ARTICLE TITLE: Intensive care unit outcomes of surgical
centenarians: the "oldest old" of the new millennium.
ARTICLE SOURCE: Am Surg (United States), Sep 2000, 66(9) p870-3
AUTHOR(S): Wilson MT; Crawford KL; Shabot MM
AUTHOR'S ADDRESS: Burns and Allen Research Institute, Los Angeles,
California, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
Mortality in the surgical intensive care unit (SICU) and hospital was
significantly different across the age groups and rose with age.
However, the modest 11.1 per cent SICU mortality rate in centenarians
along with their length of stay (LOS) statistics indicate that these
patients fare relatively well in surgical intensive care.
ARTICLE TITLE: The effect of abrupt cessation of total parenteral
nutrition on serum glucose: a randomized trial.
ARTICLE SOURCE: Am Surg (United States), Sep 2000, 66(9) p866-9
AUTHOR(S): Nirula R; Yamada K; Waxman K
AUTHOR'S ADDRESS: Department of Surgery, Santa Barbara Cottage
Hospital, California 93105, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
We conclude that there was no symptomatic hypoglycemia, and glucose
profiles returned to a similar baseline level in those whose TPN was
abruptly stopped when compared with those in the tapered group. These
data demonstrate that patients receiving TPN can have parenteral
nutrition abruptly stopped without the development of significant
hypoglycemia.
MB: & to think all the trouble we go to prevent hypoglycaemia
when these patients to theatre.
ARTICLE TITLE: Surgery in the nineties.
ARTICLE SOURCE: Am Surg (United States), Sep 2000, 66(9) p813-6
AUTHOR(S): Rigberg D; Cole M; Hiyama D; McFadden D
AUTHOR'S ADDRESS: Division of General Surgery, UCLA Medical Center,
Los Angeles, California, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
Overall perioperative mortality was 9.4 per cent (3 of 32).
Twenty-two surgeries (69%) were performed on an emergency basis, and
all three deaths were in this group (13.6%). Overall morbidity rate
was 57 per cent. Mean intensive care unit stay was 4.8 days. Most
patients were discharged home. Our findings support the perioperative
safety of elective general surgery in nonagenarians (0% mortality and
20% morbidity). We also found an acceptable risk (13.6% mortality and
68% morbidity) for emergency procedures despite significant comorbid
conditions. Most of the patients had acceptable functional
outcomes.
MB: The 90s & 100s seem to be good candidates to go to ICU. It’s
a pity the younger ones are not stronger. ;-(
ARTICLE TITLE: The influence of anesthetic technique on perioperative
blood pressure control after carotid endarterectomy.
ARTICLE SOURCE: Am Surg (United States), Jul 2000, 66(7) p641-7
AUTHOR(S): Eibes TA; Gross WS
AUTHOR'S ADDRESS: Department of Surgery, Providence Hospital,
Southfield, Michigan, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
Regional anesthesia required lower doses of antihypertensive
medication in the early postoperative period when compared with
general anesthesia. The doses of vasoactive medications used had no
significant impact on the complication rate. Regional anesthesia
allowed for shorter stay in both the intensive care unit and total
hospital stay.
MB: We stopped sending vascular surgery carotids to ICU 'cause of the
complications of their interventions.
ARTICLE TITLE: Endpoints of resuscitation of critically injured
patients: normal or supranormal? A prospective randomized trial.
ARTICLE SOURCE: Ann Surg (United States), Sep 2000, 232(3)
p409-18
AUTHOR(S): Velmahos GC; Demetriades D; Shoemaker WC; Chan LS;
Tatevossian R; Wo CC; Vassiliu P; Cornwell EE 3rd; Murray JA; Roth B;
Belzberg H; Asensio JA; Berne TV
AUTHOR'S ADDRESS: Department of Surgery, Division of Trauma and
Critical Care, and the Department of Biostatistics and Outcomes
Research, University of Southern California, Los Angeles, California,
USA. velmahos@hsc.usc.edu.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Severely injured patients who can achieve optimal
hemodynamic values are more likely to survive than those who cannot,
regardless of the resuscitation technique. In this study, attempts at
early optimization did not improve the outcome of the examined
subgroup of severely injured patients.
ARTICLE TITLE: Predictors of survival after In vivo split liver
transplantation: analysis of 110 consecutive patients.
ARTICLE SOURCE: Ann Surg (United States), Sep 2000, 232(3)
p312-23
AUTHOR(S): Ghobrial RM; Yersiz H; Farmer DG; Amersi F; Goss J; Chen
P; Dawson S; Lerner S; Nissen N; Imagawa D; Colquhoun S; Arnout W;
McDiarmid SV; Busuttil RW
AUTHOR'S ADDRESS: Dumont-UCLA Transplant Center, Departments of
Surgery and Pediatrics, University of California Los Angeles School
of Medicine and the Cedars Sinai Center for Liver Diseases and
Transplantation, Los Angeles, California 90095, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Patient survival of in vivo split liver transplantation
(SLT). is not significantly different from that of whole-organ
orthotopic liver transplantation. The variables affecting outcome of
in vivo SLT are similar to those in whole-organ transplantation. in
vivo SLT should be widely applied to expand a severely depleted donor
pool.
ARTICLE TITLE: Protective effects of ischemic preconditioning for
liver resection performed under inflow occlusion in humans [see
comments]
COMMENTS: Comment in: Ann Surg 2000 Aug; 232(2):163-5
ARTICLE SOURCE: Ann Surg (United States), Aug 2000, 232(2)
p155-62
AUTHOR(S): Clavien PA; Yadav S; Sindram D; Bentley RC
AUTHOR'S ADDRESS: Division of Transplantation and Hepatobiliary
Surgery, and the Department of Visceral and Transplantation Surgery,
Zurich University Medical Center, Switzerland.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: SUMMARY BACKGROUND DATA: Ischemic preconditioning is a
short period of ischemia followed by a brief period of reperfusion
before a sustained ischemic insult.<snip> CONCLUSIONS: Ischemic
preconditioning is a simple and effective modality protecting the
liver against subsequent prolonged periods of ischemia. This strategy
may be a more attractive technique than intermittent inflow
occlusion, which is associated with increased blood loss during each
period of reperfusion.
ARTICLE TITLE: Preconditioning for protection from ischemic injury:
discriminating cause from effect from epiphenomenon [editorial;
comment]
COMMENTS: Comment on: Ann Surg 2000 Aug; 232(2):155-62
ARTICLE SOURCE: Ann Surg (United States), Aug 2000, 232(2) p163-5
AUTHOR(S): Bulkley GB
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Efficacy and respiratory effects of low-dose spinal
morphine for postoperative analgesia following knee arthroplasty.
ARTICLE SOURCE: Br J Anaesth (England), Aug 2000, 85(2) p233-7
AUTHOR(S): Cole PJ; Craske DA; Wheatley RG
AUTHOR'S ADDRESS: Acute Pain Management Unit, York District Hospital,
UK.
INDEXING CHECK TAG(S): Comparative Study; Human
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
There was an improvement in pain relief in the intrathecal morphine
group, with significantly lower median VAS pain scores on movement at
4 h (0 (median 0-1.5) vs 5 (1.25-7.75) P < 0.01), 12 h (2 (1-5) vs
6 (3-8) P < 0.01) and 24 h (3 (1-5) vs 5 (3-7) P < 0.05)
postoperatively, despite using significantly less patient-controlled
morphine (20 mg (10.25-26.25) vs 38.5 mg (27-51) P < 0.01) in the
first 24 h. Although marked disturbances in respiratory pattern were
observed in both groups, none of the patients in the study had severe
hypoxaemia (SpO2 < 85% > 6 min h-1) and there was no
significant difference in the incidence of mild (SpO2 < 94% >
12 min h-1) or moderate (SpO2 < 90% > 12 min h-1) hypoxaemia or
in the incidence of episodes of apnoea or hypopnoea in the two
groups.
MB: Was it all worth while?
ARTICLE TITLE: The carina as a landmark in central venous catheter
placement [see comments]
COMMENTS: Comment in: Br J Anaesth 2000 Aug; 85(2):188-91
ARTICLE SOURCE: Br J Anaesth (England), Aug 2000, 85(2) p192-4
AUTHOR(S): Schuster M; Nave H; Piepenbrock S; Pabst R; Panning B
AUTHOR'S ADDRESS: Department of Anaesthesiology, Medical School
Hannover, Germany.
INDEXING CHECK TAG(S): Female; Human; Male
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Location of the tip of a central venous catheter (CVC)
within the pericardium has been associated with potentially lethal
cardiac tamponade. Because the pericardium cannot be seen on chest
x-ray (CXR), an alternative radiographic marker is needed for correct
placement of CVCs. The anatomy of the region was studied in 34
cadavers. The carina was a mean (SEM) distance of 0.4 (0.1) cm above
the pericardial sac as it transverses the superior vena cava (SVC).
In no case was the carina located below the pericardial sac. The
carina is a reliable, simple anatomical landmark for the correct
placement of CVCs. In almost all cases, the carina is radiologically
visible even in poor quality, portable CXRs. CVC tips should be
located in the SVC above the level of the carina in order to avoid
cardiac tamponade.
ARTICLE TITLE: Safe placement of central venous catheters: where
should the tip of the catheter lie? [editorial; comment]
COMMENTS: Comment on: Br J Anaesth 2000 Aug; 85(2):192-4
ARTICLE SOURCE: Br J Anaesth (England), Aug 2000, 85(2) p188-91
AUTHOR(S): Fletcher SJ; Bodenham AR
PUBLICATION TYPE: COMMENT; EDITORIAL
MB There are some inconsistencies in this editorial. They say the
Image Intensifier works but that it is not generally available. I
think it should be. We have them in our theatre block and are just as
easy to get as a portable x-ray.
ARTICLE TITLE: Anaesthetic management of patients with diabetes
mellitus.
ARTICLE SOURCE: Br J Anaesth (England), Jul 2000, 85(1) p80-90
AUTHOR(S): McAnulty GR; Robertshaw HJ; Hall GM
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care
Medicine, St George's Hospital Medical School, London, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (126 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Phaeochromocytoma--recent progress in its
management.
ARTICLE SOURCE: Br J Anaesth (England), Jul 2000, 85(1) p44-57
AUTHOR(S): Prys-Roberts C
AUTHOR'S ADDRESS: Sir Humphry Davy Department of Anaesthesia, Bristol
Royal Infirmary, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (105 references); REVIEW,
ACADEMIC
ARTICLE TITLE: Malignant hyperthermia: advances in clinical
management and diagnosis.
ARTICLE SOURCE: Br J Anaesth (England), Jul 2000, 85(1) p118-28
AUTHOR(S): Hopkins PM
AUTHOR'S ADDRESS: Malignant Hyperthermia Investigation Unit,
University of Leeds, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (129 references); REVIEW,
TUTORIAL
ARTICLE TITLE: The stress response to trauma and surgery.
ARTICLE SOURCE: Br J Anaesth (England), Jul 2000, 85(1) p109-17
AUTHOR(S): Desborough JP
AUTHOR'S ADDRESS: Department of Anaesthesia, Epsom General Hospital,
UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (51 references); REVIEW,
ACADEMIC
ARTICLE TITLE: Elevation of prostate-specific markers after
cardiopulmonary resuscitation.
ARTICLE SOURCE: Circulation (United States), Jul 18 2000, 102(3)
p290-3
AUTHOR(S): Koller-Strametz J; Fritzer M; Gwechenberger M; Geppert A;
Heinz G; Haumer M; Koreny M; Maurer G; Siostrzonek P
AUTHOR'S ADDRESS: Department of Cardiology, University of Vienna,
Austria. jeanette.koller-strametz@univie.ac.at.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS-Prolonged CPR is frequently associated with increases of
Prostate-specific antigen (PSA), acid phosphatase (AP), and prostatic
acid phosphatase (PAP)serum levels. Therefore, PSA cannot be used for
diagnosis of adenocarcinoma of the prostate during the first weeks
after CPR. Further evaluation of these parameters as additional
prognostic markers after CPR is warranted.
ARTICLE TITLE: What type of beta-blocker should be used to treat
chronic heart failure? [editorial; comment]
COMMENTS: Comment on: Circulation 2000 Aug 1; 102(5):546-51
ARTICLE SOURCE: Circulation (United States), Aug 1 2000, 102(5)
p484-6
AUTHOR(S): Bristow MR
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (30 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Differential effects of beta-blockers in patients with
heart failure: A prospective, randomized, double-blind comparison of
the long-term effects of metoprolol versus carvedilol [see
comments]
COMMENTS: Comment in: Circulation 2000 Aug 1; 102(5):484-6
ARTICLE SOURCE: Circulation (United States), Aug 1 2000, 102(5)
p546-51
AUTHOR(S): Metra M; Giubbini R; Nodari S; Boldi E; Modena MG; Dei Cas
L
AUTHOR'S ADDRESS: Cattedra di Cardiologia, Universita di Brescia,
Italy. metramarco@libero.it.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: The present study demonstrates that during long-term
therapy, carvedilol improves cardiac performance to a greater extent
than metoprolol when administered to patients with heart failure in
the doses shown to be effective in clinical trials. These differences
were likely related to a greater antiadrenergic activity of
carvedilol.
ARTICLE TITLE: Part 5: new guidelines for first aid. The American
Heart Association in collaboration with the International Liaison
Committee on Resuscitation.
ARTICLE SOURCE: Circulation (United States), Aug 22 2000, 102(8
Suppl) pI77-85
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ARTICLE TITLE: Part 6: advanced cardiovascular life support : section
3: adjuncts for oxygenation, ventilation, and airway control. The
American Heart ASsociation in collaboration with the International
Liaison Committee on Resuscitation.
ARTICLE SOURCE: Circulation (United States), Aug 22 2000, 102(8
Suppl) pI95-104
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ARTICLE TITLE: Part 6: advanced cardiovascular life support : section
6: pharmacology II: agents to optimize cardiac output and blood
pressure. The American Heart Association in collaboration with the
International Liaison Committee on Resuscitation. .
ARTICLE SOURCE: Circulation (United States), Aug 22 2000, 102(8
Suppl) pI129-35
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ARTICLE TITLE: Physical activity and coronary heart disease in men:
The Harvard Alumni Health Study.
ARTICLE SOURCE: Circulation (United States), Aug 29 2000, 102(9)
p975-80
AUTHOR(S): Sesso HD; Paffenbarger RS Jr; Lee IM
AUTHOR'S ADDRESS: Department of Epidemiology, Harvard School of
Public Health, Boston, MA, USA. hsesso@hsph.harvard.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: The quantity and intensity of physical activity
required for the primary prevention of coronary heart disease (CHD)
remain unclear. Therefore, we examined the association of the
quantity and intensity of physical activity with CHD risk and the
impact of other coronary risk factors. METHODS AND RESULTS: We
followed 12 516 middle-aged and older men (mean age 57.7 years, range
39 to 88 years) from 1977 through 1993. Physical activity was
assessed at baseline in kilojoules per week (4.2 kJ=1 kcal) from
blocks walked, flights climbed, and participation in sports or
recreational activities. During follow-up, 2,135 cases of incident
CHD, including myocardial infarction, angina pectoris,
revascularization, and coronary death, occurred. Compared with men
expending <2,100 kJ/wk, men expending 2,100 to 4,199, 4,200 to
8,399, 8,400 to 12,599, and >/=12,600 kJ/wk had multivariate
relative risks of 0.90, 0.81, 0.80, and 0.81, respectively (P: for
trend=0.003). When we considered the independent effects of specific
physical activity components, only total sports or recreational
activities (P: for trend=0.042) and vigorous activities (P: for
trend=0.02) were inversely associated with the risk of CHD. These
associations did not differ within subgroups of men defined by
coronary risk factors. Finally, among men with multiple coronary risk
factors, those expending >/=4,200 kJ/wk had reduced CHD risk
compared with men expending <4,200 kJ/wk. CONCLUSIONS: Total
physical activity and vigorous activities showed the strongest
reductions in CHD risk. Moderate and light activities, which may be
less precisely measured, showed nonsignificant inverse associations.
The association between physical activity and a reduced risk of CHD
also extends to men with multiple coronary risk factors.
ARTICLE TITLE: Progress in heart failure Management? Lessons from the
real world [comment] [editorial]
COMMENTS: Comment on: Circulation 2000 Sep 5; 102(10):1126-31
ARTICLE SOURCE: Circulation (United States), Sep 5 2000, 102(10)
p1076-8
AUTHOR(S): Konstam MA
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Physical activity and coronary heart disease risk in
men: does the duration of exercise episodes predict risk?
ARTICLE SOURCE: Circulation (United States), Aug 29 2000, 102(9)
p981-6
AUTHOR(S): Lee IM; Sesso HD; Paffenbarger RS Jr
AUTHOR'S ADDRESS: Department of Epidemiology, Harvard School of
Public Health, Boston, MA, USA. i-min.lee@channing.harvard.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: These data clearly indicate that physical activity is
associated with decreased coronary heart disease (CHD) risk.
Furthermore, they lend some support to recent recommendations that
allow for the accumulation of shorter sessions of physical activity,
as opposed to requiring 1 longer, continuous session of exercise.
This may provide some impetus for those sedentary to become more
active.
ARTICLE TITLE: When should ACE inhibitors or warfarin be discontinued
after myocardial infarction? [editorial]
ARTICLE SOURCE: Heart (England), Oct 2000, 84(4) p361-2
AUTHOR(S): Wiegers SE; St John Sutton M
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Modern management of hypertension and heart failure:
evidence and practice.
ARTICLE SOURCE: Heart (England), Sep 2000, 84 Suppl 1 pi35-8;
discussion i50
AUTHOR(S): Hobbs FD
AUTHOR'S ADDRESS: Division of Primary Care, Public and Occupational
Health, University of Birmingham, Birmingham B15 2TT, UK.
f.d.r.hobbs@bham.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: The diagnosis of heart failure.
ARTICLE SOURCE: Heart (England), Sep 2000, 84(3) p334-8
AUTHOR(S): Struthers AD
AUTHOR'S ADDRESS: Department of Clinical Pharmacology &
Therapeutics, Ninewells Hospital, Dundee, UK.
a.d.struthers@dundee.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
MB: Pretty vague.
ARTICLE TITLE: Clinical trials in cardiovascular medicine: are we
looking for statistical significance or clinical relevance?
ARTICLE SOURCE: Heart (England), Aug 2000, 84(2) p129-33
AUTHOR(S): Willenheimer R; Dahlof B; Gordon A
AUTHOR'S ADDRESS: Department of Cardiology, Malmo University
Hospital, Malmo, Sweden. ronnie.willenheimer@medforsk.mas.lu.se.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Protection from excessive resuscitation: "pushing the
pendulum back" [editorial; comment]
COMMENTS: Comment on: J Trauma 2000 Sep; 49(3):387-91
ARTICLE SOURCE: J Trauma (United States), Sep 2000, 49(3) p567-8
AUTHOR(S): Pruitt BA Jr
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Intra-abdominal hypertension and abdominal compartment
syndrome in burn patients [see comments]
COMMENTS: Comment in: J Trauma 2000 Sep; 49(3):567-8
ARTICLE SOURCE: J Trauma (United States), Sep 2000, 49(3) p387-91
AUTHOR(S): Ivy ME; Atweh NA; Palmer J; Possenti PP; Pineau M; D'Aiuto
M
AUTHOR'S ADDRESS: Bridgeport Hospital, New Haven, Connecticut 06610,
USA. pmivy@bpthosp.org.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Intra-abdominal hypertension (IAH) occurs commonly in
major burn patients, and abdominal compartment syndrome (ACS) is seen
regularly in patients with more than 70% body surface area burns. We
recommend bladder pressure measurements after infusion of more than
0.25 L/kg during the acute resuscitation phase and for peak
inspiratory pressures greater than 40 cm H2O. Whereas ACS warrants
surgical decompression of the abdominal cavity, IAH usually responds
to conservative therapy.
ARTICLE TITLE: Penile fracture with complete urethral disruption.
ARTICLE SOURCE: J Trauma (United States), Aug 2000, 49(2) p339-41
AUTHOR(S): Gottenger EE; Wagner JR
AUTHOR'S ADDRESS: Department of Urology, Beth Israel Medical Center,
New York, New York 10003, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
MB They say only 250 have been reported. I diagnosed one in the
Emergency Department when I was a resident.
ARTICLE TITLE: Sympathectomy for causalgia: experience with military
injuries.
ARTICLE SOURCE: J Trauma (United States), Aug 2000, 49(2) p266-71
AUTHOR(S): Hassantash SA; Maier RV
AUTHOR'S ADDRESS: Department of Surgery, Beheshti University of
Medical Sciences, Tehran, Iran.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Causalgia is a rare disease in civilian
practice, and most reports regarding causalgia in the literature are
from major extended wars. To increase awareness of this syndrome, our
wartime experience with this disease is presented. CONCLUSION:
Causalgia is essentially a war casualty disease. The condition is
associated with burning pain, hyperesthesia, and symptoms of
sympathetic overactivity. Sympathectomy is effective and the
treatment of choice, particularly for patients who respond
temporarily to sympathetic blocks.
MB: Why does it occur mainly in military medicine.
ARTICLE TITLE: Impact of pediatric trauma centers on mortality in a
statewide system.
ARTICLE SOURCE: J Trauma (United States), Aug 2000, 49(2) p237-45
AUTHOR(S): Potoka DA; Schall LC; Gardner MJ; Stafford PW; Peitzman
AB; Ford HR
AUTHOR'S ADDRESS: Department of Surgery, University of Pittsburgh,
Pennsylvania, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Children treated at PTC or ATC AQ have significantly
better outcome compared with those treated at ATC. Severely injured
children (Injury Severity Score > 15) with head, spleen, or liver
injuries had the best overall outcome when treated at PTC. This
difference in outcome may be attributable to the approach to
operative and nonoperative management of head, liver, and spleen
injuries at PTC.
ARTICLE TITLE: Whole blood transfusion for exsanguinating
coagulopathy in a US field surgical hospital in postwar Kosovo.
ARTICLE SOURCE: J Trauma (United States), Jul 2000, 49(1) p145-8
AUTHOR(S): Grosso SM; Keenan JO
AUTHOR'S ADDRESS: US Army 67th Combat Support Hospital (forward),
Task Force Med Falcon, Camp Bondsteel, Kosovo.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: An urgent blood drive in which active duty military field
surgical hospital personnel volunteered to donate whole blood was
conducted, and administration of warm, whole blood prevented the
exsanguination of a normothermic coagulopathic patient who had
received a massive transfusion. In austere care settings in which
full blood banking capability may not be available, physicians should
consider that exsanguinating hemorrhage can potentially be controlled
surgically, but nonsurgical bleeding requires specific replacement
therapy, and whole blood may be the best selection for repleting
deficiencies of components that are otherwise unavailable.
MB: It is essentially illegal here.
ARTICLE TITLE: Prevention of venous thromboembolism after injury: an
evidence-based report--part I: analysis of risk factors and
evaluation of the role of vena caval filters.
ARTICLE SOURCE: J Trauma (United States), Jul 2000, 49(1) p132-8;
discussion 139
AUTHOR(S): Velmahos GC; Kern J; Chan LS; Oder D; Murray JA; Shekelle
P
AUTHOR'S ADDRESS: Department of Surgery, Keck School of Medicine, Los
Angeles County, University of Southern California Medical Center,
90033, USA. velmahos@hsc.usc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
RESULTS: The incidence of deep prevent venous thromboembolism (VT)
and pulmonary embolism reported in different studies varies widely.
The pooled rates are 11.8% for deep venous thrombosis and 1.5% for
pulmonary embolism. Only a few randomized controlled trials have
evaluated the methods of VT prophylaxis among trauma patients, and
combining their data is difficult because of different designs and
preventive methods used. The quality of most studies is low.
Meta-analysis shows no evidence that low-dose heparin, mechanical
prophylaxis, or low-molecular-weight heparin are more effective than
no prophylaxis or each other. However, the 95% confidence intervals
of many of the comparisons are wide; therefore, a clinically
important difference may exist. CONCLUSION: The trauma literature on
prevent venous thromboembolism (VT) prophylaxis provides inconsistent
data. There is no evidence that any existing method of VT prophylaxis
is clearly superior to the other methods or even to no prophylaxis.
Our results cast serious doubt on the existing policies on VT
prophylaxis, and we call for a large, high-quality, multicenter trial
that can provide definitive answers.
MB: How depressing!
ARTICLE TITLE: Prevention of venous thromboembolism after injury: an
evidence-based report--part II: analysis of risk factors and
evaluation of the role of vena caval filters.
ARTICLE SOURCE: J Trauma (United States), Jul 2000, 49(1) p140-4
AUTHOR(S): Velmahos GC; Kern J; Chan LS; Oder D; Murray JA; Shekelle
P
AUTHOR'S ADDRESS: Department of Surgery, Keck School of Medicine, Los
Angeles County, University of Southern California Medical Center,
90033, USA. velmahos@hsc.usc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSION: Spinal injuries, spinal cord injuries, and age are risk
factors for development of deep venous thrombosis (DVT). Prophylactic
placement of vena caval filters (VCF) in selected trauma patients may
decrease the incidence of pulmonary embolism. Future research with
well-designed studies is required to provide definitive answers.
ARTICLE TITLE: Developing senior doctors as mentors: a form of
continuing professional development. Report Of an initiative to
develop a network of senior doctors as mentors: 1994-99.
ARTICLE SOURCE: Med Educ (England), Sep 2000, 34(9) p747-53
AUTHOR(S): Connor MP; Bynoe AG; Redfern N; Pokora J; Clarke J
AUTHOR'S ADDRESS: Head of Individual and Organisation Development
Studies, University College of Ripon and York St John, Lord Mayor's
Walk, York, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
RECOMMENDATIONS AND ISSUES FOR FURTHER DEBATE: The positive benefits
from the scheme raise questions about how to develop mentoring
training for senior doctors. Issues include: developing mentors; who
needs mentoring; mentoring and the organization; transferability of
mentoring skills, and widening the network.
MB: I don't think this type of thing is likely to work well.
ARTICLE TITLE: Problem-based learning: why curricula are likely to
show little effect on knowledge and clinical skills.
ARTICLE SOURCE: Med Educ (England), Sep 2000, 34(9) p729-38
AUTHOR(S): Albanese M
AUTHOR'S ADDRESS: University of Wisconsin Medical School, Madison,
Wisconsin 53706-1532, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVES: A recent review of problem-based learning's
effect on knowledge and clinical skills updated findings reported in
1993. The author argues that effect sizes (ES) seen with PBL have not
lived up to expectations (0.8-1.0) and the theoretical basis for PBL,
contextual learning theory, is weak. RESULTS: Effect sizes of 0.8-1.0
would require some students to move from the bottom quartile to the
top half of the class or more. The average ES reported in the
literature was 0.50 and many commonly used and accepted medical
procedures and therapies are based upon studies with ESs below 0.50.
CONCLUSIONS: Effect sizes of 0.8-1.0 are an unreasonable expectation
from PBL because, firstly, the degree of changes that would be
required of individuals would be excessive, secondly, leading up to
medical school, students are groomed and selected for success in a
traditional curriculum, expecting them to do better in a PBL
curriculum than a traditional curriculum is an unreasonable
expectation, and, thirdly, the average study reported in the
literature and many commonly used and accepted medical procedures and
therapies are based upon studies having lesser ESs.
Information-processing theory, Cooperative learning,
Self-determination theory and Control theory are suggested as
providing better theoretical support for PBL than Contextual learning
theory. Even if knowledge acquisition and clinical skills are not
improved by PBL, the enhanced work environment for students and
faculty that has been consistently found with PBL is a worthwhile
goal.
MB: Sounds as though the exercise has been a waste of time, effort
and money.
ARTICLE TITLE: Factors affecting progress of Australian and
international students in a problem-based learning medical
course.
ARTICLE SOURCE: Med Educ (England), Sep 2000, 34(9) p708-15
AUTHOR(S): Treloar C; McCall N; Rolfe I; Pearson SA; Garvey G;
Heathcote A
AUTHOR'S ADDRESS: Centre for Clinical Epidemiology and Biostatistics,
Faculty of Medicine and Health Sciences, The University of Newcastle,
Australia.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: CONTEXT: Research on the factors affecting progress in
medical schools has typically focused on mainstream (non-Indigenous
Australian, non-international) students in traditional, didactic
programmes. These results may not be applicable to students,
particularly those from culturally diverse backgrounds, undertaking
problem-based learning courses. OBJECTIVE: This study used
qualitative methodology to explore and compare factors affecting
progress for mainstream Australian students (non-Indigenous
Australian, non-international) and international students (full
fee-paying students who had relocated countries to study) in a
problem-based learning medical course. Intervention strategies were
devised on the basis of the participants' experiences. METHODS: Six
focus group discussions were conducted (three with mainstream
Australian and three with international participants). Transcripts of
these discussions were coded and analysed independently by two
researchers and discussed until consensus was attained. RESULTS:
Participants identified both positive and negative experiences
related to the course structure, which were consistent with previous
findings. The participants' experiences demonstrated a relationship
between sense of 'belongingness' to the medical school community,
participation in learning opportunities and progress through the
course. CONCLUSIONS: The results suggest that interventions aimed at
reducing barriers to progress need to promote students' confidence,
motivation and subsequent participation in course learning
opportunities. These results have application to other problem-based
learning courses particularly those which face the challenge of
providing an optimal learning environment for students from diverse
backgrounds.
MB: This sounds pretty holeless too.
ARTICLE TITLE: Problem-based learning: the story continues to unfold
[editorial]
ARTICLE SOURCE: Med Educ (England), Sep 2000, 34(9) p688-9
AUTHOR(S): Bligh J
PUBLICATION TYPE: EDITORIAL
MB: They are having trouble showing that the course alterations have
done anything in particular. I suppose the people writing this and
the next 2 papers are enthusiasts.
ARTICLE TITLE: Problem-based learning--time to step back?
[comment]
COMMENTS: Comment on: Med Educ 2000 Jul; 34(7):509-10
ARTICLE SOURCE: Med Educ (England), Jul 2000, 34(7) p510-1
AUTHOR(S): Kaufman DM
AUTHOR'S ADDRESS: Division of Medical Education, Clinical Research
Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Problem-based learning--time to move forward? [see
comments]
COMMENTS: Comment in: Med Educ 2000 Jul; 34(7):510-1
ARTICLE SOURCE: Med Educ (England), Jul 2000, 34(7) p509-10
AUTHOR(S): Rothman AI
AUTHOR'S ADDRESS: Department of Medicine, University of Toronto,
Ontario, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Reducing premature death and renal failure in
Australian aboriginals. A community-based cardiovascular and renal
protective program.
ARTICLE SOURCE: Med J Aust (Australia), May 15 2000, 172(10)
p473-8
AUTHOR(S): Hoy WE; Baker PR; Kelly AM; Wang Z
AUTHOR'S ADDRESS: Menzies School of Health Research, Darwin, NT.
wendy@menzies.su.edu.au.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
RESULTS: 258 people enrolled in the program, and 118 had complete
data for two years of treatment. In these 118, blood pressures fell
significantly, while ACR and GFR stabilised. Rates of the combined
endpoints of renal failure and natural death per 100 person-years
were 2.9 for the treatment group (95% CI, 1.7-4.6) and 4.8 for the
control group (95% CI, 3.3-7.0). After adjustment for baseline ACR
category, the relative risk of the treatment group versus the control
group for these combined endpoints was 0.47 (95% CI, 0.25-0.86; P =
0.013). Treatment benefit was especially marked in people with overt
albuminuria or hypertension and in non-diabetic people. The estimates
of benefit were supported by a fall in community rates of death and
renal failure. CONCLUSIONS: Aboriginal people can participate
enthusiastically in chronic disease management, with rapid, dramatic
improvement in clinical profiles and mortality. Similar programs
should be introduced urgently into other Aboriginal communities
nationwide.
ARTICLE TITLE: Reconciliation, social equity and indigenous health
[editorial]
ARTICLE SOURCE: Med J Aust (Australia), May 15 2000, 172(10)
p468-9
AUTHOR(S): Eades SJ
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Schizophrenia today [editorial]
ARTICLE SOURCE: Med J Aust (Australia), May 15 2000, 172(10)
p470-1
AUTHOR(S): Copolov DL; Singh BS
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Falls in the elderly: what can be done?
[editorial; comment]
COMMENTS: Comment on: Med J Aust 2000 Aug 21; 173(4):179-82
ARTICLE SOURCE: Med J Aust (Australia), Aug 21 2000, 173(4)
p176-7
AUTHOR(S): Close JC; Glucksman E
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: I think thy are saying that you have to fix everything. Well
that's fairly obvious but impossible
ARTICLE TITLE: Should there be more teaching of critical thinking in
Australian general practice?
ARTICLE SOURCE: Med J Aust (Australia), Aug 7 2000, 173(3) p153-7
AUTHOR(S): Mattes E
AUTHOR'S ADDRESS: Faculty of Medicine, University of Western
Australia, Perth. emattes@cyllene.uwa.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: For clinicians such as GPs, critical thinking includes
critical appraisal of scientific evidence and the context of their
clinical practice, and critical introspection. Largely due to a lack
of rigorous research, there is no evidence that teaching critical
thinking or appraisal, at undergraduate or postgraduate levels,
improves GPs' clinical performance or their patients' health. Before
conducting such research, a systematic review of the available
literature (largely in education and psychology) is warranted to
assess the efficacy of teaching critical thinking in non-medical
environments. Critical thinking is being taught in Australian medical
schools and will be introduced in the RACGP Training Program.
However, it will be a while before this will have an impact in GPs'
surgeries. The challenge will be to design an attractive CME program
relevant to GPs while simultaneously evaluating its efficacy.
MB: They say you need a 'built in crap detector'. This probably
should be applied to attempts at producing this in students.
ARTICLE TITLE: Moderate alcohol intake is associated with survival in
the elderly: the Dubbo Study [see comments]
COMMENTS: Comment in: Med J Aust 2000 Aug 7; 173(3):116-7
ARTICLE SOURCE: Med J Aust (Australia), Aug 7 2000, 173(3) p121-4
AUTHOR(S): Simons LA; McCallum J; Friedlander Y; Ortiz M; Simons
J
AUTHOR'S ADDRESS: University of New South Wales Lipid Research
Department, St Vincent's Hospital, Sydney, NSW.
l.simons@notes.med.unsw.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To examine the relationship between alcohol
intake and survival in elderly people. DESIGN AND SETTING: A
prospective study over 116 months of non-institutionalised subjects
living in Dubbo, a rural town (population, 34,000) in New South
Wales. PARTICIPANTS: 1235 men and 1570 women aged 60 years and over
who were first examined in 1988-89. MAIN OUTCOME MEASURES: All-causes
mortality; gross cost of alcohol per life-year gained. RESULTS: Death
occurred in 450 men and 392 women. Intake of alcohol was generally
moderate (i.e., less than 14 drinks/week). Any intake of alcohol was
associated with reduced mortality in men up to 75 years and in women
over 64 years. In a proportional hazards model, the hazard ratio for
mortality in men taking any alcohol was 0.63 (95% CI, 0.47-0.84) and
in women was 0.75 (95% CI, 0.60-0.94). Cardiovascular deaths in men
were reduced from 20/100 (95% CI, 14-26) to 11/100 (95% CI, 9-13) and
in women from 16/100 (95% CI, 13-19) to 8/100 (95% CI, 6-10). The
reduction in mortality occurred in men and women taking only 1-7
drinks/week--hazard ratios, 0.68 (95% CI, 0.49-0.94) and 0.78 (95%
CI, 0.61-0.99), respectively, with a similar protective effect from
intake of beer or other forms of alcohol. After almost 10 years'
follow-up, men taking any alcohol lived on average 7.6 months longer,
and women on average 2.7 months longer, compared with non-drinkers.
The gross cost for alcohol per life-year gained if consuming 1-7
drinks/week was $5700 in men, and $19,000 in women. CONCLUSIONS:
Moderate alcohol intake in the elderly appears to be associated with
significantly longer survival in men 60-74 years and in all elderly
women.
ARTICLE TITLE: Alcohol and cardiovascular disease: still a research
priority? [editorial; comment]
COMMENTS: Comment on: Med J Aust 2000 Aug 7; 173(3):121-4
ARTICLE SOURCE: Med J Aust (Australia), Aug 7 2000, 173(3) p116-7
AUTHOR(S): Stockwell TR
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Medibank, 25 years on: looking back, looking
forward.
ARTICLE SOURCE: Med J Aust (Australia), Jul 3 2000, 173(1) p2
AUTHOR(S): Van der Weyden MB
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE
ARTICLE TITLE: They can't say they weren't warned!.
ARTICLE SOURCE: Med J Aust (Australia), Jul 3 2000, 173(1) p17-9
AUTHOR(S): Repin GD
MAJOR SUBJECT HEADING(S): Delivery of Health Care [organization
& administration]; National Health Programs [organization
& administration]; Universal Coverage [organization &
administration]
MINOR SUBJECT HEADING(S): Australia; Delivery of Health Care
[economics] [trends]; National Health Programs
[economics] [trends]; Societies, Medical; Universal
Coverage [economics] [trends]
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: JOURNAL ARTICLE
MB: About how we eventually got to Medicare.
ARTICLE TITLE: Neurology. 4: Multiple sclerosis.
ARTICLE SOURCE: Med J Aust (Australia), Jun 5 2000, 172(11)
p556-62
AUTHOR(S): Pender MP
AUTHOR'S ADDRESS: University of Queensland, Brisbane.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (35 references); REVIEW,
TUTORIAL
.Moderate to severe attacks of MS are best treated with intravenous
infusions of high-dose methylprednisolone. Interferon beta reduces
the frequency of attacks and the progression of disability in
relapsing-remitting MS. Symptomatic therapy is important in the
management of spasticity, pain, urinary problems and the other
symptoms or complications of MS.
ARTICLE TITLE: ARDS: nothing new? [editorial]
ARTICLE SOURCE: Med J Aust (Australia), Jun 5 2000, 172(11)
p527-8
AUTHOR(S): Bersten AD; Doyle IR
PUBLICATION TYPE: EDITORIAL
MB: They think there is something new but it's not much. I wonder why
the incidence has crashed.
ARTICLE TITLE: Assessment of low-molecular-weight heparin trials in
cardiology.
ARTICLE SOURCE: Pharmacol Ther (England), Jul 2000, 87(1) p1-9
AUTHOR(S): Shulman RI
AUTHOR'S ADDRESS: Department of Pharmacy, University College London
Hospitals, Mortimer Street, W1N 8AA, London, UK.
robert.shulman@uclh.org.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (46 references); REVIEW,
TUTORIAL
The most compelling published data are in unstable angina and
non-Q-wave myocardial infarction (MI). LMWHs are at least as
effective as unfractionated heparin in terms of the composite
endpoint of death and MI. Conclusive benefits of LMWH use to prevent
restenosis after stent insertion or percutaneous transluminal
coronary angioplasty have not been established. The data in MI and
atrial fibrillation are still preliminary, but encouraging.