ARTICLE TITLE: Organ transplantation--barriers, outcomes, and
evolving policies [editorial; comment]
COMMENTS: Comment on: JAMA 1998 Oct 7; 280(13):1148-52; Comment on:
JAMA 1998 Oct 7; 280(13):1153-60
ARTICLE SOURCE: JAMA (United States), Oct 7 1998, 280(13) p1184-5
AUTHOR(S): Milford EL
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Smoke and spirits: the substance abuse dilemma
[editorial]
ARTICLE SOURCE: JAMA (United States), Oct 7 1998, 280(13) p1190
AUTHOR(S): Huang LY
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Efficacy of risk-reduction counseling to prevent
human immunodeficiency virus and sexually transmitted diseases: a
randomized controlled trial. Project RESPECT Study Group.
ARTICLE SOURCE: JAMA (United States), Oct 7 1998, 280(13) p1161-7
AUTHOR(S): Kamb ML; Fishbein M; Douglas JM Jr; Rhodes F; Rogers J;
Bolan G; Zenilman J; Hoxworth T; Malotte CK; Iatesta M; Kent C; Lentz
A; Graziano S; Byers RH; Peterman TA
AUTHOR'S ADDRESS: Division of HIV/AIDS Prevention, National Center
for HIV, STD, TB Prevention, Centers for Disease Control and
Prevention, Atlanta, GA 30333, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Short counseling interventions using personalized risk
reduction plans can increase condom use and prevent new STDs.
Effective counseling can be conducted even in busy public
clinics.
ARTICLE TITLE: From the Centers for Disease Control and
Prevention. Maternal mortality--United States, 1982-1996.
ARTICLE SOURCE: JAMA (United States), Sep 23-30 1998, 280(12)
p1042-3
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Unacceptable nursing home deaths unautopsied
[news]
ARTICLE SOURCE: JAMA (United States), Sep 23-30 1998, 280(12)
p1038-9
AUTHOR(S): Mitka M
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Girls' and boys' differing response to pain starts
early in their lives [news]
ARTICLE SOURCE: JAMA (United States), Sep 23-30 1998, 280(12)
p1035-6
AUTHOR(S): Lamberg L
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Competing risk analysis of men aged 55 to 74 years
at diagnosis managed conservatively for clinically localized prostate
cancer [see comments]
COMMENTS: Comment in: JAMA 1998 Sep 16; 280(11):1008-10
ARTICLE SOURCE: JAMA (United States), Sep 16 1998, 280(11)
p975-80
AUTHOR(S): Albertsen PC; Hanley JA; Gleason DF; Barry MJ
AUTHOR'S ADDRESS: Division of Urology, University of Connecticut
Health Center, Farmington 06030-3955, USA.
albertsen@nso.uchc.edu.
Support, Non-U.S. Gov't; Support, U.S. Gov't, P.H.S.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Men whose prostate biopsy specimens show Gleason score 2
to 4 disease face a minimal risk of death from prostate cancer within
15 years of diagnosis. Conversely, men whose biopsy specimens show
Gleason score 7 to 10 disease face a high risk of death from prostate
cancer when treated conservatively, even when cancer is diagnosed as
late as age 74 years. Men with Gleason score 5 or 6 tumors face a
modest risk of death from prostate cancer that increases slowly over
at least 15 years of follow-up.
ARTICLE TITLE: Comparing treatments for localized prostate
cancer--persisting uncertainty [editorial; comment]
COMMENTS: Comment on: JAMA 1998 Sep 16; 280(11):969-74; Comment on:
JAMA 1998 Sep 16; 280(11):975-80
ARTICLE SOURCE: JAMA (United States), Sep 16 1998, 280(11)
p1008-10
AUTHOR(S): Chodak GW
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Controversy in managing patients with prostate
cancer. Banish dogma, get more data [editorial]
ARTICLE SOURCE: BMJ (England), Jun 27 1998, 316(7149) p1919-20
AUTHOR(S): Mulley AG; Barry MJ
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: National use and effectiveness of beta-blockers for
the treatment of elderly patients after acute myocardial infarction:
National Cooperative Cardiovascular Project.
ARTICLE SOURCE: JAMA (United States), Aug 19 1998, 280(7) p623-9
AUTHOR(S): Krumholz HM; Radford MJ; Wang Y; Chen J; Heiat A;
Marciniak TA
AUTHOR'S ADDRESS: Department of Medicine, Yale School of Medicine,
and the Yale-New Haven Hospital Center for Outcomes Research and
Evaluation, CT 06520-8025, USA. PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Many ideal patients for beta-blocker therapy are not
prescribed these drugs at discharge following AMI. The clinical and
demographic characteristics of the patients do not explain much of
the variation in the treatment pattern. Geographic factors and
physician specialty are independently associated with the decision to
use beta-blockers. Elderly patients who are prescribed beta-blockers
at discharge have a better survival rate, consistent with the
findings of randomized controlled trials of younger and lower-risk
populations.
ARTICLE TITLE: Do we know what inappropriate laboratory
utilization is? A systematic review of laboratory clinical audits
[see comments]
COMMENTS: Comment in: JAMA 1998 Aug 12; 280(6):565-6
ARTICLE SOURCE: JAMA (United States), Aug 12 1998, 280(6) p550-8
AUTHOR(S): van Walraven C; Naylor CD
AUTHOR'S ADDRESS: Institute for Clinical Evaluative Sciences, North
York, Ontario, Canada. carl.vanwalraven@ices.on.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (135 references); REVIEW
LITERATURE
CONCLUSIONS: Many studies identify inappropriate laboratory use based
on implicit or explicit criteria that do not meet methodological
standards suggested for audits of therapeutic maneuvers. Researchers
should develop alternative evidentiary standards for measuring
inappropriateness of laboratory test use.
ARTICLE TITLE: Does owning a firearm increase or decrease the risk
of death? [see comments]
COMMENTS: Comment in: JAMA 1998 Aug 5; 280(5):473-5
ARTICLE SOURCE: JAMA (United States), Aug 5 1998, 280(5) p471-3
AUTHOR(S): Cummings P; Koepsell TD
AUTHOR'S ADDRESS: Harborview Injury Prevention and Research Center
and the Department of Epidemiology, School of Public Health and
Community Medicine, University of Washington, Seattle 98104-2499,
USA. peterc@u.washington.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: From the Centers for Disease Control and
Prevention. Heat-related mortality--United States, 1997.
ARTICLE SOURCE: JAMA (United States), Jul 22-29 1998, 280(4)
p316-7
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Central venous catheters-time for a change?. If you
put them in properly you don't need to change them routinely
[editorial; comment]
COMMENTS: Comment on: BMJ 1998 Jun 27; 316(7149):1944-5
ARTICLE SOURCE: BMJ (England), Jun 27 1998, 316(7149) p1918-9
AUTHOR(S): O'Leary M; Bihari D
PUBLICATION TYPE: COMMENT; EDITORIAL
The following several articles items are about the Cardiac Surgery
shambles in Bristol.
ARTICLE TITLE: All changed, changed utterly. British medicine will
be transformed by the Bristol case [editorial]
ARTICLE SOURCE: BMJ (England), Jun 27 1998, 316(7149) p1917-8
AUTHOR(S): Smith R
PUBLICATION TYPE: EDITORIAL
TITLE: Lessons from the Bristol case. More openness--on risks and on
individual surgeons' performance [editorial]
ARTICLE SOURCE: BMJ (England), Jun 6 1998, 316(7146) p1685-6
AUTHOR(S): Treasure T
PUBLICATION TYPE: EDITORIAL ARTICLE
ARTICLE TITLE: Cardiac surgery inquiry given wide remit
[news]
ARTICLE SOURCE: BMJ (England), Aug 22 1998, 317(7157) p489
AUTHOR(S): Warden J
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Public confidence and cardiac surgical outcome.
Cardiac surgery: the fall guy in medical quality assurance
[editorial]
ARTICLE SOURCE: BMJ (England), Jun 13 1998, 316(7147) p1759-60
AUTHOR(S): Keogh BE; Dussek J; Watson D; Magee P; Wheatley D
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Present system of whistleblowing is unsatisfactory
[comment]
COMMENTS: Comment on: BMJ 1998 Jun 6; 316(7146):1736-7
ARTICLE SOURCE: BMJ (England), Jun 6 1998, 316(7146) p1739-40
AUTHOR(S): Treasure T
AUTHOR'S ADDRESS: St. George's Hospital, London SW17 OQT.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ARTICLE TITLE: Understanding controlled trials. Randomising groups
of patients.
ARTICLE SOURCE: BMJ (England), Jun 20 1998, 316(7148) p1898-900
AUTHOR(S): Roberts C; Sibbald B
AUTHOR'S ADDRESS: National Primary Care Research and Development
Centre, University of Manchester, Manchester M13 9PL.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (3 references); REVIEW,
TUTORIAL
ARTICLE TITLE: The 1998 European Resuscitation Council guidelines
for adult advanced life support. Advanced Life Support Working Group
of the European Resuscitation Council [see comments]
COMMENTS: Comment in: BMJ 1998 Jun 20; 316(7148):1844-5
ARTICLE SOURCE: BMJ (England), Jun 20 1998, 316(7148) p1863-9
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ARTICLE TITLE: Confidential inquiry into quality of care before
admission to intensive care [see comments]
COMMENTS: Comment in: BMJ 1998 Jun 20; 316(7148):1841-2
ARTICLE SOURCE: BMJ (England), Jun 20 1998, 316(7148) p1853-8
AUTHOR(S): McQuillan P; Pilkington S; Allan A; Taylor B; Short A;
Morgan G; Nielsen M; Barrett D; Smith G
AUTHOR'S ADDRESS: Department of Intensive Care Medicine, Queen
Alexander Hospital, Cosham, Portsmouth, Hampshire PO6 3LY.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The management of airway, breathing, and circulation,
and oxygen therapy and monitoring in severely ill patients before
admission to intensive care units may frequently be suboptimal. Major
consequences may include increased morbidity and mortality and
requirement for intensive care. Possible solutions include improved
teaching, establishment of medical emergency teams, and widespread
debate on the structure and process of acute care.
ARTICLE TITLE: Audit commission tackles anaesthetic services.
Non-physician anaesthetists may free up consultants to concentrate on
patients requiring special attention [letter]
ARTICLE SOURCE: BMJ (England), Jun 13 1998, 316(7147) p1827
AUTHOR(S): Robinson DN
PUBLICATION TYPE: LETTER
ARTICLE TITLE: Randomised controlled trial comparing effectiveness
and acceptability of an early discharge, hospital at home scheme with
acute hospital care.
ARTICLE SOURCE: BMJ (England), Jun 13 1998, 316(7147) p1796-801
AUTHOR(S): Richards SH; Coast J; Gunnell DJ; Peters TJ; Pounsford J;
Darlow MA
AUTHOR'S ADDRESS: Department of Social Medicine, University of
Bristol, Bristol BS8 2PR. suzanne.richards@bris.ac.uk.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: The early discharge hospital at home scheme was similar
to routine hospital discharge in terms of effectiveness and
acceptability. Increased length of stay associated with the scheme
must be interpreted with caution because of different organisational
characteristics of the services.
ARTICLE TITLE: Randomised controlled trial comparing hospital at
home care with inpatient hospital care. II: cost minimisation
analysis.
ARTICLE SOURCE: BMJ (England), Jun 13 1998, 316(7147) p1791-6
AUTHOR(S): Shepperd S; Harwood D; Gray A; Vessey M; Morgan P
AUTHOR'S ADDRESS: Division of Public Health and Primary Health Care,
University of Oxford, Institute of Health Sciences, Headington,
Oxford OX3 7LF. Sasha.Shepperd@dphpc.ox.ac.uk.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: Hospital at home care did not reduce total healthcare
costs for the conditions studied in this trial, and costs were
significantly increased for patients recovering from a hysterectomy
and those with chronic obstructive airways disease. There was some
evidence that costs were shifted to primary care for elderly medical
patients and those with chronic obstructive airways disease.
ARTICLE TITLE: Randomised controlled trial comparing hospital at
home care with inpatient hospital care. I: three month follow up of
health outcomes.
ARTICLE SOURCE: BMJ (England), Jun 13 1998, 316(7147) p1786-91
AUTHOR(S): Shepperd S; Harwood D; Jenkinson C; Gray A; Vessey M;
Morgan P
AUTHOR'S ADDRESS: Division of Public Health and Primary Health Care,
University of Oxford, Institute of Health Sciences, Headington,
Oxford OX3 7LF. Sasha.Shepperd@dphpc.ox.ac.uk.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Few differences in outcome were detected. Thus, the cost
of hospital at home compared with hospital care becomes a primary
concern.
ARTICLE TITLE: Half of all doctors are below average.
ARTICLE SOURCE: BMJ (England), Jun 6 1998, 316(7146) p1734-6
AUTHOR(S): Poloniecki J
AUTHOR'S ADDRESS: Public Health Sciences, St George's Hospital
Medical School, London SW17 0RE. j.poloniecki@sghms.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Cumulative risk adjusted mortality chart for
detecting changes in death rate: observational study of heart
surgery.
ARTICLE SOURCE: BMJ (England), Jun 6 1998, 316(7146) p1697-700
AUTHOR(S): Poloniecki J; Valencia O; Littlejohns P
AUTHOR'S ADDRESS: Public Health Sciences, St George's Hospital
Medical School, London SW17 0RE. j.poloniecki@sghms.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Hospital league tables for mortality from heart surgery
will be of limited value because year to year differences in death
rate can be large (odds ratio 1.5) even when the underlying risk or
case mix does not change. Statistical quality control of a single
series with adjustment for case mix is the only way to take into
account recent performance when informing a patient of the risk of
surgery at a particular hospital. If there is an increase in the
number of deaths the chances of the next patient surviving surgery
can be calculated from the last 16 deaths.
ARTICLE TITLE: Human albumin administration in critically ill
patients: systematic review of randomised controlled trials. Cochrane
Injuries Group Albumin Reviewers [see comments]
COMMENTS: Comment in: BMJ 1998 Jul 25; 317(7153):223-4; Comment in:
BMJ 1998 Jul 25; 317(7153):240
ARTICLE SOURCE: BMJ (England), Jul 25 1998, 317(7153) p235-40
AUTHOR'S ADDRESS: Cochrane Injuries Group, Department of Epidemiology
and Public Health, Institute of Child Health, London WC1N 1EH.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ABSTRACT: OBJECTIVE: To quantify effect on mortality of administering
human albumin or plasma protein fraction during management of
critically ill patients. DESIGN: Systematic review of randomised
controlled trials comparing administration of albumin or plasma
protein fraction with no administration or with administration of
crystalloid solution in critically ill patients with hypovolaemia,
burns, or hypoalbuminaemia. SUBJECTS: 30 randomised controlled trials
including 1419 randomised patients. MAIN OUTCOME MEASURE: Mortality
from all causes at end of follow up for each trial. RESULTS: For each
patient category the risk of death in the albumin treated group was
higher than in the comparison group. For hypovolaemia the relative
risk of death after albumin administration was 1.46 (95% confidence
interval 0.97 to 2.22), for burns the relative risk was 2.40 (1.11 to
5.19), and for hypoalbuminaemia it was 1.69 (1.07 to 2.67). Pooled
relative risk of death with albumin administration was 1.68 (1.26 to
2.23). Pooled difference in the risk of death with albumin was 6%
(95% confidence interval 3% to 9%) with a fixed effects model. These
data suggest that for every 17 critically ill patients treated with
albumin there is one additional death. CONCLUSIONS: There is no
evidence that albumin administration reduces mortality in critically
ill patients with hypovolaemia, burns, or hypoalbuminaemia and a
strong suggestion that it may increase mortality. These data suggest
that use of human albumin in critically ill patients should be
urgently reviewed and that it should not be used outside the context
of rigorously conducted, randomised controlled trials.
ARTICLE TITLE: Excess mortality after human albumin administration
in critically ill patients. Clinical and pathophysiological evidence
suggests albumin is harmful [editorial; comment]
COMMENTS: Comment on: BMJ 1998 Jul 25; 317(7153):235-40
ARTICLE SOURCE: BMJ (England), Jul 25 1998, 317(7153) p223-4
AUTHOR(S): Offringa M
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Why albumin may not work [comment]
COMMENTS: Comment on: BMJ 1998 Jul 25; 317(7153):235-40
ARTICLE SOURCE: BMJ (England), Jul 25 1998, 317(7153) p240
AUTHOR(S): Berger A
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ARTICLE TITLE: Albumin: don't confuse us with the facts. Rather
than fulminating, seek to answer the questions raised
[editorial]
ARTICLE SOURCE: BMJ (England), Sep 26 1998, 317(7162) p829-30
AUTHOR(S): McClelland B
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Randomised trial of heroin maintenance programme
for addicts who fail in conventional drug treatments.
ARTICLE SOURCE: BMJ (England), Jul 4 1998, 317(7150) p13-8
AUTHOR(S): Perneger TV; Giner F; del Rio M; Mino A
AUTHOR'S ADDRESS: Institute of Social and Preventive Medicine,
University of Geneva Medical School, CH-1211 Geneva 4, Switzerland.
perneger@cmu.unige.ch.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: OBJECTIVE: To evaluate an experimental heroin maintenance
programme. Design: Randomised trial. SETTING: Outpatient clinic in
Geneva, Switzerland. SUBJECTS: Heroin addicts recruited from the
community who were socially marginalised and in poor health and had
failed in at least two previous drug treatments. INTERVENTION:
Patients in the experimental programme (n=27) received intravenous
heroin and other health and psychosocial services. Control patients
(n=24) received any other conventional drug treatment (usually
methadone maintenance). Main outcome measures: Self reported drug
use, health status (SF-36), and social functioning. RESULTS: 25
experimental patients completed 6 months in the programme, receiving
a median of 480 mg of heroin daily. One experimental subject and 10
control subjects still used street heroin daily at follow up
(difference 44%; 95% confidence interval 16% to 71%). Health status
scores that improved significantly more in experimental subjects were
mental health (0.58 SD; 0.07 to 1.10), role limitations due to
emotional problems (0.95 SD; 0.11 to 1.79), and social functioning
(0.65 SD; 0.03 to 1.26). Experimental subjects also significantly
reduced their illegal income and drug expenses and committed fewer
drug and property related offences. There were no benefits in terms
of work, housing situation, somatic health status, and use of other
drugs. Unexpectedly, only nine (38%) control subjects entered the
heroin maintenance programme at follow up. CONCLUSIONS: A heroin
maintenance programme is a feasible and clinically effective
treatment for heroin users who fail in conventional drug treatment
programmes. Even in this population, however, another attempt at
methadone maintenance may be successful and help the patient to stop
using injectable opioids.
ARTICLE TITLE: Perinatal death associated with planned home birth
in Australia: population based study.
ARTICLE SOURCE: BMJ (England), Aug 8 1998, 317(7155) p384-8
AUTHOR(S): Bastian H; Keirse MJ; Lancaster PA
AUTHOR'S ADDRESS: PO Box 569, Blackwood SA 5051, Australia.
hilda.bastian@flinders.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To assess the risk of perinatal death in planned
home births in Australia. DESIGN: Comparison of data on planned home
births during 1985-90, notified to Homebirth Australia, with national
data on perinatal deaths and outcomes of home births internationally.
RESULTS: 50 perinatal deaths occurred in 7002 planned home births in
Australia during 1985-90: 7.1 per 1000 (95% confidence interval 5.2
to 9.1) according to Australian definitions and 6.4 per 1000 (4.6 to
8.3) according to World Health Organisation definitions. The
perinatal death rate in infants weighing more than 2500 g was higher
than the national average (5.7 versus 3.6 per 1000: relative risk
1.6; 1.1 to 2.4) as were intrapartum deaths not due to malformations
or immaturity (2.7 versus 0.9 per 1000: 3.0; 1. 9 to 4.8). More than
half (52%) of the deaths were associated with intrapartum asphyxia.
CONCLUSIONS: Australian home births carried a high death rate
compared with both all Australian births and home births elsewhere.
The two largest contributors to the excess mortality were
underestimation of the risks associated with post-term birth, twin
pregnancy and breech presentation, and a lack of response to fetal
distress.
ARTICLE TITLE: Long term relative survival after surgery for
abdominal aortic aneurysm in western Australia: population based
study.
ARTICLE SOURCE: BMJ (England), Sep 26 1998, 317(7162) p852-6
AUTHOR(S): Norman PE; Semmens JB; Lawrence-Brown MM; Holman CD
AUTHOR'S ADDRESS: University Department of Surgery, Fremantle
Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia.
pnorman@cyllene.uwa.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To determine the long term relative survival of
all patients who had surgery for abdominal aortic aneurysm in Western
Australia during 1985-94. DESIGN: Population based study. SETTING:
Western Australia. SUBJECTS: All patients who had had surgery for
abdominal aortic aneurysm in Western Australia during 1985-94. MAIN
OUTCOME MEASURES: Morbidity and mortality data of patients admitted
and surgically treated for abdominal aortic aneurysm in Western
Australia during 1985-94. Elective, ruptured, and acute non-ruptured
cases were analysed separately. Independent analyses for sex and
patients aged 80 years or more were also undertaken. Postoperative
(>30 days) relative survival was assessed against age and sex
matched controls. RESULTS: Overall, 1475 (1257 men, 218 women) cases
were identified. The crude five year survival after elective surgery,
including deaths within 30 days of surgery, was 79% for both men and
women. When compared with a matched population the five year relative
survival after elective surgery was 94.9% (95% confidence interval
89.9% to 99.9%) for men but only 88.0% (76.3% to 99.7%) for women.
The five year relative survival of those aged 80 years and over was
good: 116.6% (89.1% to 144.0%) compared with 92.4% (87.7% to 97.0%)
for those under 80 years of age (men and women combined).
Cardiovascular disease caused 57.8% of the 341 deaths after 30 days.
CONCLUSION: In a condition such as abdominal aortic aneurysm, which
occurs in elderly patients, relative survival is more clinically
meaningful than crude survival. The five year relative survival in
cases of elective and ruptured abdominal aortic aneurysm was better
in men than in women. This is probably because of greater comorbidity
in women with abdominal aortic aneurysm and this deserves more
attention in the future. The long term survival outcome in
octogenarians supports surgery in selected cases.
ARTICLE TITLE: US managed care: has the UK anything to learn?
Fishbowl medicine is here to stay [editorial]
ARTICLE SOURCE: BMJ (England), Sep 26 1998, 317(7162) p831-2
AUTHOR(S): Le Grand J
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Defining the cross-sectional anatomy important to
interscalene brachial plexus block with magnetic resonance
imaging.
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Jan-Feb 1998,
23(1) p77-80
AUTHOR(S): Wong GY; Brown DL; Miller GM; Cahill DR
AUTHOR'S ADDRESS: Department of Anesthesiology, Mayo Clinic and
Foundation, Rochester, Minnesota 55905, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND AND OBJECTIVES: Interscalene brachial plexus
block is a useful technique to provide anesthesia and analgesia for
the shoulder and proximal upper extremity. The initial needle
direction at the interscalene groove has been described as being
"perpendicular to the skin in every plane" (1). A cross-sectional
(axial) approach may offer a more easily conceptualized directed
needle placement. The purpose of this study is to define the
cross-sectional anatomy and idealized needle angles important to
interscalene brachial plexus block. METHODS: Following IRB approval,
50 patients were studied. Cross-sectional volume coil T1-weighted
magnetic resonance images (MRI) were obtained from 50 patients
undergoing cervical region imaging for other reasons. At the
interscalene groove, a simulated needle path to contact the ventral
rami or trunks of the brachial plexus was approximated at the level
of C6 or C6-C7 interspace. The angle of this needle path intersecting
the sagittal plane was recorded for each patient. RESULTS: The mean
angle of the simulated needle path relative to sagittal plane was
determined to be 61.1 +/- 6.1 degrees (range, 50-78 degrees). In 13
of 50 (26%) MRI scans, the cervical nerve roots were not visualized
at the level of C6 and were measured at the C6-C7 level. CONCLUSIONS:
These findings suggest initial needle placement at the interscalene
groove should be angled less perpendicularly relative to the sagittal
plane than is often observed. A cross-sectional approach enables more
practical visualization of initial needle placement. A more accurate
initial needle placement may minimize the number of needle passes
necessary to contact the nerve roots, thereby more efficiently
obtaining a successful block.
ARTICLE TITLE: Paraplegia following intracord injection during
attempted epidural anesthesia under general anesthesia.
ARTICLE SOURCE: Reg Anesth Pain Med (United States), Jan-Feb 1998,
23(1) p104-7
AUTHOR(S): Bromage PR; Benumof JL
AUTHOR'S ADDRESS: Department of Anaesthesia, McGill University,
Montreal, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND AND OBJECTIVES: A case of permanent paraplegia
is reported following attempted epidural anesthesia for a total knee
replacement in a 62-year-old woman with a history of lumbar
laminectomy for a prolapsed intervertebral disc. METHODS: Epidural
puncture was attempted during general anesthesia and neuromuscular
block. RESULTS: After four unsuccessful attempts, an epidural
catheter was inserted above the upper end of the laminectomy scar.
Several episodes of arterial hypotension occurred intraoperative and
postoperative. Operative blood loss was minimal, and no bone glue was
used. The patient awoke paraparetic with a sensory level of
anesthesia to T5 bilaterally. MRI revealed an air bubble in the cord
at T10 and a region of increased T2-weighted signal in the anterior
aspect of the spinal cord between T4 and T5, consistent with
infarction. CONCLUSION: Standards of management are discussed in
relation to this case.
ARTICLE TITLE: Post-thoracotomy paraplegia coincident with
epidural anaesthesia.
ARTICLE SOURCE: Anaesthesia (England), Jun 1998, 53(6) p583-6
AUTHOR(S): Bhuiyan MS; Mallick A; Parsloe M
AUTHOR'S ADDRESS: Department of Anaesthesia, Pontefract General
Infirmary, West Yorkshire, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: We report a case of paraplegia in the immediate
postoperative period following right bilobectomy for carcinoma of the
lung. An epidural catheter had been inserted following induction of
anaesthesia and an infusion of bupivacaine 0.15% was used for
postoperative pain relief. Magnetic resonance imaging failed to
reveal any spinal or epidural haematoma or spinal cord ischaemia. The
patient developed respiratory failure on the third postoperative day
and required assisted ventilation. He was weaned from the ventilator
on day 15. Two days later he sustained a cardiac arrest and died.
Post-mortem examination demonstrated spinal cord infarction and
severely stenosed spinal arteries. The thoracotomy position and/or
intra-operative hypotension might have compromised the blood flow to
the spinal cord and although suspected as a possible cause, the use
of epidural analgesia was not implicated.
ARTICLE TITLE: Nurse-administered subcutaneous morphine is a
satisfactory alternative to intravenous patient-controlled analgesia
morphine after cardiac surgery.
ARTICLE SOURCE: Anesth Analg (United States), Jul 1998, 87(1)
p11-5
AUTHOR(S): Munro AJ; Long GT; Sleigh JW
AUTHOR'S ADDRESS: Department of Anaesthesia, Waikato Hospital,
Hamilton, New Zealand.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: There are no comparisons of i.v. patient controlled
analgesia (i.v. PCA) versus nurse-administered subcutaneous (NA s.c.)
morphine for acute postoperative pain. We undertook a prospective,
randomized, controlled clinical trial of 80 cardiac surgical patients
to compare i.v. PCA with NA s.c. morphine for postoperative pain
control. Visual analog scale (VAS) pain scores at rest and with
movement, daily verbal pain relief scores, and side effect profiles
were not significantly different. Total morphine requirements in the
two groups were not significantly different. A physiotherapist's
evaluation of the effectiveness of analgesia for chest physiotherapy
revealed no difference between the two groups. We conclude that NA
s.c. morphine, administered as required (up to hourly), is a
satisfactory alternative to i.v. PCA morphine after cardiac surgery.
Implications: In a prospective, randomized study, we have shown that
nurse-administered subcutaneous morphine is a satisfactory
alternative to i.v. patient-controlled analgesia after cardiac
surgery.
ARTICLE TITLE: Remifentanil pharmacokinetics in obese versus lean
patients [see comments]
COMMENTS: Comment in: Anesthesiology 1998 Sep; 89(3):557-60
ARTICLE SOURCE: Anesthesiology (United States), Sep 1998, 89(3)
p562-73
AUTHOR(S): Egan TD; Huizinga B; Gupta SK; Jaarsma RL; Sperry RJ; Yee
JB; Muir KT
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Utah
Health Sciences Center in Salt Lake City, 84132, USA.
TEGAN@anesth.med.utah.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: The essential findings of the study are that
remifentanil's pharmacokinetics are not appreciably different in
obese versus lean subjects and that remifentanil pharmacokinetic
parameters are therefore more closely related to LBM than to TBW.
Clinically this means that remifentanil dosing regimens should be
based on ideal body weight (or LBM) and not TBW.
ARTICLE TITLE: Does size matter? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1998 Sep; 89(3):562-73
ARTICLE SOURCE: Anesthesiology (United States), Sep 1998, 89(3)
p557-60
AUTHOR(S): Bouillon T; Shafer SL
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Anesthetic agents and hypothermia in ischemic brain
protection [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1998 Aug; 89(2):391-400
ARTICLE SOURCE: Anesthesiology (United States), Aug 1998, 89(2)
p289-91
AUTHOR(S): Bhardwaj A; Kirsch JR
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Choice of alpha-stat or pH-stat management and
neurologic outcomes after cardiac surgery: it depends [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 1998 Jul; 89(1):110-8
ARTICLE SOURCE: Anesthesiology (United States), Jul 1998, 89(1)
p5-7
AUTHOR(S): Hindman BJ
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Magnesium and cardiovascular disease.
ARTICLE SOURCE: Anesthesiology (United States), Jul 1998, 89(1)
p222-40
AUTHOR(S): Gomez MN
AUTHOR'S ADDRESS: Department of Anesthesia, University of Iowa
College of Medicine, Iowa City 52242, USA.
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (289 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Comparison of pH-stat and alpha-stat
cardiopulmonary bypass on cerebral oxygenation and blood flow in
relation to hypothermic circulatory arrest in piglets [see
comments]
COMMENTS: Comment in: Anesthesiology 1998 Jul; 89(1):5-7
ARTICLE SOURCE: Anesthesiology (United States), Jul 1998, 89(1)
p110-8
AUTHOR(S): Kurth CD; O'Rourke MM; O'Hara IB
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care
Medicine, Children's Hospital of Philadelphia, University of
Pennsylvania School of Medicine 19104, USA. kurth@email.chop.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Cortical deoxygenation during hypothermic arrest was
slower after pH-stat CPB. pH-stat bypass increased the prearrest ScO2
and arrest ScO2 half-life, to increase the cortical oxygen supply and
slow cortical oxygen consumption. Improved cortical physiologic
recovery after hypothermic arrest was suggested with pH-stat
management.
ARTICLE TITLE: Clinical simulation: technical novelty or
innovation in education [editorial; comment]
COMMENTS: Comment on: Anesthesiology 1998 Jul; 89(1):8-18
ARTICLE SOURCE: Anesthesiology (United States), Jul 1998, 89(1)
p1-2
AUTHOR(S): Murray DJ
PUBLICATION TYPE: COMMENT; EDITORIAL