, Japan.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Because "it is necessary to affix right ideas to words". Thomas Paine, The Age of Reason, 1794 [editorial]
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Oct 1999, 11(4) p229-30
AUTHOR(S): Hartung J
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Recovery from anesthesia and postoperative extubation of neurosurgical patients: a review.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Oct 1999, 11(4) p282-93
AUTHOR(S): Bruder N; Ravussin P
AUTHOR'S ADDRESS: Departement d'Anesthesie-Reanimation, CHU La Timone, Marseille, France.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (81 references); REVIEW, TUTORIAL

ARTICLE TITLE: Dopamine receptors--physiological understanding to therapeutic intervention potential.
ARTICLE SOURCE: Pharmacol Ther (England), Nov 1999, 84(2) p133-56
AUTHOR(S): Emilien G; Maloteaux JM; Geurts M; Hoogenberg K; Cragg S
AUTHOR'S ADDRESS: Laboratory of Pharmacology, Universite Catholique de Louvain, Cliniques Universitaires Saint Luc, Brussels, Belgium. gemilien@aol.com.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (259 references); REVIEW, ACADEMIC
However, studies have been unable to demonstrate that DA can prevent acute renal failure or reduce mortality. It appears that the significant progress that is being made in the molecular understanding of DA receptors will continue to have a tremendous impact in the pharmacological treatment of neuropsychiatric, cardiovascular, and renal diseases.
MB. Well I knew from the beginning that there was no shown effect on renal failure so I am not expecting anything.

ARTICLE TITLE: Modern concepts of paediatric analgesia.
ARTICLE SOURCE: Pharmacol Ther (England), Jul 1999, 83(1) p1-20
AUTHOR(S): Lloyd-Thomas AR
AUTHOR'S ADDRESS: Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Trust, London, UK. a.lloyd-thomas@dial.pipex.com.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (274 references); REVIEW, ACADEMIC
ABSTRACT: Laboratory data, economic pressures, and the wish for humane treatment have been some of the driving forces behind improvements in paediatric pain management. Within the space of 10 years, there have been dramatic changes in the quality of treatment received by children undergoing surgical operations. Moreover, those receiving medical treatment, for example, sickle cell disease, have also benefited from increased experience in pain management. Children receiving care in specialised centres can now expect to benefit from up-to-date techniques of pain management, such as patient-controlled analgesia, nurse-controlled analgesia, and epidural infusions. They will be managed by ward nurses experienced and trained in paediatric pain relief, they will be attended by nurses whose special interest and training is the management of children's pain, and they will be provided with the techniques of analgesia by competent, trained anaesthetic staff. Improved care, with close attention to pain relief, is not only humane, but improves the patient turnaround by enhancing rapid discharge. Further education is required to spread these benefits to children being managed outside highly specialised centres. Not only education, but investment, is needed also to ensure that all children receive a standard of care second to none.

ARTICLE TITLE: Characteristics of female obstetrician-gynecologists in the United States.
ARTICLE SOURCE: Obstet Gynecol (United States), Nov 1999, 94(5 Pt 1) p659-65
AUTHOR(S): Frank E; Rock J; Sara D
AUTHOR'S ADDRESS: Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia 30303-3219, USA. efrank@fpm.eushc.org.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Urinary incontinence in United States Air Force female aircrew.
ARTICLE SOURCE: Obstet Gynecol (United States), Oct 1999, 94(4) p532-6
AUTHOR(S): Fischer JR; Berg PH
AUTHOR'S ADDRESS: Department of Obstetrics and Gynecology, Methodist Hospital, Indiana University School of Medicine, Indianapolis, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: The rate of urinary incontinence among female Air Force aircrew is similar to rates found in other surveys of the general population. Flying high-performance military aircraft did not affect the rate of incontinence.

ARTICLE TITLE: The need for perspective in evidence-based medicine.
ARTICLE SOURCE: JAMA (United States), Dec 22-29 1999, 282(24) p2358-65
AUTHOR(S): Woolf SH
AUTHOR'S ADDRESS: Department of Family Practice, Medical College of Virginia, Virginia Commonwealth University, Fairfax 22033, USA. shwoolf@aol.com.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Research advances are generating a growing body of clinical trial and other data on the effects of tests and treatments on outcomes, but there is no information resource within the health care system that systematically puts that information in perspective. Policy makers, clinicians, and individuals lack a ready means to compare the relative effectiveness of various interventions in prolonging survival or preventing the occurrence or complications of a disease: information that is critical in setting priorities. A crude analysis of preventable deaths suggests that evidence-based primary prevention (getting the population to stop smoking, exercise, lower cholesterol levels, and control blood pressure) would prevent considerably more deaths per year than would various evidence-based treatments for cardiovascular disease. Examining evidence from this perspective calls attention to mismatched priorities-most health care expenditures in the United States go toward treatment of diseases and their late-stage complications and relatively few resources are devoted to primary prevention and health promotion. Similar analyses at the individual level can help patients put personal options in perspective. This article proposes a bibliographic evidence-collection center and simulation modeling program to estimate potential benefits and harms of competing interventions for populations and individuals. Such evidence-based projections would enable policy makers, clinicians, and patients to judge whether they give due priority to the interventions most likely to improve health. With the steady growth in research data, the need for a system that enables society and individuals to put evidence in perspective will become progressively more urgent.

ARTICLE TITLE: Where does Helicobacter pylori come from and why is it going away? [editorial; comment]
COMMENTS: Comment on: JAMA 1999 Dec 15; 282(23):2240-5
ARTICLE SOURCE: JAMA (United States), Dec 15 1999, 282(23) p2260-2
AUTHOR(S): Blaser MJ
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Economics, ethics, and end-of-life care [editorial]
ARTICLE SOURCE: JAMA (United States), Dec 1 1999, 282(21) p2076
AUTHOR(S): Weiss SC
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Legal issues concerning electronic health information: privacy, quality, and liability.
ARTICLE SOURCE: JAMA (United States), Oct 20 1999, 282(15) p1466-71
AUTHOR(S): Hodge JG Jr; Gostin LO; Jacobson PD
AUTHOR'S ADDRESS: Georgetown University Law Center, Washington, DC 20013-6305, USA. hodgej@erols.com.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Tube feeding in patients with advanced dementia: a review of the evidence [see comments]
COMMENTS: Comment in: JAMA 1999 Oct 13; 282(14):1380-1
ARTICLE SOURCE: JAMA (United States), Oct 13 1999, 282(14) p1365-70
AUTHOR(S): Finucane TE; Christmas C; Travis K
AUTHOR'S ADDRESS: Division of Geriatric Medicine and Gerontology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. tfinuc@jhmi.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (77 references); REVIEW LITERATURE

ARTICLE TITLE: Lack of evidence about tube feeding--food for thought [editorial; comment]
COMMENTS: Comment on: JAMA 1999 Oct 13; 282(14):1365-70
ARTICLE SOURCE: JAMA (United States), Oct 13 1999, 282(14) p1380-1
AUTHOR(S): McCann R
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: The unnatural nature of pain.
ARTICLE SOURCE: JAMA (United States), Jan 5 2000, 283(1) p117
AUTHOR(S): Henderson SW
AUTHOR'S ADDRESS: University of Illinois at Chicago College of Medicine, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
MEDLINE INDEXING DATE: 200003
ISSN: 0098-7484
LANGUAGE: English

ARTICLE TITLE: Pain, suffering, and meaning [editorial]
ARTICLE SOURCE: JAMA (United States), Jan 5 2000, 283(1) p114
AUTHOR(S): Magid CS
MAJOR SUBJECT HEADING(S): Pain
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Fair conduct and fair reporting of clinical trials [editorial; comment]
COMMENTS: Comment on: JAMA 1999 Nov 10; 282(18):1752-9
ARTICLE SOURCE: JAMA (United States), Nov 10 1999, 282(18) p1766-8
AUTHOR(S): Rennie D
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Serving two masters: medical practice vs administrative ethics.
ARTICLE SOURCE: JAMA (United States), Nov 3 1999, 282(17) p1678-9
AUTHOR(S): Webster G
AUTHOR'S ADDRESS: Stanford University School of Medicine, Calif, USA.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Crash risk among older drivers studied [news]
ARTICLE SOURCE: JAMA (United States), Nov 3 1999, 282(17) p1610-1
AUTHOR(S): Voelker R
PUBLICATION TYPE: NEWS