MB's Articles of Interest - June 2001

ARTICLE TITLE: Comparison of medicine alone, coronary angioplasty, and left internal mammary artery-coronary artery bypass for one-vessel proximal left anterior descending coronary artery disease.
ARTICLE SOURCE: Am J Cardiol (United States), Dec 15 2000, 86(12) p1322-6
AUTHOR(S): Greenbaum AB; Califf RM; Jones RH; Gardner LH; Phillips HR; Sketch MH; Stack RS; Puma JA
AUTHOR'S ADDRESS: Duke Clinical Research Institute, Durham, North Carolina, USA. agreenb1@smtpgw.ls.hfh.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: Despite the deleterious and sometimes catastrophic consequences of proximal left anterior descending (LAD) artery occlusion, there is a paucity of data to guide the treatment of patients with such disease. Our aim was to describe outcomes with medical therapy, angioplasty, or left internal mammary artery (LIMA) bypass grafting in patients with 1-vessel, proximal LAD disease. We retrospectively analyzed prospectively collected data from 1,188 patients first presenting only with proximal LAD disease at 1 center over 9 years. We assessed the rates of death, acute myocardial infarction, and repeat intervention by initial treatment over a median 5.7 years of follow-up. Patients undergoing angioplasty or LIMA bypass were more often men and had progressive or unstable angina; those receiving medical therapy had a lower median ejection fraction. Both revascularization procedures offered slightly better adjusted survival versus medicine (hazard ratio for angioplasty, 0.82; 95% confidence interval, 0.60 to 1.11; hazard ratio for bypass, 0.74; 95% confidence interval, 0.44 to 1.23). Bypass, but not angioplasty, was associated with significantly fewer composite end point events (death, infarction, or reintervention, p <0.0001), and angioplasty was associated with a higher composite event rate than bypass or medical therapy (p <0.0001 and p = 0.0003, respectively). The initial advantages of bypass and medicine over angioplasty diminished over time; angioplasty became more advantageous than medicine after 1 year (p = 0.05) and not significantly different from bypass. Treatment of 1-vessel, proximal LAD disease with medicine, angioplasty, or UMA bypass resulted in comparable adjusted survival. However, LIMA bypass alone reduced the long-term incidence of infarctions and repeat procedures.
MB: There has been one previous randomised study which showed no difference. (J Amer Col. Cardiology. 1995. 26.1600). The above is a retrospective study. There is not much difference between the treatments. The anatomical type involved is generally considered to be an indication for surgery because it is so dangerous.

ARTICLE TITLE: Three-dimensional color Doppler reconstruction of intracardiac blood flow in patients with different heart valve diseases.
ARTICLE SOURCE: Am J Cardiol (United States), Dec 15 2000, 86(12) p1343-8
AUTHOR(S): De Simone R; Glombitza G; Vahl CF; Meinzer HP; Hagl S
AUTHOR'S ADDRESS: University of Heidelberg and German Cancer Research Institute. r.de.simone@urz.uni-heidelberg.de.
PUBLICATION TYPE: Journal Article
The 3-D images revealed for the first time the complex spatial distribution of the blood flow abnormalities in the heart chambers caused by different heart valve diseases. New patterns of intracardiac blood flow disturbances were observed and classified. Three-dimensional color Doppler provides a unique noninvasive method that can be easily applied for studying intracardiac blood flow disturbances in clinical practice.
MB: Now even I can see it all.

ARTICLE TITLE: Importance of asking questions about erectile dysfunction.
ARTICLE SOURCE: Am J Cardiol (United States), Dec 1 2000, 86(11) p1210-3, A5
AUTHOR(S): Levine LA; Kloner RA
PUBLICATION TYPE: Editorial
ABSTRACT: Cardiovascular disease and erectile dysfunction share many common risk factors. In fact, recent studies have demonstrated evidence of occult coronary artery disease, undiagnosed hyperlipidemia, and hypertension in men presenting with erectile dysfunction. It is therefore incumbent upon all physicians, especially cardiologists, to query their patients about their erectile function.

ARTICLE TITLE: Effect of concomitant digoxin and carvedilol therapy on mortality and morbidity in patients with chronic heart failure.
ARTICLE SOURCE: Am J Cardiol (United States), Nov 1 2000, 86(9) p1032-5, A10-1
AUTHOR(S): Eichhorn EJ; Lukas MA; Wu B; Shusterman N
AUTHOR'S ADDRESS: Department of Internal Medicine, The University of Texas Southwestern and Dallas VA Medical Centers, 75216, USA. Eichhorn@Ryburn.swmed.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: We retrospectively performed stepwise logistic regression analysis on 1,509 patients with chronic heart failure in 4 multicenter United States studies and 1 Australia-New Zealand study to examine the effect of digoxin in patients randomized to carvedilol or placebo. Patients receiving digoxin had more advanced heart failure, the incidence of hospitalization for any cause and the combination of all-cause death and all-cause hospitalization were the same in the digoxin versus no-digoxin groups.

ARTICLE TITLE: Can we define patients with no and those with some chance of survival when found in asystole out of hospital?
ARTICLE SOURCE: Am J Cardiol (United States), Sep 15 2000, 86(6) p610-4
AUTHOR(S): Engdahl J; Bang A; Lindqvist J; Herlitz J
AUTHOR'S ADDRESS: Division of Cardiology, Sahlgrenska University Hospital, Goteborg, Sweden.
PUBLICATION TYPE: Journal Article
ABSTRACT: We describe the epidemiology, prognosis, and circumstances at resuscitation among a consecutive population of patients with out-of-hospital cardiac arrest (OHCA) with asystole as the arrhythmia first recorded by the Emergency Medical Service (EMS), and identify factors associated with survival. We included all patients in the municipality of Goteborg, regardless of age and etiology, who experienced an OHCA between 1981 and 1997. There were a total of 4,662 cardiac arrests attended by the EMS during the study period. Of these, 1,635 (35%) were judged as having asystole as the first-recorded arrhythmia: 156 of these patients (10%) were admitted alive to hospital, and 32 (2%) were discharged alive. Survivors were younger (median age 58 vs 68 years) and had a witnessed cardiac arrest more often than nonsurvivors (78% vs 50%). Survivors also had shorter intervals from collapse to arrival of ambulance (3.5 vs 6 minutes) and the mobile coronary care unit (MCCU) (5 vs 10 min), and they received atropine less often on scene. There were also a greater proportion of survivors with noncardiac etiologies of cardiac arrest (48% vs 27%). Survivors to discharge also displayed higher degrees of consciousness on arrival to the emergency department in comparison to nonsurvivors. Multivariate analysis among all patients with asystole indicated age (p = 0.01) and witnessed arrest (p = 0.03) as independent predictors of an increased chance of survival. Multivariate analysis among witnessed arrests indicated short time to arrival of the MCCU (p < 0.001) and no treatment with atropine (p = 0.05) as independent predictors of survival. Fifty-five percent of patients discharged alive had none or small neurologic deficits (cerebral performance categories 1 or 2). No patients > 70 years old with unwitnessed arrests (n = 211) survived to discharge.

ARTICLE TITLE: Outcome of patients with sleep apnea-associated severe bradyarrhythmias after continuous positive airway pressure therapy.
ARTICLE SOURCE: Am J Cardiol (United States), Sep 15 2000, 86(6) p688-92, A9
AUTHOR(S): Grimm W; Koehler U; Fus E; Hoffmann J; Menz V; Funck R; Peter JH; Maisch B
AUTHOR'S ADDRESS: Department of Cardiology, Philipps-University Marburg, Germany.
PUBLICATION TYPE: Journal Article
ABSTRACT: Twenty-nine patients in whom severe bradyarrhythmias occurred exclusively during obstructive sleep apnea and in whom advanced sinus node disease or atrioventricular conduction system dysfunction had been excluded by invasive electrophysiologic evaluation were prospectively followed on nasal continuous positive airway pressure. During 54 +/- 10 months follow-up, no syncope and no sudden deaths were observed, suggesting that patients with sleep apnea-associated bradyarrhythmias and a normal electrophysiologic study appear to have a favorable prognosis with continuous positive airway pressure.

ARTICLE TITLE: Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery.
ARTICLE SOURCE: Am J Cardiol (United States), Mar 1 2001, 87(5) p505-9
AUTHOR(S): Rohde LE; Polanczyk CA; Goldman L; Cook EF; Lee RT; Lee TH
AUTHOR'S ADDRESS: Partners Community HealthCare Inc, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02199, USA.
PUBLICATION TYPE: Journal Article
In conclusion, preoperative transthoracic echocardiography (TTE) before noncardiac surgery can provide independent information about the risk of postoperative cardiac complications in selected patients.

ARTICLE TITLE: Effect of combined aspirin and angiotensin-converting enzyme inhibitor therapy versus angiotensin-converting enzyme inhibitor therapy alone on readmission rates in heart failure [In Process Citation]
ARTICLE SOURCE: Am J Cardiol (United States), Feb 15 2001, 87(4) p483-7, A7
AUTHOR(S): Harjai KJ; Nunez E; Turgut T; Newman J
AUTHOR'S ADDRESS: Department of Cardiology, Ochsner Medical Institutions, New Orleans, Louisiana, USA. kharjai@ochsner.org.
PUBLICATION TYPE: Journal Article
Our study found that combining aspirin with angiotensin-converting enzyme (ACE) inhibitors is associated with higher early readmission rates than use of ACE inhibitors alone, particularly in patients with depressed ejection fraction and in those without coronary artery disease.

ARTICLE TITLE: Usefulness of transesophageal echocardiographic monitoring to improve the outcome of stent-graft treatment of thoracic aortic aneurysms.
ARTICLE SOURCE: Am J Cardiol (United States), Feb 1 2001, 87(3) p315-9
AUTHOR(S): Rapezzi C; Rocchi G; Fattori R; Caldarera I; Ferlito M; Napoli G; Pierangeli A; Branzi A
AUTHOR'S ADDRESS: Institute of Cardiovascular Diseases and Department of Cardiovascular Surgery, University of Bologna, Italy. crapezzi@orsola-malpighi.med.unibo.it.
PUBLICATION TYPE: Journal Article
Considering the total patient cohort, transesophageal echocardiography (TEE) yielded relevant information, resulting in procedure changes in 59% (13 of 22). In conclusion, TEE provided additional information with respect to angiography in all phases of stent-graft treatment, improving immediate outcome and reducing complications.

ARTICLE TITLE: Factors influencing a woman's choice to undergo breast-conserving surgery versus modified radical mastectomy.
ARTICLE SOURCE: Am J Surg (United States), Dec 2000, 180(6) p413-8
AUTHOR(S): Nold RJ; Beamer RL; Helmer SD; McBoyle MF
AUTHOR'S ADDRESS: Department of Surgery, University of Kansas School of Medicine-Wichita, Wichita, Kansas 67214, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: The surgeon's input is important in a woman's choice to undergo breast-conserving surgery (BCS) or modified radical mastectomy with reconstruction (MRM-R). However, it appears that if a woman wants to have MRM without reconstruction (MRM-NR), even when she is a candidate for BCS, the surgeon's input is overshadowed by the patient's fear of cancer.

ARTICLE TITLE: Central venous catheter placement in patients with disorders of hemostasis.
ARTICLE SOURCE: Am J Surg (United States), Dec 2000, 180(6) p503-5; discussion 506
AUTHOR(S): Mumtaz H; Williams V; Hauer-Jensen M; Rowe M; Henry-Tillman RS; Heaton K; Mancino AT; Muldoon RL; Klimberg VS; Broadwater JR; Westbrook KC; Lang NP
AUTHOR'S ADDRESS: Department of Surgery, University of Arkansas for Medical Science, Little Rock, Arkansas, USA.
PUBLICATION TYPE: Journal Article
RESULTS: In a 2-year period, 2,010 central venous catheters were placed in 1,825 patients. Three hundred and thirty placements were in patients with disorders of hemostasis. In 88 of the 330 patients, the underlying coagulopathy was not corrected before catheter placement. In these patients, there were 3 bleeding complications requiring placement of a purse string suture at the catheter entry site. In the remaining 242 patients, there was 1 bleeding complication. Of the variables analyzed, only a low platelet count (<50 x 10(9)/L) was significantly associated with bleeding complications. CONCLUSION: Central venous access procedures can be safely performed in patients with underlying disorders of hemostasis. Even patients with low platelet counts have infrequent (3 of 88) bleeding complications, and these problems are easily managed.

ARTICLE TITLE: Is immediate chest radiograph necessary after central venous catheter placement in a surgical intensive care unit?
ARTICLE SOURCE: Am J Surg (United States), Dec 2000, 180(6) p517-21; discussion 521-2
AUTHOR(S): Bailey SH; Shapiro SB; Mone MC; Saffle JR; Morris SE; Barton RG
AUTHOR'S ADDRESS: Department of Surgery, University of Utah Medical Center, Salt Lake City, Utah, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: Placement of CVC is safe in experienced hands. In monitored intensive care unit patients who undergo a "straightforward" procedure with <3 needle passes, chest radiograph can be safely deferred until the next scheduled examination.
MB: We have a lot of inexperienced hands. Who decides who is experienced? When I was doing a list of subclavians all the major disasters occurred with the non-consultant surgeons. When a disaster occurs any saving made by omitting the X-ray is lost.

ARTICLE TITLE: Is regionalization of trauma care using telemedicine feasible and desirable?
ARTICLE SOURCE: Am J Surg (United States), Dec 2000, 180(6) p535-9
AUTHOR(S): Aucar J; Granchi T; Liscum K; Wall M; Mattox K
AUTHOR'S ADDRESS: Department of Surgery, Baylor College of Medicine and the Ben Taub General Hospital, Houston, Texas, USA.
PUBLICATION TYPE: Evaluation Studies; Journal Article
CONCLUSION: Remote evaluation of trauma victims is feasible. Accurate clinical data can be recorded, tasks delegated, and therapeutic measures advised using telemedicine. This can make expert trauma care available to hospitals without advanced trauma systems and potentially reduce cost, prevent unnecessary transfers, and promote early transfer when indicated.

ARTICLE TITLE: Preemptive bupivacaine offers no advantages to postoperative wound infiltration in analgesia for outpatient breast biopsy.
ARTICLE SOURCE: Am J Surg (United States), Jul 2000, 180(1) p29-32
AUTHOR(S): O'Hanlon DM; Colbert ST; Keane PW; Given FH
AUTHOR'S ADDRESS: National Breast Cancer Research Institute and the Department of Surgery, Galway, Ireland.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing ambulatory breast biopsy.

ARTICLE TITLE: Continuous regional analgesia: can we afford not to use it?
ARTICLE SOURCE: Anaesthesia (England), Apr 2001, 56(4) p299-301
AUTHOR(S): Harrop-Griffiths W; Picard J
AUTHOR'S ADDRESS: Department of Anaesthesia, St Mary's Hospital, Paddington, London; Imperial School of Anaesthesia, London.
PUBLICATION TYPE: Journal Article
MB: Over-enthusiastic.

ARTICLE TITLE: Patient-controlled analgesia and intra-operative suggestion.
ARTICLE SOURCE: Anaesthesia (England), Jan 2001, 56(1) p65-9
AUTHOR(S): Dawson P; Van Hamel C; Wilkinson D; Warwick P; O'Connor M
AUTHOR'S ADDRESS: Department of Anaesthetics, Swindon and Marlborough NHS Trust, Okus Road, Swindon SN1 4JU, UK.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
We found that the positive intra-operative suggestions had no beneficial effects in reducing postoperative pain or nausea scores, nor was the consumption of morphine or anti-emetics reduced.

ARTICLE TITLE: Survey of 1057 patients receiving postoperative patient-controlled epidural analgesia.
ARTICLE SOURCE: Anaesthesia (England), Jan 2001, 56(1) p70-5
AUTHOR(S): Wigfull J; Welchew E
AUTHOR'S ADDRESS: Senior House Officer and Consultant in Anaesthesia, Northern General Hospital NHS Trust, Herries Road, Sheffield S5 7AU, UK.
PUBLICATION TYPE: Journal Article
There were no cases of epidural haematoma or abscess. We conclude that a patient-controlled epidural analgesia service as described is both efficacious and safe for use on surgical wards.
MB:The big disasters are rarer than that.

ARTICLE TITLE: Postoperative pain relief using thoracic epidural analgesia: outstanding success and disappointing failures.
ARTICLE SOURCE: Anaesthesia (England), Jan 2001, 56(1) p75-81
AUTHOR(S): McLeod G; Davies H; Munnoch N; Bannister J; MacRae W
AUTHOR'S ADDRESS: Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: Six hundred and forty patients received epidural analgesia for postoperative pain relief following major surgery in the 6-year period 1993-1998. Although satisfactory pain relief was achieved in over two-thirds of patients for a median duration of 44 h after surgery, one-fifth of patients (133 individuals) still experienced poor pain relief. Almost one out of three patients (194 individuals) had a problem with their epidural. Eighty-three patients (13%) suffered a technical failure and 84 (13%) patients had their epidurals removed at night time when pain-free because of pressure on beds. Seven patients had their epidural replaced and subsequently experienced excellent pain relief for a median of 77 h. Lack of resources prevented a further 480 patients from receiving the potential benefits of epidural analgesia. These results would suggest that the practical problems of delivering an epidural service far outweigh any differences in drug regimens or modes of delivery of epidural solutions.
MB: When is this nonsense going to stop? The method is inherently unsatisfactory.

ARTICLE TITLE: Intra-operative blood salvage in abdominal trauma: a review of 5 years' experience.
ARTICLE SOURCE: Anaesthesia (England), Mar 2001, 56(3) p217-20
AUTHOR(S): Hughes LG; Thomas DW; Wareham K; Jones JE; John A; Rees M
AUTHOR'S ADDRESS: Intensive Care Unit, Swansea NHS Trust, Morriston Hospital, Swansea SA6 6NL, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: We performed a retrospective audit of 1235 patients presenting between 1992 and 1997, following the introduction of intra-operative blood salvage at our hospital. Twenty-two cases of severe abdominal trauma requiring emergency laparotomy and intra-operative blood salvage were identified. The impact of intra-operative blood salvage in aiding resuscitation and reducing demand on allogeneic blood supplies is discussed.
MB: We should be doing this as a spin off from the liver transplant program.

ARTICLE TITLE: Non-invasive ventilation in the treatment of ventilatory failure following corrective spinal surgery.
ARTICLE SOURCE: Anaesthesia (England), Mar 2001, 56(3) p235-8
AUTHOR(S): Doherty MJ; Millner PA; Latham M; Dickson RA; Elliott MW
AUTHOR'S ADDRESS: Department of Respiratory Medicine, St. James's University Hospital, Beckett Street, Leeds, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: Non-invasive positive pressure ventilation has previously been used successfully to treat both acute and chronic ventilatory failure secondary to a number of conditions, including scoliosis. We report two patients in whom it was used, on three separate occasions, to treat acute ventilatory failure following corrective spinal surgery. Non-invasive positive pressure ventilation may be useful postoperatively in high-risk patients undergoing major spinal surgery in an attempt to prevent intubation and its attendant complications.

ARTICLE TITLE: Damage to the conus medullaris following spinal anaesthesia.
ARTICLE SOURCE: Anaesthesia (England), Mar 2001, 56(3) p238-47
AUTHOR(S): Reynolds F
AUTHOR'S ADDRESS: Department of Anaesthetics, St Thomas' Hospital, London SE1 7EH, UK. felicity.reynolds@btinternet.com.
PUBLICATION TYPE: Journal Article
ABSTRACT: Seven cases are described in which neurological damage followed spinal or combined spinal-epidural anaesthesia using an atraumatic spinal needle. All patients were women, six obstetric and one surgical. All experienced pain during insertion of the needle, which was usually believed to be introduced at the L2-3 interspace. In all cases, there was free flow of cerebrospinal fluid before spinal injection. There was one patchy block but, in the rest, anaesthesia was successful. Unilateral sensory loss at the levels of L4-S1 (and sometimes pain) persisted in all patients; there was foot drop in six and urinary symptoms in three. Magnetic resonance imaging showed a spinal cord of normal length with a syrinx in the conus (n = 6) on the same side as both the persisting clinical deficit and the symptoms that had occurred at insertion of the needle. The tip of the conus usually lies at L1-2, although it may extend further. Tuffier's line is an unreliable method of identifying the lumbar interspaces, and anaesthetists commonly select a space that is one or more segments higher than they assume. Because of these sources of error, anaesthetists need to relearn the rule that a spinal needle should not be inserted above L3.
MB: So much for atraumatic needles. The cases were mostly from medico-legal sources. Anaesthetists cannot get the correct spaces reliably.

ARTICLE TITLE: Renal and respiratory failure in Scottish ICUs.
ARTICLE SOURCE: Anaesthesia (England), Feb 2001, 56(2) p124-9
AUTHOR(S): Noble JS; MacKirdy FN; Donaldson SI; Howie JC
AUTHOR'S ADDRESS: Department of Anaesthetics, Victoria Infirmary, Langside Road, Glasgow G42 9TY, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Fatal subdural haemorrhage following lumbar spinal drainage during repair of thoraco-abdominal aneurysm.
ARTICLE SOURCE: Anaesthesia (England), Feb 2001, 56(2) p168-70
AUTHOR(S): McHardy FE; Bayly PJ; Wyatt MG
AUTHOR'S ADDRESS: Victoria Infirmary, Langside Road, Glasgow G42 9TY, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: A 63-year-old male patient collapsed and died from a major subdural haemorrhage 5 days after elective repair of a Type III thoraco-abdominal aortic aneurysm. The anaesthetic technique had included the use of a lumbar cerebrospinal fluid drain. The management of the patient is described, and the association between subdural haemorrhage and cerebrospinal fluid drainage is discussed.

ARTICLE TITLE: Randomised double-blind comparison of ondansetron and droperidol to prevent postoperative nausea and vomiting associated with patient-controlled analgesia.
ARTICLE SOURCE: Anaesthesia (England), Jan 2001, 56(1) p60-5
AUTHOR(S): Millo J; Siddons M; Innes R; Laurie PS
AUTHOR'S ADDRESS: Specialist Registrar, Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
We conclude that in the regimens studied, ondansetron is not more effective than droperidol at preventing postoperative nausea and vomiting.

ARTICLE TITLE: National obstetric anaesthetic practice in the UK 1997/1998.
ARTICLE SOURCE: Anaesthesia (England), Dec 2000, 55(12) p1168-72
AUTHOR(S): Khor LJ; Jeskins G; Cooper GM; Paterson-Brown S
AUTHOR'S ADDRESS: Specialist Registrar in Anaesthesia, and Senior Lecturer in Anaesthesia, University of Birmingham Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK; Consultant Obstetrician and Gynaecolo.
PUBLICATION TYPE: Journal Article
ABSTRACT: In the United Kingdom, the Royal College of Obstetricians and Gynaecologists requires maternity units recognised for training to complete annual statistical returns. Analysis of these data revealed that anaesthetists were directly involved in more than 251 000 procedures in the peripartum period in 1997/1998. There had been an increase in the number of women delivered by Caesarean section (18. 5% of all deliveries) compared with previous reports. The proportion of Caesarean sections performed under regional anaesthesia had increased for both elective and emergency Caesarean section deliveries (85.5% and 70.2%, respectively). For pain relief in labour, there had been neither an increase nor a decrease in the uptake of regional analgesia (23.6%). There were limited training opportunities for anaesthetists in general anaesthesia for Caesarean section and for obstetricians in vaginal breech delivery. The known admissions to intensive care units equated to over 100 women per month in the United Kingdom requiring intensive care as a result of childbirth.
MB: Why were 100/month going to ICUs?

ARTICLE TITLE: Inadequate pre-operative evaluation and preparation: a review of 197 reports from the Australian incident monitoring study.
ARTICLE SOURCE: Anaesthesia (England), Dec 2000, 55(12) p1173-8
AUTHOR(S): Kluger MT; Tham EJ; Coleman NA; Runciman WB; Bullock MF
AUTHOR'S ADDRESS: Specialist Anaesthetist, Department of Anaesthesia, North Shore Hospital, Auckland, New Zealand; Consultant Anaesthetist, and Professor, Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, Australia; Specialist Anaes.
PUBLICATION TYPE: Journal Article
ABSTRACT: The Australian Incident Monitoring Study database was examined for incidents involving inadequate pre-operative patient preparation and/or evaluation. Of 6271 reports, 727 had appropriate keywords, of which 197 (3.1%) were used for subsequent analysis. All surgical categories were represented. In 10% of reports the patient was not reviewed pre-operatively by an anaesthetist, whilst in 23% the anaesthetist involved in the operating theatre had not performed the pre-operative assessment. Death followed in seven cases, major morbidity in 23 cases, admission to a high-dependency unit or intensive care unit in 17 cases, and surgery was cancelled in nine cases. Poor airway assessment, communication problems and inadequate evaluation were the most common contributing factors. Respondents indicated that the incident was preventable in 57% of cases. Proposed corrective strategies include improved communication, quality assurance activities, development of protocols and additional training. A structured assessment of the airway, along with improvements in information exchange, patient assessment, and use of clearly defined patient management plans and pathways would prevent most of the incidents reported.
MB: We have had difficulty getting those on the head & neck list admitted the night before.

ARTICLE TITLE: Peripheral nerve injuries associated with anaesthesia.
ARTICLE SOURCE: Anaesthesia (England), Oct 2000, 55(10) p980-91
AUTHOR(S): Sawyer RJ; Richmond MN; Hickey JD; Jarrratt JA
AUTHOR'S ADDRESS: Department of Anaesthesia, and Consultant Clinical Neurophysiologist, Department of Clinical Neurophysiology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: Peripheral nerve injuries can occur at any time during the peri-operative period. The long-term disability that results may have serious consequences for a patient. The incidence of peri-operative nerve injuries can be reduced by anaesthetists being aware of their causes and pathophysiology. This review article aims to explain the incidence, pathophysiology and medicolegal implications of peri-operative nerve injury and provides suggestions as to how they may best be avoided.
MB: They'd better read the following because they reckon that you can't tell how to prevent the problems.

ARTICLE TITLE: Nerve injury associated with anesthesia: a closed claims analysis.
ARTICLE SOURCE: Anesthesiology (United States), Apr 1999, 90(4) p1062-9
AUTHOR(S): Cheney FW; Domino KB; Caplan RA; Posner KL
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Washington School of Medicine, Seattle 98195, USA. fcheney@u.washington.edu.
RESULTS: Six hundred seventy (16% of 4,183) claims were for anesthesia-related nerve injury. CONCLUSION: New strategies for prevention of nerve damage cannot be recommended at this time because the mechanism for most injuries, particularly those of the ulnar nerve, is not apparent.

ARTICLE TITLE: Closed loop control of anaesthesia: an assessment of the bispectral index as the target of control.
ARTICLE SOURCE: Anaesthesia (England), Oct 2000, 55(10) p953-9
AUTHOR(S): Morley A; Derrick J; Mainland P; Lee BB; Short TG
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
Convenience aside, the closed-loop system showed no clinical advantage over conventional, manually adjusted techniques of anaesthetic administration.

ARTICLE TITLE: Substance misuse amongst anaesthetists in the United Kingdom and Ireland. The results of a study commissioned by the Association of Anaesthetists of Great Britain and Ireland.
ARTICLE SOURCE: Anaesthesia (England), Oct 2000, 55(10) p946-52
AUTHOR(S): Berry CB; Crome IB; Plant M; Plant M
AUTHOR'S ADDRESS: Royal Devon and Exeter NHS Trust, Barrack Road, Exeter EX2 5DW, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: Three hundred and four departments of anaesthesia in UK and Ireland were sent questionnaires about alcohol and drug abuse in anaesthetists over the preceding 10-year period. Information was sought on the nature and extent of substance problems, their presentation and management. The survey achieved a high response rate of 71.7% and a total of 130 cases were reported, of whom 34.6% were consultants and 43.2% were trainees. Over 50% of respondents felt a lack of confidence in dealing with alcohol or drug misuse amongst colleagues. The results of this survey demonstrate that over one anaesthetist per month has presented with significant alcohol or drug misuse in the UK and Ireland over the last 10 years.

ARTICLE TITLE: Substance misuse amongst anaesthetists.
ARTICLE SOURCE: Anaesthesia (England), Oct 2000, 55(10) p943-5
AUTHOR(S): Baird WL; Morgan M
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Principles of appropriate antibiotic use for treatment of acute respiratory tract infections in adults: background, specific aims, and methods.
ARTICLE SOURCE: Ann Intern Med (United States), Mar 20 2001, 134(6) p479-86
AUTHOR(S): Gonzales R; Bartlett JG; Besser RE; Cooper RJ; Hickner JM; Hoffman JR; Sande MA
AUTHOR'S ADDRESS: Division of General Internal Medicine, Campus Box B-180, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults: background.
ARTICLE SOURCE: Ann Intern Med (United States), Mar 20 2001, 134(6) p490-4
AUTHOR(S): Gonzales R; Bartlett JG; Besser RE; Hickner JM; Hoffman JR; Sande MA
AUTHOR'S ADDRESS: Division of General Internal Medicine, Campus Box B-180, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, Denver, CO 80262, USA; Collective Name: American Academy of Family Physicians; Collective Name: Infectious Diseases Society of America; Collective Name: Centers for Disease Control; Collective Name: American College of Physicians-American Society of Internal Medicine.
PUBLICATION TYPE: Guideline; Journal Article; Practice Guideline
MB: Why have they written 2 articles?

ARTICLE TITLE: Clinical trials that have influenced the treatment of venous thromboembolism: a historical perspective.
ARTICLE SOURCE: Ann Intern Med (United States), Mar 6 2001, 134(5) p409-17
AUTHOR(S): Hirsh J; Bates SM
AUTHOR'S ADDRESS: Hamilton Civic Hospitals Research Centre, Henderson Division, 711 Concession Street, Hamilton, Ontario L8V 1C3, Canada. jhirsh@thrombosis.hhscr.org.
PUBLICATION TYPE: Historical Article; Journal Article

ARTICLE TITLE: Coronary events in world leaders.
COMMENTS: Ann Intern Med. 2001 Feb 20; 134(4):287-90/21091626
ARTICLE SOURCE: Ann Intern Med (United States), Feb 20 2001, 134(4) p338-9
AUTHOR(S): Hurst JW
PUBLICATION TYPE: Comment; Editorial
MB: Keep them on the job. Chaney is the latest.

ARTICLE TITLE: Breaking the camel's back: multicenter clinical trials and local institutional review boards.
COMMENTS: Ann Intern Med. 2001 Jan 16; 134(2):161-3/21091588
ARTICLE SOURCE: Ann Intern Med (United States), Jan 16 2001, 134(2) p152-7
AUTHOR(S): Burman WJ; Reves RR; Cohn DL; Schooley RT
AUTHOR'S ADDRESS: Denver Public Health, 605 Bannock Street, Denver, CO 80204, USA. bburman@dhha.org.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Institutional review boards: a crisis in confidence.
COMMENTS: Ann Intern Med. 2001 Jan 16; 134(2):152-7/21091586
ARTICLE SOURCE: Ann Intern Med (United States), Jan 16 2001, 134(2) p161-3
AUTHOR(S): Levine RJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Cost-effectiveness of colonoscopy in screening for colorectal cancer.
COMMENTS: Ann Intern Med. 2000 Oct 17; 133(8):647-9
ARTICLE SOURCE: Ann Intern Med (United States), Oct 17 2000, 133(8) p573-84
AUTHOR(S): Sonnenberg A; Delco F; Inadomi JM
AUTHOR'S ADDRESS: Gastroenterologie, Kantonsspital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Colonoscopy represents a cost-effective means of screening for colorectal cancer because it reduces mortality at relatively low incremental costs. Low compliance rates render colonoscopy every 10 years the most cost-effective primary screening strategy for colorectal cancer.

ARTICLE TITLE: Prevention and treatment of colorectal cancer: pay now or pay later.
COMMENTS: Ann Intern Med. 2000 Oct 17; 133(8):573-84
ARTICLE SOURCE: Ann Intern Med (United States), Oct 17 2000, 133(8) p647-9
AUTHOR(S): Lewis JD
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients.
ARTICLE SOURCE: Ann Thorac Surg (United States), Dec 2000, 70(6) p1986-90
AUTHOR(S): Dacey LJ; Munoz JJ; Johnson ER; Leavitt BJ; Maloney CT; Morton JR; Olmstead EM; Birkmeyer JD; O'Connor GT
AUTHOR'S ADDRESS: Department of Surgery, Center for the Evaluative Clinical Sciences, Community & Family Medicine, Lebanon, New Hampshire, USA. lawrence.j.dacey@dartmouth.edu; Collective Name: Northern New England Cardiovascular Disease Study Group.
CONCLUSIONS: Preoperative aspirin use appears to be associated with a decreased risk of mortality in before coronary artery bypass grafting (CABG) patients without significant increase in hemorrhage, blood product requirements, or related morbidities.

ARTICLE TITLE: Pro: beating-heart surgery for coronary revascularization: is it the most important development since the introduction of the heart-lung machine?
COMMENTS: Ann Thorac Surg. 2000 Nov; 70(5):1779-81
ARTICLE SOURCE: Ann Thorac Surg (United States), Nov 2000, 70(5) p1774-8
AUTHOR(S): Mack MJ
AUTHOR'S ADDRESS: Cardiopulmonary Research Science Technology Institute, Dallas, Texas, USA. mmack@cristi.org.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Con: beating-heart surgery for coronary revascularization: is it the most important development since the introduction of the heart-lung machine?
COMMENTS: Ann Thorac Surg. 2000 Nov; 70(5):1774-8
ARTICLE SOURCE: Ann Thorac Surg (United States), Nov 2000, 70(5) p1779-81
AUTHOR(S): Cooley DA
AUTHOR'S ADDRESS: Texas Heart Institute and University of Texas Medical School, Houston 77225-0345, USA. dcooley@heart.thi.tmc.edu.
PUBLICATION TYPE: Comment; Journal Article
It may benefit older or sicker patients who are poor candidates for CPB, especially those with left anterior descending or right coronary artery lesions, but it should be used with discretion and not be considered for all coronary patients.

ARTICLE TITLE: Is that outcome different or not? The effect of experimental design and statistics on neurobehavioral outcome studies.
ARTICLE SOURCE: Ann Thorac Surg (United States), Nov 2000, 70(5) p1782-5
AUTHOR(S): Stump DA; James RL; Murkin JM
AUTHOR'S ADDRESS: Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. dstump@wfubmc.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Processing scavenged blood with a cell saver reduces cerebral lipid microembolization.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2000, 70(4) p1296-300
AUTHOR(S): Kincaid EH; Jones TJ; Stump DA; Brown WR; Moody DM; Deal DD; Hammon JW
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Use of a cell saver to scavenge shed blood during cardiopulmonary bypass (CPB) decreases cerebral lipid microembolization.

ARTICLE TITLE: Effects of intraoperative administration of atrial natriuretic peptide.
ARTICLE SOURCE: Ann Thorac Surg (United States), Oct 2000, 70(4) p1319-26
AUTHOR(S): Hayashida N; Chihara S; Kashikie H; Tayama E; Yokose S; Akasu K; Aoyagi S
AUTHOR'S ADDRESS: Department of Surgery, Kurume University, Fukuoka, Japan. nobuhiko@med.kurume-u.ac.jp.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Intraoperative administration of endogenous atrial natriuretic peptide (ANP) had potent effects on natriuresis and systemic vasodilation by elevating cyclic guanosine monophosphate levels. The results suggest that the technique is useful for the management of hemodynamics and water-sodium retention after cardiopulmonary bypass.

ARTICLE TITLE: As originally published in 1993: Protection from postischemic spinal cord injury by perfusion cooling of the epidural space. Updated in 2001
ARTICLE SOURCE: Ann Thorac Surg (United States), Mar 2001, 71(3) p1063-4
AUTHOR(S): Tabayashi K; Motoyoshi N
AUTHOR'S ADDRESS: Department of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Direct cardiac compression for cardiogenic shock with the CardioSupport system
ARTICLE SOURCE: Ann Thorac Surg (United States), Mar 2001, 71(3 Suppl) pS188-9
AUTHOR(S): Williams MR; Artrip JH
AUTHOR'S ADDRESS: Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York, USA. mw365@columbia.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: Epicardial direct cardiac compression for cardiogenic shock avoids a blood surface interface with associated thromboembolic and immunologic sequelae and could be placed rapidly with technical ease. The Cardio Technologies device provides synchronized biventricular cardiac compression, is placed via a thoracotomy, and remains on the heart without need for sutures. In preclinical work, the system has successfully restored cardiac function to near normal in the setting of heart failure. The CardioSupport system offers an attractive and novel alternative for treating cardiogenic shock and is being prepared for upcoming clinical trials.

ARTICLE TITLE: Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 2001, 71(1) p14-21
AUTHOR(S): Stecker MM; Cheung AT; Pochettino A; Kent GP; Patterson T; Weiss SJ; Bavaria JE
AUTHOR'S ADDRESS: Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA. mark_stecker@yahoo.com.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: With the high degree of interpatient variability in these neurophysiologic measures, the only absolute predictors of electrocerebral silence were nasopharyngeal temperature below 12.5 degrees C and cooling longer than 50 minutes.

ARTICLE TITLE: Deep hypothermic circulatory arrest: II. Changes in electroencephalogram and evoked potentials during rewarming.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 2001, 71(1) p22-8
AUTHOR(S): Stecker MM; Cheung AT; Pochettino A; Kent GP; Patterson T; Weiss SJ; Bavaria JE
AUTHOR'S ADDRESS: Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, USA. mark_stecker@yahoo.com.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: No trend toward shortened recovery times or improved neurologic outcome was noted with lower temperatures at circulatory arrest, indicating that the process of cooling to electrocerebral silence produced a relatively uniform degree of cerebral protection, independent of the actual nasopharyngeal temperature.

ARTICLE TITLE: Revascularization of severe hibernating myocardium in the beating heart: early hemodynamic and metabolic features.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jan 2001, 71(1) p176-9
AUTHOR(S): Pasini E; Ferrari G; Cremona G; Ferrari M
AUTHOR'S ADDRESS: S. Maugeri Foundation IRCCS, Medical Centre of Gussago, Italy. evpasini@libero.it.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Early hemodynamic and metabolic features of coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) in patients with hibernating (MB ie warm caedioplegia) myocardium suggest that this procedure is safe and results in a significant improvement of cardiac function without affecting myocardial metabolism.

ARTICLE TITLE: Physicians' attitudes about involvement in lethal injection for capital punishment.
ARTICLE SOURCE: Arch Intern Med (United States), Oct 23 2000, 160(19) p2912-6
AUTHOR(S): Farber N; Davis EB; Weiner J; Jordan J; Boyer EG; Ubel PA
AUTHOR'S ADDRESS: Deartment of Medicine, Christiana Care Health System, 501 W 14th St, Wilmington, DE 19899, USA. nfarber@christianacare.org.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: Physicians could play various roles in carrying out capital punishment via lethal injection. Medical societies like the American Medical Association (AMA) and American College of Physicians have established which roles are acceptable and which are disallowed. No one has explored physicians' attitudes toward their potential roles in this process. METHODS: We surveyed physicians about how acceptable it was for physicians to engage in 8 actions disallowed by the AMA and 4 allowed actions involving lethal injection. Questions assessing attitudes toward capital punishment and assisted suicide were included. The impact of attitudinal and demographic variables on the number of disallowed actions deemed acceptable was analyzed via analysis of variance and multiple logistic regression analysis. RESULTS: Four hundred eighty-two physicians (51%) returned questionnaires. Eighty percent indicated that at least 1 of the disallowed actions was acceptable, 53% indicated that 5 or more were acceptable, and 34% approved all 8 disallowed actions. The percentage of respondents approving of disallowed actions varied from 43% for injecting lethal drugs to 74% for determining when death occurred. All 4 allowed actions were deemed acceptable by the majority of respondents. Favoring the death penalty (P<.001) and the acceptance of assisted suicide (P<.001) were associated with an increased number of disallowed actions that were deemed acceptable. CONCLUSIONS: Despite medical society policies, the majority of physicians surveyed approved of most disallowed actions involving capital punishment, indicating that they believed it is acceptable in some circumstances for physicians to kill individuals against their wishes. It is possible that the lack of stigmatization by colleagues allows physicians to engage in such practices

ARTICLE TITLE: A search for sex differences in response to analgesia.
ARTICLE SOURCE: Arch Intern Med (United States), Dec 11-25 2000, 160(22) p3424-8
AUTHOR(S): Averbuch M; Katzper M
AUTHOR'S ADDRESS: Division of Analgesic, Anti-inflammatory, and Ophthalmic Drug Products, HFD-550, Center for Drug Evaluation and Research, Food and Drug Administration, 2 Locks Pond Ct, Rockville, MD 20854, USA.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSIONS: Our results demonstrated no sex effect on the analgesic response to ibuprofen. These results were obtained under the post-third-molar extraction setting, in which the least possible confounding factors are present. To fully establish the generality of this phenomenon, studies should be carried out in other pain models and using analgesic medications with different mechanisms of action.
MB: That would not establish the generality. There are already studies showing the opposite.

ARTICLE TITLE: Is it worth treating fever in intensive care unit patients? Preliminary results from a randomized trial of the effect of external cooling.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 8 2001, 161(1) p121-3
AUTHOR(S): Gozzoli V; Schottker P; Suter PM; Ricou B
AUTHOR'S ADDRESS: Division of Surgical Intensive Care, University Hospital of Geneva, CH-1211 Geneva 14-Switzerland.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: These results suggest that the systematic suppression of fever may not be useful in patients without severe cranial trauma or significant hypoxemia. Letting fever take its natural course does not seem to harm patients with systemic inflammatory response syndrome or influence the discomfort level and may save costs.
MB: How about just treating the cause.

ARTICLE TITLE: Anaphylaxis in the United States: an investigation into its epidemiology.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 8 2001, 161(1) p15-21
AUTHOR(S): Neugut AI; Ghatak AT; Miller RL
AUTHOR'S ADDRESS: Department of Medicine, College of Physicians and Surgeons, Columbia University, 630 W 168th St, Room PH18-127, New York, NY 10032, USA. ain1@columbia.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Multicase
CONCLUSION: The occurrence of anaphylaxis in the US is not as rare as is generally believed. On the basis of our figures, the problem of anaphylaxis may, in fact, affect 1.21% to 15.04% of the US population.

ARTICLE TITLE: Zanamivir for the treatment of influenza A and B infection in high-risk patients: a pooled analysis of randomized controlled trials.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 22 2001, 161(2) p212-7
AUTHOR(S): Lalezari J; Campion K; Keene O; Silagy C
AUTHOR'S ADDRESS: Quest Clinical Research, 2300 Sutter St, Suite 202, San Francisco, Calif 94115, USA. drjay@questclinical.com.
PUBLICATION TYPE: Journal Article; Meta-Analysis
RESULTS: Zanamivir-treated high-risk patients had a treatment benefit of 2.5 days compared with those given placebo (P = .015). Patients treated with zanamivir returned to normal activities 3.0 days earlier (P = .022) and had an 11% reduction (P = .039) in the median total symptom score over 1 to 5 days relative to those taking placebo. In addition, zanamivir reduced the incidence of complications requiring antibiotic use by 43% relative to placebo users (P = .045). Adverse events reported were of a similar nature and frequency between the two groups. CONCLUSION: This pooled analysis shows that zanamivir is an effective and well-tolerated treatment for influenza in patients considered at high-risk of developing influenza-related complications.

ARTICLE TITLE: Diabetes and all-cause and coronary heart disease mortality among US male physicians.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 22 2001, 161(2) p242-7
AUTHOR(S): Lotufo PA; Gaziano JM; Chae CU; Ajani UA; Moreno-John G; Buring JE; Manson JE
AUTHOR'S ADDRESS: Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass 02215-1204, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: These prospective data indicate that diabetes is associated with a substantial increase in all-cause and coronary heart disease (CHD mortality. For all-cause mortality, the magnitude of excess risk conferred by diabetes is similar to that conferred by a history of CHD; for mortality from CHD, a history of CHD is a more potent predictor of death. The presence of both diabetes and CHD, however, identifies a particularly high-risk group.
MB: How surprising.

ARTICLE TITLE: Poor recovery facilities put patients' lives at risk.
ARTICLE SOURCE: BMJ (England), Nov 25 2000, 321(7272) p1305
AUTHOR(S): Kmietowicz Z
PUBLICATION TYPE: News
MB: No high dependency is bad. That's us.

ARTICLE TITLE: "Is there a doctor on the aircraft?" Top 10 in-flight medical emergencies.
ARTICLE SOURCE: BMJ (England), Nov 25 2000, 321(7272) p1336-7
AUTHOR(S): Dowdall N
AUTHOR'S ADDRESS: British Airways Health Services, PO Box 365, Harmondsworth UP7 0GB. nigel.1.dowdall@BritishAirways.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: In-flight medical emergencies: an overview.
ARTICLE SOURCE: BMJ (England), Nov 25 2000, 321(7272) p1338-41
AUTHOR(S): Goodwin T
AUTHOR'S ADDRESS: Airport Medical Services, Forte Posthouse Hotel, Horley, Surrey RH6 0BA. amsgatwick@compuserve.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Cost effectiveness analysis of intravenous ketorolac and morphine for treating pain after limb injury: double blind randomised controlled trial.
COMMENTS: BMJ. 2000 Nov 18; 321(7271):1236-7/20534700
ARTICLE SOURCE: BMJ (England), Nov 18 2000, 321(7271) p1247-51
AUTHOR(S): Rainer TH; Jacobs P; Ng YC; Cheung NK; Tam M; Lam PK; Wong R; Cocks RA
AUTHOR'S ADDRESS: Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Rooms G05/06, Cancer Center, Prince of Wales Hospital, Shatin, NT, Hong Kong.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Intravenous ketorolac is a more cost effective analgesic than intravenous morphine in the management of isolated limb injury in an emergency department in Hong Kong, and its use may be considered as the dominant strategy.
MB: Why not try aspirin?

ARTICLE TITLE: Ketorolac versus morphine for severe pain. Ketorolac is more effective, cheaper, and has fewer side effects.
COMMENTS: BMJ. 2000 Nov 18; 321(7271):1247-51/20534715
ARTICLE SOURCE: BMJ (England), Nov 18 2000, 321(7271) p1236-7
AUTHOR(S): Jelinek GA
PUBLICATION TYPE: Comment; Journal Article
MEDLINE INDEXING DATE: 200101

ARTICLE TITLE: Families to sue over organ removals.
ARTICLE SOURCE: BMJ (England), Nov 18 2000, 321(7271) p1242
AUTHOR(S): Dyer C
PUBLICATION TYPE: News

ARTICLE TITLE: Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis.
COMMENTS: BMJ. 2000 Nov 11; 321(7270):1170-1/20525526
ARTICLE SOURCE: BMJ (England), Nov 11 2000, 321(7270) p1183-7
AUTHOR(S): Derry S; Loke YK
AUTHOR'S ADDRESS: Department of Clinical Pharmacology, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE.
PUBLICATION TYPE: Journal Article; Meta-Analysis
CONCLUSIONS: Long term therapy with aspirin is associated with a significant increase in the incidence of gastrointestinal haemorrhage. No evidence exists that reducing the dose or using modified release formulations would reduce the incidence of gastrointestinal haemorrhage.

ARTICLE TITLE: Taking heart failure seriously.
COMMENTS: BMJ. 2000 Nov 4; 321(7269):1113-6
ARTICLE SOURCE: BMJ (England), Nov 4 2000, 321(7269) p1095-6
AUTHOR(S): Cleland JG; Clark A; Caplin JL
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Spain tops the table for organ donation.
ARTICLE SOURCE: BMJ (England), Nov 4 2000, 321(7269) p1098
AUTHOR(S): Ferriman A
PUBLICATION TYPE: News
MB: Spain has 33.6 donors/million. Oz is the lowest with 10/million. UK &US are about 14/million.

ARTICLE TITLE: Lesson of the week: tracheal stenosis after intubation.
ARTICLE SOURCE: BMJ (England), Oct 21 2000, 321(7267) p1000-2
AUTHOR(S): Spittle N; McCluskey A
AUTHOR'S ADDRESS: Department of Anaesthesia, Hope Hospital, Salford M6 8HD.
PUBLICATION TYPE: Journal Article; Review; Review of Reported Cases

ARTICLE TITLE: Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture.
COMMENTS: BMJ. 2000 Oct 21; 321(7267):973-4
ARTICLE SOURCE: BMJ (England), Oct 21 2000, 321(7267) p986-90
AUTHOR(S): Thomas SR; Jamieson DR; Muir KW
AUTHOR'S ADDRESS: Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Atraumatic needles significantly reduced the incidence of moderate to severe headache and the need for medical interventions after diagnostic lumbar punctures, but they were associated with a higher failure rate than standard needles.

ARTICLE TITLE: Lesson of the week: postoperative pressure sores after epidural anaesthesia.
ARTICLE SOURCE: BMJ (England), Oct 14 2000, 321(7266) p941-2
AUTHOR(S): Shah JL
AUTHOR'S ADDRESS: Department of Anaesthetics, City Hospital, Birmingham B18 7QH. JantiShah@aol.com.
PUBLICATION TYPE: Journal Article )

ARTICLE TITLE: Data protection legislation: interpretation and barriers to research.
ARTICLE SOURCE: BMJ (England), Oct 7 2000, 321(7265) p890-2
AUTHOR(S): Strobl J; Cave E; Walley T
AUTHOR'S ADDRESS: Prescribing Research Group, Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool L69 3GE. strobl@liv.ac.uk.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Holy water not always a blessing.
ARTICLE SOURCE: BMJ (England), Jan 27 2001, 322(7280) p190
AUTHOR(S): Payne D
PUBLICATION TYPE: News
MB: They found green worms and a variety of bugs. One church removed the holy water when they found drug addicts washing their syringes.

ARTICLE TITLE: Sifting the evidence-what's wrong with significance tests?
COMMENTS: BMJ. 2001 Jan 27; 322(7280):232/21096612
ARTICLE SOURCE: BMJ (England), Jan 27 2001, 322(7280) p226-31
AUTHOR(S): Sterne JA; Smith GD
AUTHOR'S ADDRESS: Department of Social Medicine, University of Bristol, Bristol BS8 2PR. jonathan.sterne@bristol.ac.uk.
PUBLICATION TYPE: Historical Article; Journal Article; Review; Review, Tutorial
MB: Read full text.

ARTICLE TITLE: Hepatitis associated with Kava, a herbal remedy for anxiety.
ARTICLE SOURCE: BMJ (England), Jan 20 2001, 322(7279) p139
AUTHOR(S): Escher M; Desmeules J; Giostra E; Mentha G
AUTHOR'S ADDRESS: Division of Clinical Pharmacology and Toxicology, Geneva University Hospital, 1211 Geneva, Switzerland.
PUBLICATION TYPE: Journal Article
MB: It tastes like fine sand.

ARTICLE TITLE: Hospitals to spend 200m pounds sterling to prevent spread of vCJD ARTICLE SOURCE: BMJ (England), Jan 13 2001, 322(7278) p68
AUTHOR(S): Dyer O
PUBLICATION TYPE: News

ARTICLE TITLE: The NHS through American eyes.
ARTICLE SOURCE: BMJ (England), Dec 23-30 2000, 321(7276) p1545-6
AUTHOR(S): Leatherman S; Berwick DM
PUBLICATION TYPE: Editorial
MB: Not very realistic.

ARTICLE TITLE: Why are (male) surgeons still addressed as Mr?
ARTICLE SOURCE: BMJ (England), Dec 23-30 2000, 321(7276) p1589-91
AUTHOR(S): Loudon I
AUTHOR'S ADDRESS: The Mill House, Locks Lane, Wantage OX12 9EH. irvine.loudon@wuhmo.ox.ac.uk.
PUBLICATION TYPE: Historical Article; Journal Article

ARTICLE TITLE: Serial homicide by doctors: Shipman in perspective.
ARTICLE SOURCE: BMJ (England), Dec 23-30 2000, 321(7276) p1594-7
AUTHOR(S): Kinnell HG
AUTHOR'S ADDRESS: 18 Cross Street, Reading, Berkshire RG1 1SN.
PUBLICATION TYPE: Historical Article; Journal Article
MB: There have been several others.

ARTICLE TITLE: Operations: spinal versus general anaesthetics- a patient's view.
ARTICLE SOURCE: BMJ (England), Dec 23-30 2000, 321(7276) p1606-7
AUTHOR(S): Stern V
AUTHOR'S ADDRESS: 30 Goldhurst Terrace, London NW6 3HU, UK. vivien.stern.bushinternet.com.
PUBLICATION TYPE: Journal Article
MB: The author wanted a spinal.

ARTICLE TITLE: Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials.
ARTICLE SOURCE: BMJ (England), Dec 16 2000, 321(7275) p1493
AUTHOR(S): Rodgers A; Walker N; Schug S; McKee A; Kehlet H; van Zundert A; Sage D; Futter M; Saville G; Clark T; MacMahon S
AUTHOR'S ADDRESS: Clinical Trials Research Unit, Department of Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: OBJECTIVES: To obtain reliable estimates of the effects of neuraxial blockade with epidural or spinal anaesthesia on postoperative morbidity and mortality. DESIGN: Systematic review of all trials with randomisation to intraoperative neuraxial blockade or not. STUDIES: 141 trials including 9559 patients for which data were available before 1 January 1997. Trials were eligible irrespective of their primary aims, concomitant use of general anaesthesia, publication status, or language. Trials were identified by extensive search methods, and substantial amounts of data were obtained or confirmed by correspondence with trialists. MAIN OUTCOME MEASURES: All cause mortality, deep vein thrombosis, pulmonary embolism, myocardial infarction, transfusion requirements, pneumonia, other infections, respiratory depression, and renal failure. RESULTS: Overall mortality was reduced by about a third in patients allocated to neuraxial blockade (103 deaths/4871 patients versus 144/4688 patients, odds ratio=0.70, 95% confidence interval 0.54 to 0.90, P=0. 006). Neuraxial blockade reduced the odds of deep vein thrombosis by 44%, pulmonary embolism by 55%, transfusion requirements by 50%, pneumonia by 39%, and respiratory depression by 59% (all P<0.001). There were also reductions in myocardial infarction and renal failure. Although there was limited power to assess subgroup effects, the proportional reductions in mortality did not clearly differ by surgical group, type of blockade (epidural or spinal), or in those trials in which neuraxial blockade was combined with general anaesthesia compared with trials in which neuraxial blockade was used alone. CONCLUSIONS: Neuraxial blockade reduces postoperative mortality and other serious complications. The size of some of these benefits remains uncertain, and further research is required to determine whether these effects are due solely to benefits of neuraxial blockade or partly to avoidance of general anaesthesia. Nevertheless, these findings support more widespread use of neuraxial blockade.

ARTICLE TITLE: Presence of relatives during testing for brain stem death: questionnaire study.
ARTICLE SOURCE: BMJ (England), Dec 16 2000, 321(7275) p1505-6
AUTHOR(S): Pugh J; Clarke L; Gray J; Haveman J; Lawler P; Bonner S
AUTHOR'S ADDRESS: Intensive Care Unit, South Cleveland Hospital, Middlesbrough TS4 3BW, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effect of multifaceted intervention promoting early switch from intravenous to oral acetaminophen for postoperative pain: controlled, prospective, before and after study.
COMMENTS: BMJ. 2000 Dec 9; 321(7274):1428/20564025
ARTICLE SOURCE: BMJ (England), Dec 9 2000, 321(7274) p1460-3
AUTHOR(S): Ripouteau C; Conort O; Lamas JP; Auleley GR; Hazebroucq G; Durieux P
AUTHOR'S ADDRESS: Department of Pharmacy, Hopital Cochin, 27, rue du Faubourg Saint-Jacques, 75006 Paris, France.
PUBLICATION TYPE: Clinical Trial; Controlled Clinical Trial; Journal Article
MB: Abstract sounded pretty useless.

ARTICLE TITLE: Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: clinical effectiveness.
COMMENTS: BMJ. 2000 Dec 2; 321(7273):1362-3/20551184
ARTICLE SOURCE: BMJ (England), Dec 2 2000, 321(7273) p1383-8
AUTHOR(S): Ward E; King M; Lloyd M; Bower P; Sibbald B; Farrelly S; Gabbay M; Tarrier N; Addington-Hall J
AUTHOR'S ADDRESS: Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, University College London, London NW3 2PF, UK.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: Psychological therapy was a more effective treatment for depression than usual general practitioner care in the short term, but after one year there was no difference in outcome.

ARTICLE TITLE: Wider lessons of the pulmonary artery catheter trial.
ARTICLE SOURCE: BMJ (England), Feb 24 2001, 322(7284) p446
AUTHOR(S): Angus D; Black N
PUBLICATION TYPE: Editorial
MB: They are doing a 6000 trial but participants will not be blinded.

ARTICLE TITLE: Lesson of the week: Splenic trauma complicating cardiopulmonary resuscitation.
ARTICLE SOURCE: BMJ (England), Feb 24 2001, 322(7284) p480-1
AUTHOR(S): Fitchet A; Neal R; Bannister P
AUTHOR'S ADDRESS: Manchester Heart Centre, Manchester Royal Infirmary, Manchester M13 9WL, UK. Alan. Fitchet@mhc.cmht.nwest.nhs.uk.

ARTICLE TITLE: Drug company fined for excessive hospitality.
ARTICLE SOURCE: BMJ (England), Feb 17 2001, 322(7283) p382
AUTHOR(S): Sheldon T
PUBLICATION TYPE: News

ARTICLE TITLE: Fury as Australia appoints former industry lobbyist to drugs watchdog.
ARTICLE SOURCE: BMJ (England), Feb 17 2001, 322(7283) p383
AUTHOR(S): Zinn C
PUBLICATION TYPE: News

ARTICLE TITLE: Wellbeing of gay, lesbian, and bisexual doctors.
ARTICLE SOURCE: BMJ (England), Feb 17 2001, 322(7283) p422-5
AUTHOR(S): Burke BP; White JC
AUTHOR'S ADDRESS: Legacy Clinic Northwest, 1130 NW 22nd Ave, Suite 220, Portland, OR 97210, USA. bburke@lhs.org.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: What have we learnt from the Alder Hey affair? That monitoring physicians' performance is necessary to ensure good practice.
COMMENTS: BMJ. 2001 Feb 10; 322(7282):320/21096672
ARTICLE SOURCE: BMJ (England), Feb 10 2001, 322(7282) p309-10
AUTHOR(S): Bauchner H; Vinci R
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: GMC suspends former Alder Hey pathologist.
ARTICLE SOURCE: BMJ (England), Feb 10 2001, 322(7282) p320
AUTHOR(S): Hunter M
PUBLICATION TYPE: News

ARTICLE TITLE: Alder Hey report condemns doctors, management, and coroner.
ARTICLE SOURCE: BMJ (England), Feb 3 2001, 322(7281) p255
AUTHOR(S): Hunter M
PUBLICATION TYPE: News

ARTICLE TITLE: Tissue samples often retained without informed consent.
COMMENTS: BMJ. 2001 Feb 10; 322(7282):309-10/21096658
ARTICLE SOURCE: BMJ (England), Feb 10 2001, 322(7282) p320
AUTHOR(S): Hunter M
AUTHOR'S ADDRESS: Leeds.
INDEXING CHECK TAG(S): Human

ARTICLE TITLE: Ethical issues in diagnosis and management of patients in the permanent vegetative state.
ARTICLE SOURCE: BMJ (England), Feb 10 2001, 322(7282) p352-4
AUTHOR(S): Wade DT
AUTHOR'S ADDRESS: Rivermead Rehabilitation Centre, Oxford OX1 4XD. derick.wade@dial.pipex.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Doctors suspended after injecting wrong drug into spine.
ARTICLE SOURCE: BMJ (England), Feb 3 2001, 322(7281) p257
AUTHOR(S): Dyer C
PUBLICATION TYPE: News

ARTICLE TITLE: Not again!.
ARTICLE SOURCE: BMJ (England), Feb 3 2001, 322(7281) p247-8
AUTHOR(S): Berwick DM
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Are "tomorrow's doctors" honest? Questionnaire study exploring medical students' attitudes and reported behaviour on academic misconduct.
COMMENTS: BMJ. 2001 Feb 3; 322(7281):250-1/21096616
ARTICLE SOURCE: BMJ (England), Feb 3 2001, 322(7281) p274-5
AUTHOR(S): Rennie SC; Crosby JR
AUTHOR'S ADDRESS: Dundee University Medical School, Curriculum Office, Ninewells Hospital and Medical School, Dundee DD1 9SY.
PUBLICATION TYPE: Journal Article
MB: What about today's and yesterday's?

ARTICLE TITLE: Cheating at medical school.
COMMENTS: BMJ. 2001 Feb 3; 322(7281):274-5/21096633
ARTICLE SOURCE: BMJ (England), Feb 3 2001, 322(7281) p250-1
AUTHOR(S): Glick SM
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Acute hyponatraemia in children admitted to hospital: retrospective analysis of factors contributing to its development and resolution
ARTICLE SOURCE: BMJ (England), Mar 31 2001, 322(7289) p780-2
AUTHOR(S): Halberthal M; Halperin ML; Bohn D
AUTHOR'S ADDRESS: Department of Critical Care Medicine, Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Thromboprophylaxis after replacement arthroplasty. Anticoagulants are more effective than aspirin ARTICLE SOURCE: BMJ (England), Mar 24 2001, 322(7288) p686-7
AUTHOR(S): Thomas DP
AUTHOR'S ADDRESS: The Old Barn, North Green, Kirtlington, Oxford OX5 3JZ (dpt@patrol.i-way.co.uk).
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Sex differences in speed of emergence and quality of recovery after anaesthesia: cohort study ARTICLE SOURCE: BMJ (England), Mar 24 2001, 322(7288) p710-1
AUTHOR(S): Myles PS; McLeod AD; Hunt JO; Fletcher H
AUTHOR'S ADDRESS: Department of Anaesthesia and Pain Management, Alfred Hospital, Prahran, Victoria 3181, Australia.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Book: hitler's gift: scientists who fled nazi germany
ARTICLE SOURCE: BMJ (England), Mar 17 2001, 322(7287) p681
AUTHOR(S): Paton A
AUTHOR'S ADDRESS: Oxfordshire.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Medical errors: a common problem. It is time to get serious about them
ARTICLE SOURCE: BMJ (England), Mar 3 2001, 322(7285) p501-2
AUTHOR(S): Alberti KG
AUTHOR'S ADDRESS: Royal College of Physicians of London, London NW1 4LE.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Adverse events in British hospitals: preliminary retrospective record review
ARTICLE SOURCE: BMJ (England), Mar 3 2001, 322(7285) p517-9
AUTHOR(S): Vincent C; Neale G; Woloshynowych M
AUTHOR'S ADDRESS: Clinical Risk Unit, Department of Psychology, University College London, London WC1E 6BT.
PUBLICATION TYPE: Journal Article
ABSTRACT: Objectives: To examine the feasibility of detecting adverse events through record review in British hospitals and to make preliminary estimates of the incidence and costs of adverse events. Design: Retrospective review of 1014 medical and nursing records. Setting: Two acute hospitals in Greater London area. Main outcome measure: Number of adverse events. Results: 110 (10.8%) patients experienced an adverse event, with an overall rate of adverse events of 11.7% when multiple adverse events were included. About half of these events were judged preventable with ordinary standards of care. A third of adverse events led to moderate or greater disability or death. Conclusions: These results suggest that adverse events are a serious source of harm to patients and a large drain on NHS resources. Some are major events; others are frequent, minor events that go unnoticed in routine clinical care but together have massive economic consequences.
MB: A massive problem.

ARTICLE TITLE: Press: Blunders will never cease; How the media report medical error; A risky business
ARTICLE SOURCE: BMJ (England), Mar 3 2001, 322(7285) p562
AUTHOR(S): Jackson T
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Blood pressure measuring devices: recommendations of the European Society of Hypertension
ARTICLE SOURCE: BMJ (England), Mar 3 2001, 322(7285) p531-6
AUTHOR(S): O'Brien E; Waeber B; Parati G; Staessen J; Myers MG
AUTHOR'S ADDRESS: Blood Pressure Unit, Beaumont Hospital, Dublin 9, Ireland.
PUBLICATION TYPE: Journal Article
MB: I doubt that our automatic devices fulfil requirements.

ARTICLE TITLE: Blood pressure measurement is changing!.
ARTICLE SOURCE: Heart (England), Jan 2001, 85(1) p3-5
AUTHOR(S): O'Brien E
PUBLICATION TYPE: Editorial
MB: Continuous devices are replacing individual measurements.

ARTICLE TITLE: Spironolactone for heart failure: spiraling out of control.
ARTICLE SOURCE: Chest (United States), Dec 2000, 118(6) p1522-3
AUTHOR(S): Geraci JM; Knowlton AA
PUBLICATION TYPE: Editorial
MB: They suggest caution & continuation of other treatment. I wonder what they would recommend if the sprinolactone trial had been done first.

ARTICLE TITLE: Serious adverse events experienced by patients with chronic heart failure taking spironolactone
ARTICLE SOURCE: Heart (England), Apr 2001, 85(4) pE8
AUTHOR(S): Berry C; McMurray JJ
AUTHOR'S ADDRESS: Department of Cardiology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: In patients with chronic heart failure, spironolactone added to conventional treatment may lead to serious and, occasionally, fatal hyperkalaemia. In some cases this seems to happen because spironolactone causes diarrhoea. Four cases involving men with New York Heart Association functional class III heart failure are presented. As these cases revealed, close monitoring of blood chemistry is mandatory after starting spironolactone, and patients should be advised to stop spironolactone immediately if diarrhoea develops.

ARTICLE TITLE: Does an IV bolus of methylprednisolone relieve dyspnea in asthma exacerbations?
ARTICLE SOURCE: Chest (United States), Dec 2000, 118(6) p1530-7
AUTHOR(S): Noseda A; De Bruyne I; De Maertelaer V; Yernault JC
AUTHOR'S ADDRESS: Pulmonary Division, Department of Internal Medicine, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
PATIENTS: Twenty-five asthma patients attending the chest clinic with spontaneous complaints of increases in dyspnea and with a Borg scale dyspnea rating >/= 1 at rest. CONCLUSIONS: We conclude that in patients with an exacerbation of asthma, an IV bolus of methylprednisolone does not reduce dyspnea more than saline solution after 5 min and 60 min.
MB: I have been badgering respiratory physicians to do such studies since the 1960s..

ARTICLE TITLE: Morbid results of prolonged intubation after coronary artery bypass surgery.
ARTICLE SOURCE: Chest (United States), Dec 2000, 118(6) p1724-31
AUTHOR(S): Cohen AJ; Katz MG; Frenkel G; Medalion B; Geva D; Schachner A
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Israel. sally@wolfson.health.gov.il.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Patients undergoing coronary artery bypass grafting (CABG with reduced FEV(1), renal failure, and positive fluid balance 24 h postoperatively are at risk for prolonged intubation. Prolonged intubation results in significant acute and midterm morbidity and mortality. Early extubation followed by reintubation further increases morbidity and mortality rates in these patients.
MB: This is fairly obvious. If they are still intubated at 24hrs they will do less well. If extubated too early they will do worse still.

ARTICLE TITLE: Performance of APACHE III models in an Australian ICU.
ARTICLE SOURCE: Chest (United States), Dec 2000, 118(6) p1732-8
AUTHOR(S): Cook DA
AUTHOR'S ADDRESS: Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, Australia. d.cook@mailbox.uq.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSION: In contrast to other non-American studies, this Australian study demonstrates that the APACHE (acute physiology and chronic health evaluation III can perform well on independent assessment. As perfect discrimination and calibration cannot coexist in a probabilistic model with dichotomous outcomes, performance of APACHE III models with proprietary adjustment for hospital characteristic provide a good compromise for use in quality surveillance.
MB: This is nonsense. How can hospitals be standardised to calibrate the test?

ARTICLE TITLE: Progressive portopulmonary hypertension after liver transplantation treated with epoprostenol.
ARTICLE SOURCE: Chest (United States), Nov 2000, 118(5) p1497-500
AUTHOR(S): Rafanan AL; Maurer J; Mehta AC; Schilz R
AUTHOR'S ADDRESS: Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, OH 44195, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients.
COMMENTS: Chest. 2000 Nov; 118(5):1236-8/20536285
ARTICLE SOURCE: Chest (United States), Nov 2000, 118(5) p1412-8
AUTHOR(S): Freeman BD; Isabella K; Lin N; Buchman TG
AUTHOR'S ADDRESS: Department of Surgery, Section of Burn, Trauma, Surgical Critical Care, Washington University School of Medicine, St. Louis, MO 63110, USA. freemanb@msnotes.wustl.edu.
PUBLICATION TYPE: Journal Article; Meta-Analysis
Our meta-analysis of these studies suggests potential advantages of percutaneous dilational tracheostomy (PDT) relative to surgical tracheostomy, including ease of performance, and lower incidence of peristomal bleeding and postoperative infection. If confirmed by additional, adequately powered prospective trials, these findings support PDT as the procedure of choice for the establishment of elective tracheostomy in the appropriately selected critically ill patient.
MB: Success is more likely to be reported.

ARTICLE TITLE: Barbara, what's a nice girl like you doing writing an article like this? : the scientific basis of folk remedies for colds and flu.
COMMENTS: Chest. 2000 Oct; 118(4):1150-7/20490290
ARTICLE SOURCE: Chest (United States), Oct 2000, 118(4) p887-8
AUTHOR(S): Bender BS
PUBLICATION TYPE: Comment; Editorial; Review; Review, Tutorial
MB: Chicken soup is good for colds in vitro.

ARTICLE TITLE: Adrenal insufficiency in high-risk surgical ICU patients
ARTICLE SOURCE: Chest (United States), Mar 2001, 119(3) p889-96
AUTHOR(S): Rivers EP; Gaspari M; Saad GA; Mlynarek M; Fath J; Horst HM; Wortsman J
AUTHOR'S ADDRESS: Department of Surgery, Henry Ford Hospital, Case Western Reserve University, Detroit, MI 48202, USA. erivers1@hfhs.org.
PUBLICATION TYPE: Journal Article
CONCLUSION: There is a high incidence of adrenal insufficiency (AI) among surgical ICU patients > 55 years of age with postoperative hypotension requiring vasopressors. There is also a significant association between hydrocortisone replacement therapy, resolution of vasopressor requirements, and improved survival.

ARTICLE TITLE: Reality-based medicine-the response
ARTICLE SOURCE: Chest (United States), Mar 2001, 119(3) p992-3
AUTHOR(S): Noppen M
AUTHOR'S ADDRESS: Respiratory Division, Academic Hospital Brussels, Belgium.
PUBLICATION TYPE: Journal Article
MB: Asthma patients don't know how to sue inhalers.

ARTICLE TITLE: Predictability of oxygen desaturation during sleep in patients with cystic fibrosis : clinical, spirometric, and exercise parameters
ARTICLE SOURCE: Chest (United States), Feb 2001, 119(2) p434-41
AUTHOR(S): Frangolias DD; Wilcox PG
AUTHOR'S ADDRESS: Pulmonary Research Laboratory, University of British Columbia, Vancouver, BC, Canada.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Spirometric parameters and measurements of awake resting oxygenation are of limited utility in predicting nocturnal desaturation. Nocturnal oximetry should be considered in patients with moderate to severe lung disease even with preserved awake resting SpO(2).

ARTICLE TITLE: Sleep apnea : a global perspective.
COMMENTS: Chest. 2001 Jan; 119(1):62-9/21097835
ARTICLE SOURCE: Chest (United States), Jan 2001, 119(1) p4-5
AUTHOR(S): Loube D
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: The sixth (2000) ACCP guidelines for antithrombotic therapy for prevention and treatment of thrombosis. American College of Chest Physicians [In Process Citation]
ARTICLE SOURCE: Chest (United States), Jan 2001, 119(1 Suppl) p1S-2S
AUTHOR(S): Hirsh J; Dalen J; Guyatt G
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Etiology of acute pulmonary edema during liver transplantation : a series of cases with analysis of the edema fluid.
ARTICLE SOURCE: Chest (United States), Jan 2001, 119(1) p219-23
AUTHOR(S): Yost CS; Matthay MA; Gropper MA
AUTHOR'S ADDRESS: Department of Anesthesia and Perioperative Care, Herbert C. Moffitt Hospital, University of California, San Francisco, CA 94143, USA. spyost@itsa.ucsf.edu.
PUBLICATION TYPE: Journal Article
.CONCLUSIONS: The most likely cause of the reaction is transfusion-related acute lung injury (TRALI). An incidence of TRALI that is higher than previously reported in this population indicates that other elements, such as reperfusion of the newly implanted liver, may be contributing factors.
MB: I can't imagine how they could come to any conclusion about causation. We have not seen such a syndrome.

ARTICLE TITLE: Prevention of contrast nephropathy after cardiac catheterisation
ARTICLE SOURCE: Heart (England), Apr 2001, 85(4) p361-2
AUTHOR(S): Baker CS; Baker LR
AUTHOR'S ADDRESS: Department of Cardiology London Chest Hospital Bonner Road London E2 9BJ, UK cbaker6751@aol.com.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effect of surgical training on outcome and hospital costs in coronary surgery [In Process Citation]
ARTICLE SOURCE: Heart (England), Apr 2001, 85(4) p454-7
AUTHOR(S): Goodwin AT; Birdi I; Ramesh TP; Taylor GJ; Nashef SA; Dunning JJ; Large SR
AUTHOR'S ADDRESS: Department of Cardiothoracic Surgery and Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Trainees performed 44.4% of all coronary artery bypass (CABG) operations. There was no detrimental effect on patient outcome, length of hospital stay, or overall hospital costs. There need be little conflict between service and training needs, even in hospitals with extensive training programmes.

ARTICLE TITLE: Pulmonary arterial hypertension: new ideas and perspectives
ARTICLE SOURCE: Heart (England), Apr 2001, 85(4) p475-80
AUTHOR(S): Galie N; Torbicki A
AUTHOR'S ADDRESS: Institute of Cardiology, University of Bologna, Italy.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Who should take aspirin for primary prophylaxis of coronary heart disease? [In Process Citation]
ARTICLE SOURCE: Heart (England), Mar 2001, 85(3) p245-6
AUTHOR(S): Lowe GD
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Aspirin for primary prevention of coronary heart disease: safety and absolute benefit related to coronary risk derived from meta-analysis of randomised trials
ARTICLE SOURCE: Heart (England), Mar 2001, 85(3) p265-71
AUTHOR(S): Sanmuganathan PS; Ghahramani P; Jackson PR; Wallis EJ; Ramsay LE
AUTHOR'S ADDRESS: Clinical Pharmacology and Therapeutics, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Aspirin treatment for primary prevention is safe and worthwhile at coronary event risk >/= 1.5%/year; safe but of limited value at coronary risk 1%/year; and unsafe at coronary event risk 0.5%/year. Advice on aspirin for primary prevention requires formal accurate estimation of absolute coronary event risk.

ARTICLE TITLE: Should we give antibiotic prophylaxis against infective endocarditis in all cardiac patients, whatever the type of dental treatment?
ARTICLE SOURCE: Heart (England), Jan 2001, 85(1) p9-10
AUTHOR(S): Delahaye F; De Gevigney G
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Three dimensional echocardiography for the assessment of mitral valve disease.
ARTICLE SOURCE: Heart (England), Nov 2000, 84 Suppl 2 pII7-10
AUTHOR(S): Sutaria N; Northridge D; Masani N; Pandian N
AUTHOR'S ADDRESS: Department of Cardiology, Western General Hospital, Edinburgh, UK. N.Sutaria@ed.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: A survey of sedation and monitoring practices during transoesophageal echocardiography in the UK: are recommended guidelines being followed?
ARTICLE SOURCE: Heart (England), Nov 2000, 84 Suppl 2 pII19
AUTHOR(S): Sutaria N; Northridge D; Denvir M
AUTHOR'S ADDRESS: Department of Cardiology Western General Hospital Crewe Road, Edinburgh EH4 2XU,UK. N.Sutaria@ed.ac.uk.
PUBLICATION TYPE: Journal Article; Multicenter Study
MB: They are skating on thin ice. It would be particularly dangerous sedating cardiac patients.

ARTICLE TITLE: Stent magic! The genie has escaped from the bottle.
COMMENTS: Heart. 2000 Nov; 84(5):522-8
ARTICLE SOURCE: Heart (England), Nov 2000, 84(5) p469-70
AUTHOR(S): Karsch KR; Newby AC
PUBLICATION TYPE: Comment; Editorial; Review; Review, Tutorial

ARTICLE TITLE: Prevention of commotio cordis in baseball: an evaluation of chest protectors.
ARTICLE SOURCE: J Trauma (United States), Dec 2000, 49(6) p1023-8
AUTHOR(S): Viano DC; Bir CA; Cheney AK; Janda DH
AUTHOR'S ADDRESS: Institute for Preventative Sport Medicine, Ann Arbor, Michigan, USA. david.viano@GM.com.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The majority of commercially available chest protectors fail to provide consistent reductions in commotio cordis risk. Nonetheless, there are benefits from their use in baseball until improved safety equipment is developed and standard tests are established to assess sport equipment effectiveness.
MB: How about giving up baseball?

ARTICLE TITLE: Prehospital intubation in patients with severe head injury.
ARTICLE SOURCE: J Trauma (United States), Dec 2000, 49(6) p1065-70
AUTHOR(S): Murray JA; Demetriades D; Berne TV; Stratton SJ; Cryer HG; Bongard F; Fleming A; Gaspard D
AUTHOR'S ADDRESS: Department of Surgery, Los Angeles County, University of Southern California Medical Center, Los Angeles County Department of Health Services, 90033, USA. jamurray@hsc.usc.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: For patients with severe head injury, prehospital intubation did not demonstrate an improvement in survival. Further prospective randomized trials are necessary to confirm these results.

ARTICLE TITLE: Nitroprusside in resuscitation of major torso trauma.
ARTICLE SOURCE: J Trauma (United States), Dec 2000, 49(6) p1089-95
AUTHOR(S): McKinley BA; Marvin RG; Cocanour CS; Pousman RM; Ware DN; Moore FA
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Texas-Houston Medical School, 77030, USA. Bruce.A.McKinley@uth.tmc.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: During aggressive shock resuscitation, control of mean arterial pressure (MAP) using nitroprusside is feasible and is associated with a favorable resuscitation response. Nitroprusside may be a useful adjunct during shock resuscitation of major torso trauma (MTT) as a vasoactive agent that promotes peripheral tissue perfusion.
MB: This is about post-operative therapy.

ARTICLE TITLE: Firearm availability and homicide rates across 26 high-income countries.
ARTICLE SOURCE: J Trauma (United States), Dec 2000, 49(6) p985-8
AUTHOR(S): Hemenway D; Miller M
AUTHOR'S ADDRESS: Harvard Injury Control Research Center, Harvard School of Public Health, Boston, Massachusetts 02115, USA. hemenway@hsph.harvard.edu.
PUBLICATION TYPE: Journal Article
RESULTS: In simple regressions (no control variables) across 26 high-income nations, there is a strong and statistically significant association between gun availability and homicide rates..

ARTICLE TITLE: Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days.
ARTICLE SOURCE: J Trauma (United States), Nov 2000, 49(5) p822-32
AUTHOR(S): Kirton OC; O'Neill PA; Kestner M; Tortella BJ
AUTHOR'S ADDRESS: University of Miami, Jackson Memorial Medical Center, Florida, USA. okirton@harthosp.org.
PUBLICATION TYPE: Clinical Trial; Multicenter Study; Randomized Controlled Trial
CONCLUSION: High-risk patients with colon or other hollow viscus injuries from penetrating abdominal trauma are at no greater risk for surgical-site or nonsurgical-site infection when treated with only a 24-hour course of a broad-spectrum antibiotic.

ARTICLE TITLE: Positioning of a double-lumen endobronchial tube without the aid of any instruments: an implication for emergency management.
ARTICLE SOURCE: J Trauma (United States), Nov 2000, 49(5) p899-902
AUTHOR(S): Bahk JH; Lim YJ; Kim CS
AUTHOR'S ADDRESS: Department of Anesthesiology and Clinical Research Institute, Seoul National University Hospital, Korea. bahkjh@plaza.snu.ac.kr.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: This method, which requires no specific instrument and no time-consuming technique, can be taught easily and may be used in a situation where the rapidity of lung isolation or collapse is the key to saving life. We conclude that this blind method can be an alternative to the fiberoptic bronchoscope (FOB) and/or auscultation for the positioning of double-lumen tube (DLT) in an emergency situation.
MB: They were using a laryngoscope etc but not a tube without a carinal hook. They blew up the bronchial cuff and then pulled the tube back slowly squeezing the pilot tube till the pressure suddenly dropped. They then pushed the tube back 1.5 cms and reinflated the cuff.

ARTICLE TITLE: Injury in America: the role of alcohol and other drugs--an EAST position paper prepared by the Injury Control and Violence Prevention Committee
ARTICLE SOURCE: J Trauma (United States), Jan 2001, 50(1) p1-12
AUTHOR(S): Soderstrom CA; Cole FJ; Porter JM
AUTHOR'S ADDRESS: Division of Traumatology, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA. csoderstrom@umm.edu.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The impact of major in-hospital complications on functional outcome and quality of life after trauma ARTICLE SOURCE: J Trauma (United States), Jan 2001, 50(1) p91-5
AUTHOR(S): Holbrook TL; Hoyt DB; Anderson JP
AUTHOR'S ADDRESS: Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0073, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Resuscitation with a blood substitute abrogates pathologic postinjury neutrophil cytotoxic function ARTICLE SOURCE: J Trauma (United States), Mar 2001, 50(3) p449-56
AUTHOR(S): Johnson JL; Moore EE; Offner PJ; Partrick DA; Tamura DY; Zallen G; Silliman CC
AUTHOR'S ADDRESS: Department of Surgery, Denver Health Medical Center (J.L.J., E.E.M., P.J.O., D.A.P., D.Y.T., G.Z.), and the Bonfils Blood Center and the Department of Pediatrics (C.C.S.), University of Colorado Health Sciences Center, Denver, Colorado.
PUBLICATION TYPE: Journal Article
METHODS: Injured patients requiring urgent transfusion were given either PolyHeme (up to 20 units) or packed red blood cells [PRBCs]. Early postinjury PMN priming was measured via beta-2 integrin expression, superoxide production, and elastase release. RESULTS: Treatment groups were comparable with respect to extent of injury and early physiologic compromise. priming of circulating neutrophils (PMNs ) from patients resuscitated with PRBCs showed priming in the early postinjury period by all three measures. No such priming was evident in patients resuscitated with PolyHeme. CONCLUSION: The use of a blood substitute in the early postinjury period avoids PMN priming and may thereby provide an avenue to decrease the incidence or severity of postinjury multiple organ failure.
MB: & it may not.

ARTICLE TITLE: Outcome analysis of Pennsylvania trauma centers: factors predictive of nonsurvival in seriously injured patients
ARTICLE SOURCE: J Trauma (United States), Mar 2001, 50(3) p465-74
AUTHOR(S): Pasquale MD; Peitzman AB; Bednarski J; Wasser TE
AUTHOR'S ADDRESS: Department of Surgery, Lehigh Valley Hospital, Allentown, Pennsylvania, USA.
PUBLICATION TYPE: Journal Article
CONCLUSION: In this analysis, only volume of patients treated had a direct impact on survival outcome. Accreditation, regardless of level, appears to be beneficial.

ARTICLE TITLE: A fifth amendment for the Declaration of Helsinki.
ARTICLE SOURCE: Lancet (England), Sep 30 2000, 356(9236) p1123
PUBLICATION TYPE: Editorial
MB: It is critical of the process of making the declaration.

ARTICLE TITLE: US doctor pleads guilty to murdering patients.
ARTICLE SOURCE: Lancet (England), Sep 16 2000, 356(9234) p1010
AUTHOR(S): McCarthy M
PUBLICATION TYPE: News
MB: The doctor had killed over 12 patients in places in the US & Zimbabwe.

ARTICLE TITLE: The idea is more important than the experiment.
ARTICLE SOURCE: Lancet (England), Sep 9 2000, 356(9233) p934-7
AUTHOR(S): Martin J
AUTHOR'S ADDRESS: Department of Medicine, University College London, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Risk of asthma in children with exposure to mite and cat allergens.
COMMENTS: Lancet. 2000 Oct 21; 356(9239):1375-83
ARTICLE SOURCE: Lancet (England), Oct 21 2000, 356(9239) p1369-70
AUTHOR(S): Grad R
AUTHOR'S ADDRESS: Department of Pediatrics, University of Alabama School of Medicine, Birmingham 35233, USA.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study. Multicentre Allergy Study Group.
COMMENTS: Lancet. 2000 Oct 21; 356(9239):1368-9
ARTICLE SOURCE: Lancet (England), Oct 21 2000, 356(9239) p1392-7
AUTHOR(S): Lau S; Illi S; Sommerfeld C; Niggemann B; Bergmann R; von Mutius E; Wahn U
AUTHOR'S ADDRESS: Department of Paediatric Pneumology and Immunology, Humboldt University, Berlin, Germany.
PUBLICATION TYPE: Journal Article; Multicenter Study
INTERPRETATION: Our data do not support the hypothesis that exposure to environmental allergens causes asthma in childhood, but rather that the induction of specific IgE responses and the development of childhood asthma are determined by independent factors.

ARTICLE TITLE: Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group.
COMMENTS: Lancet. 2000 Oct 21; 356(9239):1369-70
ARTICLE SOURCE: Lancet (England), Oct 21 2000, 356(9239) p1375-83
AUTHOR(S): Hannah ME; Hannah WJ; Hewson SA; Hodnett ED; Saigal S; Willan AR
AUTHOR'S ADDRESS: Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. mary.hannah@utoronto.ca.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
INTERPRETATION: Planned caesarean section is better than planned vaginal birth for the term fetus in the breech presentation; serious maternal complications are similar between the groups.

ARTICLE TITLE: Coronary heart disease mortality among Arab and Jewish residents of Jerusalem.
ARTICLE SOURCE: Lancet (England), Oct 21 2000, 356(9239) p1410-1
AUTHOR(S): Kark JD; Gordon ES; Haklai Z
PUBLICATION TYPE: Letter
ABSTRACT: Information on coronary heart disease (CHD) in the Palestinian population is sparse. We compared mortality rates in the largely Palestinian Arab population of Jerusalem with the Jewish population of the district between 1984 and 1997 based on official Israeli statistics. CHD mortality and all-cause mortality rates were significantly higher among Arab residents than among Jewish residents aged 35-74 years. Whether the excess CHD mortality reflects increased incidence of events, higher case fatality, or both remains to be established. Possible explanations include a higher prevalence of conventional risk factors such as diabetes, obesity, and smoking in Palestinians, stress effects related to the complex political situation and socioeconomic inequalities, and suspected differences in medical care.
MB: I think the last suggestion is the most likely. You would probably find the same in Sydney.

ARTICLE TITLE: Phage therapy--advantages over antibiotics?
ARTICLE SOURCE: Lancet (England), Oct 21 2000, 356(9239) p1418
AUTHOR(S): Pirisi A
PUBLICATION TYPE: News

ARTICLE TITLE: All change at the top of the national health service.
ARTICLE SOURCE: Lancet (England), Oct 21 2000, 356(9239) p1419
AUTHOR(S): Dean M
PUBLICATION TYPE: News
MB: Changes at the top are hardly going to fix the problems of 53y of central control.

ARTICLE TITLE: Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.
COMMENTS: Lancet. 2000 Oct 14; 356(9238):1290-1
ARTICLE SOURCE: Lancet (England), Oct 14 2000, 356(9238) p1307-12
AUTHOR(S): Pittet D; Hugonnet S; Harbarth S; Mourouga P; Sauvan V; Touveneau S; Perneger TV
AUTHOR'S ADDRESS: Department of Internal Medicine, University of Geneva Hospitals, and Institute of Social and Preventive Medicine, University of Geneva, Switzerland. didier.pittet@hcuge.ch.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study
METHODS: We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. INTERPRETATION: The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.

ARTICLE TITLE: Clean hands closer to the bedside.
COMMENTS: Lancet. 2000 Oct 14; 356(9238):1307-12
ARTICLE SOURCE: Lancet (England), Oct 14 2000, 356(9238) p1290-1
AUTHOR(S): Vandenbroucke-Grauls CM
AUTHOR'S ADDRESS: Department of Medical Microbiology and Infection Control, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Helium/oxygen and severe COPD.
ARTICLE SOURCE: Lancet (England), Nov 25 2000, 356(9244) p1785-6
AUTHOR(S): Morice AH
AUTHOR'S ADDRESS: Academic Department of Medicine, Castle Hill Hospital, Cottingham, East Yorkshire, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Physics and biology of mobile telephony.
COMMENTS: Lancet. 2000 Nov 25; 356(9244):1782-3/21003981
ARTICLE SOURCE: Lancet (England), Nov 25 2000, 356(9244) p1833-6
AUTHOR(S): Hyland GJ
AUTHOR'S ADDRESS: Department of Physics, University of Warwick, Coventry, UK. G.J.Hyland@warwick.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: Although safety guidelines--to which mobile telephones and their base-stations conform--do protect against excessive microwave heating, there is evidence that the low intensity, pulsed radiation currently used can exert subtle non-thermal influences. If these influences entail adverse health consequences, current guidelines would be inadequate. This review will focus on this possibility. The radiation used is indeed of very low intensity, but an oscillatory similitude between this pulsed microwave radiation and certain electrochemical activities of the living human being should prompt concern. However, being so inherently dependent on aliveness, non-thermal effects cannot be expected to be as robust as thermal ones, as is indeed found; nor can everyone be expected to be affected in the same way by exposure to the same radiation. Notwithstanding uncertainty about whether the non-thermal influences reported do adversely affect health, there are consistencies between some of these effects and the neurological problems reported by some mobile-telephone users and people exposed longterm to base-station radiation. These should be pointers for future research.

ARTICLE TITLE: Caesarean section on the rise.
ARTICLE SOURCE: Lancet (England), Nov 18 2000, 356(9243) p1697
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Choosing caesarean section.
ARTICLE SOURCE: Lancet (England), Nov 11 2000, 356(9242) p1677-80
AUTHOR(S): Wagner M
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: Oxygen-induced hypercapnia revisited.
ARTICLE SOURCE: Lancet (England), Nov 4 2000, 356(9241) p1538-9
AUTHOR(S): Calverley PM
AUTHOR'S ADDRESS: Department of Medicine, University Hospital Aintree, Liverpool, UK.
PUBLICATION TYPE: Journal Article
MB: This seems to be confused to me.

ARTICLE TITLE: Renal-dose dopamine: will the message now get through?
COMMENTS: Lancet. 2000 Dec 23-30; 356(9248):2139
ARTICLE SOURCE: Lancet (England), Dec 23-30 2000, 356(9248) p2112-3
AUTHOR(S): Galley HF
AUTHOR'S ADDRESS: Department of Medicine and Therapeutics, University of Aberdeen, UK.
PUBLICATION TYPE: Comment; Journal Article

ARTICLE TITLE: Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group.
COMMENTS: Lancet. 2000 Dec 23-30; 356(9248):2112-3
ARTICLE SOURCE: Lancet (England), Dec 23-30 2000, 356(9248) p2139-43
AUTHOR(S): Bellomo R; Chapman M; Finfer S; Hickling K; Myburgh J
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
ABSTRACT: BACKGROUND: Low-dose dopamine is commonly administered to critically ill patients in the belief that it reduces the risk of renal failure by increasing renal blood flowINTERPRETATION: Administration of low-dose dopamine by continuous intravenous infusion to critically ill patients at risk of renal failure does not confer clinically significant protection from renal dysfunction.
MB: It's strange that I knew this right from the beginning. What is wrong with the credulity of practically every one else.

ARTICLE TITLE: UK's failure to act on research misconduct.
ARTICLE SOURCE: Lancet (England), Dec 16 2000, 356(9247) p2030
AUTHOR(S): Farthing M; Horton R; Smith R
PUBLICATION TYPE: Journal Article
MB: Nothing has been done.

ARTICLE TITLE: Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists' Collaboration.
COMMENTS: Lancet. 2000 Dec 9; 356(9246):1942-3/21012979
ARTICLE SOURCE: Lancet (England), Dec 9 2000, 356(9246) p1955-64
AUTHOR(S): Neal B; MacMahon S; Chapman N
AUTHOR'S ADDRESS: Collective Name: Blood Pressure Lowering Treatment Trialists' Collaboration.
PUBLICATION TYPE: Journal Article; Meta-Analysis

ARTICLE TITLE: Let's not make the same mistakes.
ARTICLE SOURCE: Lancet (England), Dec 2000, 356 Suppl ps9
AUTHOR(S): Chockalingam A
AUTHOR'S ADDRESS: arunshakuntala@hotmail.com.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: What can be achieved with an HIV vaccine?
ARTICLE SOURCE: Lancet (England), Jan 20 2001, 357(9251) p223-4
AUTHOR(S): Levy JA
AUTHOR'S ADDRESS: Department of Medicine, University of California, San Francisco 94143, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: The real lessons from Harold Frederick Shipman.
ARTICLE SOURCE: Lancet (England), Jan 13 2001, 357(9250) p82-3
AUTHOR(S): Horton R
AUTHOR'S ADDRESS: The Lancet, London, UK.
PUBLICATION TYPE: Journal Article
MB: This points out the proposed bureaucratic methods of fixing the problems are hopelessly beside the point.

ARTICLE TITLE: We all make mistakes: tell us yours.
COMMENTS: Lancet. 2001 Jan 13; 357(9250):140/21037812
ARTICLE SOURCE: Lancet (England), Jan 13 2001, 357(9250) p88
AUTHOR(S): Horton R
AUTHOR'S ADDRESS: The Lancet, London, UK.
PUBLICATION TYPE: Comment; Journal Article
MB: The Lancet want us to tell them. They should have given us their email address.

ARTICLE TITLE: The human genome, in proportion.
ARTICLE SOURCE: Lancet (England), Feb 17 2001, 357(9255) p489
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Australian government loosens its grip on the pharmaceutical industry.
ARTICLE SOURCE: Lancet (England), Feb 10 2001, 357(9254) p453
AUTHOR(S): Loff B; Cordner S
PUBLICATION TYPE: News

ARTICLE TITLE: Bristol, Shipman, and clinical governance: Shewhart's forgotten lessons.
ARTICLE SOURCE: Lancet (England), Feb 10 2001, 357(9254) p463-7
AUTHOR(S): Mohammed MA; Cheng KK; Rouse A; Marshall T
AUTHOR'S ADDRESS: Department of Surgery, University of Birmingham, Edgbaston, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: During the past century, manufacturing industry has achieved great success in improving the quality of its products. An essential factor in this success has been the use of Walter A Shewhart's pioneering work in the economic control of variation, which culminated in the development of a simple yet powerful graphical method known as the control chart. This chart classifies variation as having a common cause or special cause and thus guides the user to the most appropriate action to effect improvement. Using six case studies, including the excess deaths after paediatric cardiac surgery seen in Bristol, UK, and the activities of general practitioner turned murderer Harold Shipman, we show a central role for Shewhart's approach in turning the rhetoric of clinical governance into a reality.
MB: We should look at the outliers of events.

ARTICLE TITLE: Is the normalisation of blood pressure in bleeding trauma patients harmful?
ARTICLE SOURCE: Lancet (England), Feb 3 2001, 357(9253) p385-7
AUTHOR(S): Roberts I; Evans P; Bunn F; Kwan I; Crowhurst E
AUTHOR'S ADDRESS: Department of Epidemiology and Public Health, Institute of Child Health, London, UK. Ian.Roberts@ich.ucl.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: Moderately sensible review. I suppose all relevant studies are included. They mention the Houston study (Bichell. NEJM 1994, 331, 1105) but point out that it was not randomised. In that study the paramedic resuscitation gave a slightly worse result so you don't waste time doing it.

ARTICLE TITLE: Catheter ablation for cardiac arrhythmias.
ARTICLE SOURCE: Med Clin North Am (United States), Mar 2001, 85(2) p473-502, xii
AUTHOR(S): Calkins H
AUTHOR'S ADDRESS: Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA. hcalkins@jhmi.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Academic
ABSTRACT: The safety and efficacy of catheter ablation for treatment of most types of cardiac arrhythmias are well established. These arrhythmias and arrhythmia substrates include AVNRT, accessory pathways, focal atrial tachycardia, atrial flutter, idiopathic ventricular tachycardia, and bundle-branch re-entry. Catheter ablation is considered as an alternative to pharmacologic therapy in the treatment of these cardiac arrhythmias.

ARTICLE TITLE: Anesthesia options: choices and caveats.
ARTICLE SOURCE: Orthopedics (United States), Sep 2000, 23(9) p919-20
AUTHOR(S): Mallory TH; Lombardi AV; Fada RA; Dodds KL
AUTHOR'S ADDRESS: Joint Implant Surgeons Inc, Columbus, Ohio 43215, USA.
PUBLICATION TYPE: Clinical Trial

ARTICLE TITLE: Deep vein thrombosis: beyond the operating table.
ARTICLE SOURCE: Orthopedics (United States), Jun 2000, 23(6 Suppl) ps629-32
AUTHOR(S): Haas S
AUTHOR'S ADDRESS: Institute for Experimental Oncology and Therapeutic Research, Technical University of Munich, Germany.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
Post-thrombotic syndrome (PTS) is not reliably prevented by treatment of the initial Deep vein thrombosis (DVT) with anticoagulant therapy or thrombolysis. Therefore, prevention of DVT is the only effective approach to PTS prevention. Pharmacological thromboprophylaxis prevents venographically proven DVT in patients following orthopedic surgery, and is now recommended by North American and European consensus statements. Uncertainties remain, however, regarding the optimal duration of postsurgical prophylaxis.

ARTICLE TITLE: DVT treatment in 2000: state of the art.
ARTICLE SOURCE: Orthopedics (United States), Jun 2000, 23(6 Suppl) ps651-4
AUTHOR(S): Davidson BL
AUTHOR'S ADDRESS: Pulmonary and Critical Care Medicine Section, Virginia Mason Medical Center, Seattle, Wash. 91801, USA.
PUBLICATION TYPE: Journal Article; Review; Review Literature
ABSTRACT: In the past, only symptomatic, objectively confirmed, deep vein thrombosis (DVT) was treated with intravenous (or less commonly, twice-daily subcutaneous) unfractionated heparin in the hospital. Now, asymptomatic DVT (especially calf DVT) is also diagnosed by venography in clinical trials of antithrombotic therapies. Magnetic resonance imaging, ultrasound tests, and occasionally venography are identifying symptomatic calf DVT. Upper extremity and superior vena cava DVT are also being diagnosed more frequently, especially in hospitalized patients. For all of these patients, hospitalized or not, subcutaneous low-molecular-weight heparin likely represents the best therapeutic alternative. Twice-daily dosing is probably safest, but evidence supports once-daily dosing with some agents in certain circumstances. Outpatient treatment is proven safe in reliable patients with minimal comorbidities and significant cost-saving implications. The duration of anticoagulant treatment (usually, but not necessarily, oral) for different patient categories is the next area requiring disciplined scientific investigation.

ARTICLE TITLE: New therapeutic options in DVT prophylaxis.
ARTICLE SOURCE: Orthopedics (United States), Jun 2000, 23(6 Suppl) ps639-42
AUTHOR(S): Wille-Jorgensen P
AUTHOR'S ADDRESS: Department of Surgical Gastroenterology K, Bispebjerg Hospital, University of Copenhagen, Denmark.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: In the absence of prophylaxis, elective orthopedic surgery is associated with a high risk of venous thromboembolic events that are responsible for substantial morbidity and mortality. Despite the publication of articles questioning the significance of fatal pulmonary embolism (PE) following elective hip replacement, recent reports support the need for effective thromboprophylaxis in this indication. These reports also provide evidence of a significant reduction in fatal PE and overall mortality provided by treatment with low-molecular-weight heparin (LMWH), compared with unfractionated heparin. Even with the most effective prophylaxis currently available, however, deep vein thrombosis still develops in a minority of high-risk patients, indicating a need for improved therapies. Desirudin, a novel recombinant hirudin and direct thrombin inhibitor, has been shown to provide more effective prophylaxis than the most widely used LMWH, enoxaparin, in orthopedic surgery patients with multiple thromboembolic risk factors. This benefit was not associated with any increase in bleeding. Regional anesthesia and use of graduated compression stockings may provide additional independent reductions in thromboembolic risk in elective orthopedic surgery.
MB: The last statement is not supported by the California Study.