ARTICLE TITLE: Intubation conditions and postoperative myalgia in
outpatient dental surgery: a comparison of succinylcholine with
mivacurium.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Apr 2000, 28(2)
p146-50
AUTHOR(S): Deehan S; Henderson D; Stewart K
AUTHOR'S ADDRESS: Department of Anaesthetics, St John's Hospital at
Howden, Livingston, West Lothian, U.K.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: Ninety-four patients undergoing elective outpatient third
molar extraction were recruited into a double-blind, randomized,
prospective trial comparing mivacurium (group M) with succinylcholine
(Group S) for conditions for endotracheal intubation and the
occurrence of postoperative myalgia. <snip> The incidence of
postoperative myalgia was 9.5% in group M and 26% in group S but this
was not statistically significant (P = 0.09).
MB: There was some myalgia after mivacurium but difference was not
statistically significant.!!!
ARTICLE TITLE: Use of inhaled nitric oxide perioperatively and in
intensive care patients.
ARTICLE SOURCE: Anesthesiology (United States), Jun 2000, 92(6)
p1821-5
AUTHOR(S): Haddad E; Lowson SM; Johns RA; Rich GF
AUTHOR'S ADDRESS: Department of Anesthesiology, University of
Virginia Health System, Charlottesville, Virginia 22906-0010,
USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (19 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Current issues in clinical trial design: superiority
versus equivalency studies.
ARTICLE SOURCE: Anesthesiology (United States), Jun 2000, 92(6)
p1814-20
AUTHOR(S): Landow L
AUTHOR'S ADDRESS: Department of Anesthesiology, Perioperative and
Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts,
USA. landow@mediaone.net.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (15 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Preemptive analgesia by intravenous low-dose ketamine
and epidural morphine in gastrectomy: a randomized double-blind
study.
ARTICLE SOURCE: Anesthesiology (United States), Jun 2000, 92(6)
p1624-30
AUTHOR(S): Aida S; Yamakura T; Baba H; Taga K; Fukuda S; Shimoji
K
AUTHOR'S ADDRESS: Departments of Anesthesiology, Teikyo University
School of Medicine, Tokyo, Japan.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: The results suggest that for definitive preemptive
analgesia, blockade of opioid and N-methyl-d-aspartate receptors is
necessary for upper abdominal surgery such as gastrectomy; singly,
either treatment provided significant, but not definitive,
postsurgical pain relief. Epidural morphine may affect the spinal
cord segmentally, whereas intravenous ketamine may block brain stem
sensitization via the vagus nerve during upper abdominal surgery.
MB: Full of 'suggests' & 'mays'.
ARTICLE TITLE: Efficacy of continuous insufflation of oxygen combined
with active cardiac compression-decompression during out-of-hospital
cardiorespiratory arrest [see comments]
COMMENTS: Comment in: Anesthesiology 2000 Jun; 92(6):1517-8
ARTICLE SOURCE: Anesthesiology (United States), Jun 2000, 92(6)
p1523-30
AUTHOR(S): Saissy JM; Boussignac G; Cheptel E; Rouvin B; Fontaine D;
Bargues L; Levecque JP; Michel A; Brochard L
AUTHOR'S ADDRESS: Service d'Anesthesie-Reanimation, Hopital
d'Instruction des Armees BEGIN, Saint-Mande, France.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: During experimental cardiac arrest, continuous
insufflation of air or oxygen (CIO) through microcannulas inserted
into the inner wall of a modified intubation tube and generating a
permanent positive intrathoracic pressure, combined with external
cardiac massage, has previously been shown to be as effective as
intermittent positive pressure ventilation (IPPV). METHODS: After
basic cardiorespiratory resuscitation, the adult patients who
experienced nontraumatic, out-of-hospital cardiac arrest with
asystole, were randomized to two groups: an IPPV group tracheally
intubated with a standard tube and ventilated with standard IPPV and
a CIO group for whom a modified tube was inserted, and in which CIO
at a flow rate of 15 l/min replaced IPPV (the tube was left open to
atmosphere). Both groups underwent active cardiac
compression-decompression with a device. Resuscitation was continued
for a maximum of 30 min. Blood gas analysis was performed as soon as
stable spontaneous cardiac activity was restored, and a second blood
gas analysis was performed at admission to the hospital. RESULTS: The
two groups of patients (47 in the IPPV and 48 in the CIO group) were
comparable. The percentages of patients who underwent successful
resuscitation (stable cardiac activity; 21.3 in the IPPV group and
27.1% in the CIO group) and the time necessary for successful
resuscitation (11.8 +/- 1.8 and 12.8 +/- 1.9 min) were also
comparable. The blood gas analysis performed after resuscitation (8
patients in the IPPV and 10 in the CIO group) did not show
significant differences. The arterial blood gases performed after
admission to the hospital and ventilation using a transport
ventilator (seven patients in the IPPV group and six in the CIO
group) showed that the partial pressure of arterial carbon dioxide
(PaCO2) was significantly lower in the CIO group (35.7 +/- 2.1
compared with 72.7 +/- 7.4 mmHg), whereas the pH and the partial
pressure of arterial oxygen (PaO2) were significantly higher (all P
< 0.05). CONCLUSIONS: Continuous insufflation of air or oxygen
alone through a multichannel open tube was as effective as IPPV
during out-of-hospital cardiac arrest. A significantly greater
elimination of carbon dioxide and a better level of oxygenation in
the group previously treated with CIO probably reflected better lung
mechanics.
ARTICLE TITLE: Field evaluation of experimental cardiopulmonary
resuscitation techniques [editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 Jun; 92(6):1523-30
ARTICLE SOURCE: Anesthesiology (United States), Jun 2000, 92(6)
p1517-8
AUTHOR(S): Hevesi ZG; Downs JB; Smith RA
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: Says that this research would not be permitted in the US. I think
that would apply here. French law permits research in emergency
patients without individual consent.
ARTICLE TITLE: Cardiopulmonary resuscitation by chest compression
alone or with mouth-to-mouth ventilation [see comments]
COMMENTS: Comment in: N Engl J Med 2000 May 25; 342(21):1599-601
ARTICLE SOURCE: N Engl J Med (United States), May 25 2000, 342(21)
p1546-53
AUTHOR(S): Hallstrom A; Cobb L; Johnson E; Copass M
AUTHOR'S ADDRESS: Department of Biostatistics, University of
Washington, and Medic I, Seattle, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Despite extensive training of citizens of
Seattle in cardiopulmonary resuscitation (CPR), bystanders do not
perform CPR in almost half of witnessed cardiac arrests. Instructions
in chest compression plus mouth-to-mouth ventilation given by
dispatchers over the telephone can require 2.4 minutes. In
experimental studies, chest compression alone is associated with
survival rates similar to those with chest compression plus
mouth-to-mouth ventilation. We conducted a randomized study to
compare CPR by chest compression alone with CPR by chest compression
plus mouth-to-mouth ventilation. METHODS: The setting of the trial
was an urban, fire-department-based, emergency-medical-care system
with central dispatching. In a randomized manner, telephone
dispatchers gave bystanders at the scene of apparent cardiac arrest
instructions in either chest compression alone or chest compression
plus mouth-to-mouth ventilation. The primary end point was survival
to hospital discharge. RESULTS: Data were analyzed for 241 patients
randomly assigned to receive chest compression alone and 279 assigned
to chest compression plus mouth-to-mouth ventilation. Complete
instructions were delivered in 62 percent of episodes for the group
receiving chest compression plus mouth-to-mouth ventilation and 81
percent of episodes for the group receiving chest compression alone
(P=0.005). Instructions for compression required 1.4 minutes less to
complete than instructions for compression plus mouth-to-mouth
ventilation. Survival to hospital discharge was better among patients
assigned to chest compression alone than among those assigned to
chest compression plus mouth-to-mouth ventilation (14.6 percent vs.
10.4 percent), but the difference was not statistically significant
(P=0.18). CONCLUSIONS: The outcome after CPR with chest compression
alone is similar to that after chest compression with mouth-to-mouth
ventilation, and chest compression alone may be the preferred
approach for bystanders inexperienced in CPR.
MB: This experiment was done in the US.
ARTICLE TITLE: Cardiopulmonary resuscitation--strengthening the links
in the chain of survival [editorial; comment]
COMMENTS: Comment on: N Engl J Med 2000 May 25; 342(21):1546-53
ARTICLE SOURCE: N Engl J Med (United States), May 25 2000, 342(21)
p1599-601
AUTHOR(S): Ewy GA
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: Chest compression and defibrillation.
ARTICLE TITLE: Massive hemoptysis after the initiation of positive
pressure ventilation in a patient with pulmonary tuberculosis.
ARTICLE SOURCE: Anesthesiology (United States), May 2000, 92(5)
p1480-2
AUTHOR(S): Wang YL; Hong CL; Chung HS; Ho AC; Yu CL; Liu HP; Lee YH;
Tan PP
AUTHOR'S ADDRESS: Department of Anesthesia, Chang Gung Memorial
Hospital, Taiwan, Republic of China.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Citrate storage affects Thrombelastograph analysis
[see comments]
COMMENTS: Comment in: Anesthesiology 2000 May; 92(5):1223-5
ARTICLE SOURCE: Anesthesiology (United States), May 2000, 92(5)
p1242-9
AUTHOR(S): Camenzind V; Bombeli T; Seifert B; Jamnicki M; Popovic D;
Pasch T; Spahn DR
AUTHOR'S ADDRESS: Institute of Anesthesiology, University Hospital,
Zurich, Switzerland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSIONS: Analysis of native blood yields the most reliable TEG
results. Should immediate TEG processing not be possible, citrated
blood may be used if recalcified after 1-8 h.
MB: There was a similar article in last months Articles of
Interest.
ARTICLE TITLE: Thromboelastography: past, present, and future
[editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 May; 92(5):1242-9
ARTICLE SOURCE: Anesthesiology (United States), May 2000, 92(5)
p1223-5
AUTHOR(S): Whitten CW; Greilich PE
PUBLICATION TYPE: COMMENT; EDITORIAL; REVIEW (17 references); REVIEW,
TUTORIAL
MB: Not very enthusiastic about present level of knowledge.
ARTICLE TITLE: Difficult mask ventilation: an underestimated aspect
of the problem of the difficult airway? [editorial;
comment]
COMMENTS: Comment on: Anesthesiology 2000 May; 92(5):1229-36
ARTICLE SOURCE: Anesthesiology (United States), May 2000, 92(5)
p1217-8
AUTHOR(S): Adnet F
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: It is getting worse 'cause of the LMA.
ARTICLE TITLE: Robert H. Goetz: the surgeon who performed the first
successful clinical coronary artery bypass operation.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jun 2000, 69(6)
p1966-72
AUTHOR(S): Konstantinov IE
AUTHOR'S ADDRESS: Division of Cardiovascular Surgery, Mayo Clinic,
Rochester, Minnesota 55902, USA. konstantinov.igor@mayo.edu.
PUBLICATION TYPE: BIOGRAPHY; HISTORICAL ARTICLE; JOURNAL ARTICLE
ABSTRACT: Robert H. Goetz performed the first successful clinical
coronary artery bypass operation on May 2, 1960. He used a nonsuture
technique to connect the right internal thoracic artery to the
coronary artery by means of a modified Payr's cannula made of
tantalum. The patency of the anastomosis was demonstrated
angiographically and the patient remained free of angina pectoris for
1 year. It was an important and brave step forward, a step that was
far ahead of its time. Unfortunately, his pioneering work was not
appreciated and fell into oblivion.
MB: I think the first vein graft was in Argentina in 1968---after I
had wondered why it was not being done.
ARTICLE TITLE: Third-degree burns due to intraoperative use of a Bair
Hugger warming device.
ARTICLE SOURCE: Ann Thorac Surg (United States), Jun 2000, 69(6)
p1933-4
AUTHOR(S): Truell KD; Bakerman PR; Teodori MF; Maze A
AUTHOR'S ADDRESS: Department of Pediatric Cardiothoracic Surgery,
Phoenix Children's Hospital, Arizona 85006, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: We report the case of a 3-year-old boy who underwent
correction of transposition of the great arteries who developed burns
from use of a patient warming device. His repair had been delayed
because he was from a developing country, and he was offered surgery
as part of a humanitarian effort. Postoperatively he was noted to
have second- and third-degree burns from use of a Bair Hugger
(Augustine Medical, Eden Prairie, MN) warming system after
cardiopulmonary bypass.
ARTICLE TITLE: Effects of single dose, postinduction dexamethasone on
recovery after cardiac surgery.
ARTICLE SOURCE: Ann Thorac Surg (United States), May 2000, 69(5)
p1420-4
AUTHOR(S): Yared JP; Starr NJ; Torres FK; Bashour CA; Bourdakos G;
Piedmonte M; Michener JA; Davis JA; Rosenberger TE
AUTHOR'S ADDRESS: Department of Cardiothoracic Anesthesiology, The
Cleveland Clinic Foundation, Ohio 44195, USA.
yaredj@cesmtp.ccf.org.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: Dexamethasone facilitates early tracheal extubation and
is associated with a lower incidence of early postoperative fever and
new-onset atrial fibrillation. Apart from a treatable decreased
glucose tolerance, dexamethasone treatment was not shown to affect
morbidity or mortality significantly.
MB: The authors were responsible for the first sentence. Don't do
it.
ARTICLE TITLE: Ventilator-associated pneumonia.
ARTICLE SOURCE: Arch Intern Med (United States), Jul 10 2000, 160(13)
p1926-36
AUTHOR(S): Morehead RS; Pinto SJ
AUTHOR'S ADDRESS: Division of Pulmonary and Critical Care Medicine,
University of Kentucky School of Medicine, Lexington, KY, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (164 references); REVIEW,
TUTORIAL
Several strategies seem to reduce pneumonia incidence; however,
mortality and cost benefits have yet to be convincingly shown.
MB: Does not sound very encouraging.
ARTICLE TITLE: Prayer and medical science: a commentary on the prayer
study by Harris et al and a response to critics.
ARTICLE SOURCE: Arch Intern Med (United States), Jun 26 2000, 160(12)
p1735-7
AUTHOR(S): Dossey L
AUTHOR'S ADDRESS: ldossey@ix.netcom.com.
PUBLICATION TYPE: JOURNAL ARTICLE
MB: A very long philosophical letter.
ARTICLE TITLE: All-cause mortality associated with physical activity
during leisure time, work, sports, and cycling to work.
ARTICLE SOURCE: Arch Intern Med (United States), Jun 12 2000, 160(11)
p1621-8
AUTHOR(S): Andersen LB; Schnohr P; Schroll M; Hein HO
AUTHOR'S ADDRESS: Institute for Exercise and Sport Sciences,
University of Copenhagen, Denmark. lbandersen@ifi.ku.dk.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Leisure time physical activity was inversely associated
with all-cause mortality in both men and women in all age groups.
Benefit was found from moderate leisure time physical activity, with
further benefit from sports activity and bicycling as
transportation.
MB: Well they would say that, wouldn't they.
ARTICLE TITLE: Does aspirin attenuate the beneficial effects of
angiotensin-converting enzyme inhibition in heart failure?
ARTICLE SOURCE: Arch Intern Med (United States), May 22 2000, 160(10)
p1409-13
AUTHOR(S): Stys T; Lawson WE; Smaldone GC; Stys A
AUTHOR'S ADDRESS: Department of Medicine, State University of New
York, Stony Brook, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (45 references); REVIEW,
TUTORIAL
(T)he counteracting effect of acetylsalicylic acid [ASA] on
the augmentation of prostacyclin synthesis by ACE inhibitors could
result in a potential reduction of the beneficial effects of the
angiotensin-converting enzyme (ACE) inhibitor's and could be of great
importance. This article reviews reports from large clinical trials
pertaining to this issue and relates their findings to the currently
available theoretical bases for support of the counteracting effect
of ASA on augmentation of prostacyclin synthesis by ACE inhibitors.
The clinical implications of such an interaction are discussed.
ARTICLE TITLE: Beta-blockers: the new standard of therapy for mild
heart failure.
ARTICLE SOURCE: Arch Intern Med (United States), May 8 2000, 160(9)
p1237-47
AUTHOR(S): Abraham WT
AUTHOR'S ADDRESS: The University of Cincinnati College of Medicine,
Ohio 45267-0542, USA. william.abraham@uc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (81 references); REVIEW,
TUTORIAL
The educational objective of this article is to provide the primary
care physician with a review of the current understanding of the
pathophysiological characteristics underlying chronic systolic heart
failure, the clinical benefits of administering beta-blockers during
the early stages of heart failure, and the practical considerations
of initiating therapy.
ARTICLE TITLE: Drug treatment in heart failure.
ARTICLE SOURCE: BMJ (England), Apr 29 2000, 320(7243) p1188-92
AUTHOR(S): Lonn E; McKelvie R
AUTHOR'S ADDRESS: Hamilton Health Sciences Corporation, General Site,
McMaster Clinic, Hamilton, Ontario L8L 2X2, Canada.
lonnem@fhs.McMaster.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (26 references); REVIEW,
TUTORIAL
MB: A very sensible summary.
ARTICLE TITLE: Multicentre research ethics committees: has the cure
been worse than the disease? No, but idiosyncracies and obstructions
to good research must be removed [editorial; comment]
COMMENTS: Comment on: BMJ 2000 Apr 29; 320(7243):1179-82; Comment on:
BMJ 2000 Apr 29; 320(7243):1182-3
ARTICLE SOURCE: BMJ (England), Apr 29 2000, 320(7243) p1157-8
AUTHOR(S): Alberti KG
ARTICLE TITLE: Smoking and dementia in male British doctors:
prospective study [see comments]
COMMENTS: Comment in: BMJ 2000 Apr 22; 320(7242):1087-8
ARTICLE SOURCE: BMJ (England), Apr 22 2000, 320(7242) p1097-102
AUTHOR(S): Doll R; Peto R; Boreham J; Sutherland I
AUTHOR'S ADDRESS: Clinical Trial Service Unit and Epidemiological
Studies Unit, Radcliffe Infirmary, Oxford OX2 6HE.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Contrary to previous suggestions persistent smoking does
not substantially reduce the age specific onset rate of Alzheimer's
disease or of dementia in general. If anything, it might increase
rather than decrease the rate, but any net effect on severe dementia
cannot be large in either direction.
ARTICLE TITLE: Smoking and the brain [editorial; comment]
COMMENTS: Comment on: BMJ 2000 Apr 22; 320(7242):1097-102
ARTICLE SOURCE: BMJ (England), Apr 22 2000, 320(7242) p1087-8
AUTHOR(S): Brayne C
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Government announces army of 133 to rescue England's
NHS [news]
ARTICLE SOURCE: BMJ (England), Apr 15 2000, 320(7241) p1027
AUTHOR(S): Jones J
PUBLICATION TYPE: NEWS
MB: Central planning gone wild. They should ask Hillary to help
them.
ARTICLE TITLE: Doctors and nurses: doing it differently
[editorial]
ARTICLE SOURCE: BMJ (England), Apr 15 2000, 320(7241) p1019-20
AUTHOR(S): Salvage J; Smith R
PUBLICATION TYPE: EDITORIAL
MB: Pretty silly.
ARTICLE TITLE: The decreasing supply of registered nurses: inevitable
future or call to action? [comment]
COMMENTS: Comment on: JAMA 2000 Jun 14; 283(22):2948-54
ARTICLE SOURCE: JAMA (United States), Jun 14 2000, 283(22)
p2985-7
AUTHOR(S): Bednash G
AUTHOR'S ADDRESS: American Association of Colleges of Nursing, 1
Dupont Cir, Suite 530, Washington, DC 20036, USA.
pbednash@aacn.nche.edu.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ARTICLE TITLE: "Chest pain-please admit": is there an alternative?. A
rapid cardiological assessment service may prevent unnecessary
admissions [editorial]
ARTICLE SOURCE: BMJ (England), Apr 8 2000, 320(7240) p951-2
AUTHOR(S): Capewell S; McMurray J
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Effect of beer drinking on risk of myocardial
infarction: population based case-control study.
ARTICLE SOURCE: BMJ (England), May 20 2000, 320(7246) p1378-9
AUTHOR(S): Bobak M; Skodova Z; Marmot M
AUTHOR'S ADDRESS: International Centre for Health and Society,
Department of Epidemiology and Public Health, University College
London, London WC1E 6BT. martinb@public-health.ucl.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Heart transplants suspended in Scotland
[news]
ARTICLE SOURCE: BMJ (England), May 20 2000, 320(7246) p1361
AUTHOR(S): Christie B
PUBLICATION TYPE: NEWS
MB: No surgeons.
ARTICLE TITLE: Controversy over new editor at New England Journal of
Medicine [news]
ARTICLE SOURCE: BMJ (England), May 20 2000, 320(7246) p1358
AUTHOR(S): Gottlieb S
PUBLICATION TYPE: NEWS
MB: Sounds like the end of independent medical journals. They are now
openly like any other newspaper dependent on the owners. The acting
Editor decided not to take on the editorship and is going to write
about alternative medicine. The new editor has conflicts of
interest.
ARTICLE TITLE: Reperfusion in acute myocardial infarction. Ensuring
early reperfusion, by whatever means, is the best strategy for now
[editorial]
ARTICLE SOURCE: BMJ (England), May 20 2000, 320(7246) p1354-5
AUTHOR(S): Robinson NM; Timmis AD
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Thyroid function tests-time for a reassessment.
ARTICLE SOURCE: BMJ (England), May 13 2000, 320(7245) p1332-4
AUTHOR(S): O'Reilly DS
AUTHOR'S ADDRESS: Department of Clinical Biochemistry and Clinic for
Thyroid Diseases, Royal Infirmary, Glasgow G4 0SF.
doreilly@clinmed.gla.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (28 references); REVIEW,
TUTORIAL
ARTICLE TITLE: A promising start, but fundamental reform is
needed.
ARTICLE SOURCE: BMJ (England), May 13 2000, 320(7245) p1329-31
AUTHOR(S): Enthoven AC
AUTHOR'S ADDRESS: Graduate School of Business, Stanford, CA
94305-5015, USA. enthoven_alain@gsb.stanford.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (7 references); REVIEW,
TUTORIAL
MB: His earlier ideas influenced changes in Eng. NHS in 1990s which
of course have not worked. He now advocates more utopian to fix it. I
am sure he means well. It is worth looking at the full text. It
proposes systems that are obviously impossible ---like the dead
Soviet Block command economies.
ARTICLE TITLE: The health hazards of mobile phones
[editorial]
ARTICLE SOURCE: BMJ (England), May 13 2000, 320(7245) p1288-9
AUTHOR(S): Maier M; Blakemore C; Koivisto M
PUBLICATION TYPE: EDITORIAL
MB: Driving while using them is bad but otherwise they don't
know.
ARTICLE TITLE: Mobile phones: are they safe? [news]
ARTICLE SOURCE: Lancet (England), May 20 2000, 355(9217) p1793
AUTHOR(S): Senior K
PUBLICATION TYPE: NEWS
ARTICLE TITLE: Babies and consent: yet another NHS scandal. But it
should lead to improvements in research governance within the NHS
[editorial]
ARTICLE SOURCE: BMJ (England), May 13 2000, 320(7245) p1285-6
AUTHOR(S): Smith R
PUBLICATION TYPE: EDITORIAL
MB: Muddled thought process by the actual Editor.
ARTICLE TITLE: Isolated systolic hypertension: a radical rethink.
It's a risk factor that needs treatment, especially in the over 50s
[editorial]
ARTICLE SOURCE: BMJ (England), Jun 24 2000, 320(7251) p1685
AUTHOR(S): Wilkinson IB; Webb Christison DJ; Cockcroft JR
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Senior doctors split over general medical council
[editorial; comment]
COMMENTS: Comment on: BMJ 2000 Jun 17; 320(7250):1627-31
ARTICLE SOURCE: BMJ (England), Jun 17 2000, 320(7250) p1621
AUTHOR(S): Beecham L
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: The Pommes are making a mess of this.
ARTICLE TITLE: Suicidal behaviour in gay, lesbian, and bisexual youth
[editorial]
ARTICLE SOURCE: BMJ (England), Jun 17 2000, 320(7250) p1617-8
AUTHOR(S): Bagley C; D'Augelli AR
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: How does male circumcision protect against HIV
infection?
ARTICLE SOURCE: BMJ (England), Jun 10 2000, 320(7249) p1592-4
AUTHOR(S): Szabo R; Short RV
AUTHOR'S ADDRESS: Faculty of Medicine, Monash University, Wellington
Road, Melbourne 3168, Australia.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (16 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Doctors' strike in Israel may be good for health
[news]
ARTICLE SOURCE: BMJ (England), Jun 10 2000, 320(7249) p1561
AUTHOR(S): Siegel-Itzkovich J
PUBLICATION TYPE: NEWS
MB: Mortality down. A similar thing happened some years ago.
ARTICLE TITLE: HIV risk behaviour in gay men: on the rise?
[editorial; comment]
COMMENTS: Comment on: BMJ 2000 Jun 3; 320(7248):1510-1
ARTICLE SOURCE: BMJ (England), Jun 3 2000, 320(7248) p1487-8
AUTHOR(S): Grulich A
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Sleep medicine practices, training, and attitudes: a
wake-up call for pulmonologists.
ARTICLE SOURCE: Chest (United States), Jun 2000, 117(6) p1603-7
AUTHOR(S): Phillips B; Collop N; Goldberg R
AUTHOR'S ADDRESS: University of Kentucky College of Medicine.
Lexington, KY 40536-00847, USA. BPHIL95@aol.com.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Participants were actively involved in the practice of
sleep medicine, most had trained informally, and performance on
questions about nonpulmonary sleep disorders was not good.
ARTICLE TITLE: Thromboembolism management in Europe vs North America:
are the differences clinically significant? [editorial;
comment]
COMMENTS: Comment on: Chest 2000 Jun; 117(6):1755-70
ARTICLE SOURCE: Chest (United States), Jun 2000, 117(6) p1536-7
AUTHOR(S): Goldhaber SZ
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Negative fluid balance predicts survival in patients
with septic shock: a retrospective pilot study [see
comments]
COMMENTS: Comment in: Chest 2000 Jun; 117(6):1535-6
ARTICLE SOURCE: Chest (United States), Jun 2000, 117(6) p1749-54
AUTHOR(S): Alsous F; Khamiees M; De Girolamo A; Amoateng-Adjepong Y;
Manthous CA
AUTHOR'S ADDRESS: Division of Pulmonary and Critical Care, Bridgeport
Hospital and Yale University School of Medicine, Bridgeport, CT
06610, USA. pcmant@bpthosp.org.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: We hypothesized that patients with septic shock
who achieve negative fluid balance (< or =-500 mL) on any day in
the first 3 days of management are more likely to survive than those
who do not. DESIGN: Retrospective chart review. PATIENTS: Thirty-six
patients admitted with the diagnosis of septic shock. SETTING:
Twelve-bed medical ICU of a 300-bed community teaching hospital.
METHODS: Medical records of 36 patients admitted to our medical ICU
over a 21-month period were examined. Patients with septic shock who
required dialysis prior to hospitalization were not included. A
number of demographic and physiologic variables were extracted from
the medical records. Admission APACHE (acute physiology and chronic
health evaluation) II and daily sequential organ failure assessment
(SOFA) scores were computed from the extracted data. Variables were
compared between survivors and nonsurvivors and in patients who did
vs those who did not achieve negative (< or = 500 mL) fluid
balance in > or = 1 day of the first 3 days of management.
Survival risk ratios (RRs) were used as the measure of association
between negative fluid balance and survival. RRs were adjusted for
age, APACHE II scores, SOFA scores on the first and third days, and
the need for mechanical ventilation, by stratified analyses. RESULTS:
Patients ranged in age from 16 to 85 years with a mean (+/- SE) age
of 67.4 +/- 3.3 years. The mean admission APACHE II score was 25.4
+/- 1.4, and the day 1 SOFA score was 9.0 +/- 0.8. Twenty patients
did not survive; nonsurvivors had higher mean APACHE II scores than
survivors (29.8 vs 20.4, respectively) and higher first day SOFA
scores than survivors (10.8 vs 6.9, respectively), and they were more
likely to require vasopressors and mechanical ventilation compared to
patients who survived. Whereas all 11 patients who achieved a
negative balance of > 500 mL on > or = 1 of the first 3 days of
treatment survived, only 5 of 25 patient who failed to achieve a
negative fluid balance of > 500 mL by the third day of treatment
survived (RR, 5.0; 95% CI, 2.3 to 10.9; p = 0.00001). At least 1 day
of net negative fluid balance in the first 3 days of treatment
strongly predicted survival across the strata of age, APACHE II
scores, first- and third-day SOFA scores, the need for mechanical
ventilation, and creatinine levels measured at admission. CONCLUSION:
These results suggest that at least 1 day of negative fluid balance
(< or = -500 mL) achieved by the third day of treatment may be a
good independent predictor of survival in patients with septic shock.
These findings suggest the hypothesis "that negative fluid balance
achieved in any of the first 3 days of septic shock portends a good
prognosis," for a larger prospective cohort study.
MB: They suggest that one should not even think of giving diuretics
to fix sepsis but I am sure that will not stop a new fashion.
ARTICLE TITLE: Fluid balance in sepsis: are we ready for a negative
balance? [editorial; comment]
COMMENTS: Comment on: Chest 2000 Jun; 117(6):1749-54
ARTICLE SOURCE: Chest (United States), Jun 2000, 117(6) p1535-6
AUTHOR(S): Varon J; Fromm RE Jr
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: This is trying to stop any temptation to treat 'sepsis' with
diuretics.
ARTICLE TITLE: Obstructive sleep apnea syndrome-associated nocturnal
myocardial ischemia [editorial; comment]
COMMENTS: Comment on: Chest 2000 Jun; 117(6):1597-602
ARTICLE SOURCE: Chest (United States), Jun 2000, 117(6) p1534-5
AUTHOR(S): Mutlu GM; Rubinstein I
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Safety of bedside percutaneous dilatational
tracheostomy in obese patients in the ICU.
ARTICLE SOURCE: Chest (United States), May 2000, 117(5) p1426-9
AUTHOR(S): Mansharamani NG; Koziel H; Garland R; Lo Cicero J 3rd;
Critchlow J; Ernst A
AUTHOR'S ADDRESS: Division of Pulmonary and Critical Care Medicine,
Beth Israel Deaconess Medical Center and Harvard Medical School,
Boston, MA 02115, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Bedside percutaneous tracheostomy can be safely performed
in obese patients.
MB: Of course anything can be true.
ARTICLE TITLE: Serum lidocaine concentrations in asthmatics
undergoing research bronchoscopy.
ARTICLE SOURCE: Chest (United States), Apr 2000, 117(4) p1055-60
AUTHOR(S): Langmack EL; Martin RJ; Pak J; Kraft M
AUTHOR'S ADDRESS: Department of Medicine, National Jewish Medical and
Research Center, Denver, CO 80206, USA. langmacke@njc.org.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: STUDY OBJECTIVES: To determine how often serum lidocaine
concentrations (SLC) fall into the potentially toxic range (> 5
mg/L) in asthmatics undergoing research bronchoscopy, and to
determine whether subject or procedure characteristics are associated
with higher SLC. DESIGN: Prospective, observational study. SETTING:
Academic research center. CONCLUSIONS: An average total dose of 600
mg (8.2 mg/kg) of lidocaine appears to be safe in mild to moderate
asthmatics undergoing research bronchoscopy.
MB: A student was killed in New York a while ago having some
experimental bronchooscopic thing done.
ARTICLE TITLE: Effects of temperature strategy during cardiopulmonary
bypass on cerebral oxygen balance.
ARTICLE SOURCE: J Cardiovasc Surg (Torino) (Italy), Feb 2000, 41(1)
p1-6
AUTHOR(S): Ip-Yam PC; Thomas SD; Jackson M; Rashid A; Behl S
AUTHOR'S ADDRESS: Department of Anaesthesia, Royal Liverpool
University Hospital, UK.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSION: During pump flows employed in this study, cerebral oxygen
balance and perfusion appear unaffected by temperature.
ARTICLE TITLE: Endocrine consequences of long-term intrathecal
administration of opioids.
ARTICLE SOURCE: J Clin Endocrinol Metab (United States), Jun 2000,
85(6) p2215-22
AUTHOR(S): Abs R; Verhelst J; Maeyaert J; Van Buyten JP; Opsomer F;
Adriaensen H; Verlooy J; Van Havenbergh T; Smet M; Van Acker K
AUTHOR'S ADDRESS: Department of Endocrinology, University Hospital
Antwerp, Belgium.
PUBLICATION TYPE: JOURNAL ARTICLE
In conclusion, of all patients receiving intrathecal opioids, the
large majority of men and all women developed hypogonadotropic
hypogonadism, about 15% developed central hypocorticism, and about
15% developed GH deficiency. These findings suggest that further
investigations are required to determine the need for systematic
endocrine work-up in these patients and the necessity for
substitutive therapy.
ARTICLE TITLE: The changing incidence and spectrum of thyroid
carcinoma in Tasmania (1978-1998) during a transition from iodine
sufficiency to iodine deficiency.
ARTICLE SOURCE: J Clin Endocrinol Metab (United States), Apr 2000,
85(4) p1513-7
AUTHOR(S): Burgess JR; Dwyer T; McArdle K; Tucker P; Shugg D
AUTHOR'S ADDRESS: Department of Diabetes and Endocrine Services,
Royal Hobart Hospital, Australia. jburges@postoffice.utas.edu.au.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Exposure to ionizing radiation, changing levels of iodine
nutrition, and increased pathologic diagnosis of clinically
unimportant thyroid neoplasia have all been proposed as explanations
for a worldwide rise in the incidence of thyroid carcinoma (TC) over
the past 6 decades. Tasmania is geographically an area of endemic
iodine deficiency. In this report, we describe the spectrum of TC in
a population averaging 450,000 persons during a 21-yr period that
spans the communities transition from iodine sufficiency to iodine
deficiency after discontinuation of universal iodine prophylaxis in
the mid 1980s. The Tasmanian Cancer Register was used to ascertain
all cases of TC diagnosed in Tasmania between 1978 and 1998.
Histopathological and demographic data were reviewed. A total of 289
cases of TC were identified. Papillary TC (PTC), follicular TC,
medullary TC, and other species accounted for 62%, 23%, 4%, and 11%
of cases, respectively. The age standardized incidence rate for total
TC increased from 2.45 to 5.33 per 100,000 for females and 0.75 to
1.76 per 100,000 for males between 1978 and 1984 and 1992 and 1998,
respectively. A rise in the incidence of PTC by 4.5-fold (P <
0.05) in females and 2.1-fold in males (not significant) was the
dominant change over this period. In parallel, the proportion of
follicular TC relative to PTC fell from 0.35 to 0.17 during these
years (P < 0.05). The rise in PTC incidence was, in part, due to
an increase in the occurrence of tumors 1cm or less in diameter.
Nonetheless, a 3-fold rise in incidence of larger lesions was also
observed during the study period. Forty-three (24%) PTC cases had
multifocal disease, 17 (40%) of whom had bilateral tumors. Familial
(autosomal dominant) PTC was identified in nine (5%) total PTC cases.
Prior studies have linked iodine prophylaxis to a rise in the
proportion of differentiated TC, particularly PTC. Our data suggest a
complex relationship between iodine nutrition and thyroid
tumorigenesis. Factors such as a long latency between changes in
iodine nutrition and thyroid tumorigenesis, a dose threshold for the
effect of iodine nutrition on thyroid tumorigenesis, and an
interaction between iodine nutrition and thyroidal sensitivity to
ionizing radiation may all play a role.
MB: Did they really stop giving iodine in Tasi? Look at the full text
for the changes which must have been politically generated. There is
now iodine deficiency in Tasmania where there had been
sufficiency.
ARTICLE TITLE: Clinical review 113: Hypopituitarism secondary to head
trauma.
ARTICLE SOURCE: J Clin Endocrinol Metab (United States), Apr 2000,
85(4) p1353-61
AUTHOR(S): Benvenga S; Campenni A; Ruggeri RM; Trimarchi F
AUTHOR'S ADDRESS: Cattedra e Divisione di Endocrinologia, University
of Messina School of Medicine, Italy.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (33 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Sevoflurane and anesthesia for neurosurgery: a
review.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Apr 2000,
12(2) p128-40
AUTHOR(S): Duffy CM; Matta BF
AUTHOR'S ADDRESS: Department of Anesthesia, Addenbrookes Hospital,
Cambridge, United Kingdom.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (116 references); REVIEW,
ACADEMIC
ABSTRACT: This review assesses the extent to which sevoflurane
fulfills the requirements of the ideal inhalational agent for use in
neuroanesthetic practice. Sevoflurane's pharmacokinetic profile is
outlined. Data from animal and human studies are used to discuss its
effects on cerebral hemodynamics, central nervous system monitoring,
and cardiovascular parameters. Where possible, sevoflurane is
compared with isoflurane, currently considered the inhalational agent
of choice in neuroanesthesia. Sevoflurane's potential for toxicity is
reviewed.
ARTICLE TITLE: Craniotomy performed with LMA: a case report.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Apr 2000,
12(2) p112-3
AUTHOR(S): Audu P; Cooper H
AUTHOR'S ADDRESS: Department of Anesthesiology, Thomas Jefferson
University Hospital, Philadelphia, Pennsylvania 19107-5092, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Since its introduction into clinical practice in 1988, the
laryngeal mask airway (LMA) has been used as an alternative device to
achieve and maintain control of the airway during anesthetics. The
LMA has been used primarily in patients undergoing peripheral
procedures in the supine position. The authors describe its use in an
open intracranial neurosurgical procedure for a patient with a space
occupying lesion. To our knowledge, this is the first such
description in the literature.
MB: I think I would keep quiet about it. I can remember when
craniotomies were done with a Guedel airway + a whiff of oxygen.
ARTICLE TITLE: Problems with the interpretation of pharmacoeconomic
analyses: a review of submissions to the Australian Pharmaceutical
Benefits Scheme [see comments]
COMMENTS: Comment in: JAMA 2000 Apr 26; 283(16):2158-60
ARTICLE SOURCE: JAMA (United States), Apr 26 2000, 283(16)
p2116-21
AUTHOR(S): Hill SR; Mitchell AS; Henry DA
AUTHOR'S ADDRESS: Discipline of Clinical Pharmacology, School of
Population Health Sciences, Faculty of Medicine and Health Sciences,
The University of Newcastle, New South Wales, Australia.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: CONTEXT: Pharmacoeconomic analyses are being used
increasingly as the basis for reimbursement of the costs of new
drugs. Reports of these analyses are often published in peer-reviewed
journals. However, the analyses are complex and difficult to
evaluate. OBJECTIVE: To describe the nature of problems encountered
in the evaluation and interpretation of pharmacoeconomic analyses
used as a basis for reimbursement decisions. DATA SOURCES: All major
submissions to the Department of Health and Aged Care (DHAC) by the
pharmaceutical industry for funding made under the Australian
Pharmaceutical Benefits Scheme. Specifically, the DHAC's database of
submissions that were received between January 1994 and December 1997
were reviewed. STUDY SELECTION: Of a total of 326 submissions, 218
had serious problems of interpretation and were included in the
analysis. The nature of the serious problems reviewed were classified
as estimates of comparative clinical efficacy, comparator issues,
modeling issues, and calculation errors. DATA EXTRACTION: All
submissions in the DHAC's database were reviewed and data were
extracted if both the DHAC evaluators and technical subcommittee
considered problems to have a significant bearing on the decisions of
the parent committee. DATA SYNTHESIS: Of a total of 326 submissions,
218 (67%) had significant problems and 31 had more than 1 problem. Of
the 249 problems identified, 154 (62%) related to uncertainty in the
estimates of comparative clinical efficacy, and 71 (28.5%) related to
modeling issues, which included clinical assumptions or cost
estimates, used in the construction of the economic models. There
were 15 instances of disagreement over the choice of comparator, and
serious calculation errors were found on 9 occasions. Overall, 159
problems (64%) were considered to be avoidable. CONCLUSIONS:
Significant problems were identified in these pharmacoeconomic
analyses. The intensive evaluation process used in the Australian
Pharmaceutical Benefits Scheme allowed for identification and
correction of pharmacoecomomic analysis problems, but the resources
that are required may be beyond the capacity of many organizations,
including peer-reviewed journals.
MB: They are no doubt correct but how can they fix it? See full
text.
ARTICLE TITLE: From the Centers for Disease Control and Prevention.
Injuries from fireworks in the United States.
ARTICLE SOURCE: JAMA (United States), Jul 19 2000, 284(3) p302
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Trends in incidence and prevalence of major
transfusion-transmissible viral infections in US blood donors, 1991
to 1996. Retrovirus Epidemiology Donor Study (REDS) [see
comments]
COMMENTS: Comment in: JAMA 2000 Jul 12; 284(2):238-40
ARTICLE SOURCE: JAMA (United States), Jul 12 2000, 284(2) p229-35
AUTHOR(S): Glynn SA; Kleinman SH; Schreiber GB; Busch MP; Wright DJ;
Smith JW; Nass CC; Williams AE
AUTHOR'S ADDRESS: Westat, WB 280, 1441 W Montgomery Ave, Rockville,
MD 20850-2062. GlynnS1@westat.com.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRCONCLUSION: The decrease in human immunodeficiency virus (HIV)
and hepatitis B virus (HBV) prevalence rates, combined with the
previously documented lower rates of infection in first-time donors
compared with the general population, suggests the continued benefit
of behavioral risk factor screening. JAMA. 2000; 284:229-235.
ARTICLE TITLE: Will blood transfusion ever be safe enough?
[editorial; comment]
COMMENTS: Comment on: JAMA 2000 Jul 12; 284(2):210-4; Comment on:
JAMA 2000 Jul 12; 284(2):229-35
ARTICLE SOURCE: JAMA (United States), Jul 12 2000, 284(2) p238-40
AUTHOR(S): Klein HG
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: They risk is obviously lower than the conditions for which the
dwindling blood supply is used.
ARTICLE TITLE: Institute of Medicine medical error figures are not
exaggerated [comment]
COMMENTS: Comment on: JAMA 2000 Jul 5; 284(1):93-5
ARTICLE SOURCE: JAMA (United States), Jul 5 2000, 284(1) p95-7
AUTHOR(S): Leape LL
AUTHOR'S ADDRESS: Harvard School of Public Health, 677 Huntington
Ave, Boston, MA 02115, USA. leape@hsph.harvard.edu.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE
ARTICLE TITLE: Deaths due to medical errors are exaggerated in
Institute of Medicine report [see comments]
COMMENTS: Comment in: JAMA 2000 Jul 5; 284(1):95-7
ARTICLE SOURCE: JAMA (United States), Jul 5 2000, 284(1) p93-5
AUTHOR(S): McDonald CJ; Weiner M; Hui SL
AUTHOR'S ADDRESS: Regenstrief Institute, 1050 Wishard Blvd, Fifth
Floor, Indianapolis, IN 46202, USA. clem@regen.rg.iupui.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ARTICLE TITLE: Physicians' recommendations to patients for use of
antibiotic prophylaxis to prevent endocarditis.
ARTICLE SOURCE: JAMA (United States), Jul 5 2000, 284(1) p68-71
AUTHOR(S): Seto TB; Kwiat D; Taira DA; Douglas PS; Manning WJ
AUTHOR'S ADDRESS: Cardiovascular Division, Beth Israel Deaconess
Medical Center, 330 Brookline Ave, Boston, MA 02215, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: We found that although most patients reported receiving
instructions for infectious endocarditis (IE) prophylaxis use
consistent with American Heart Association guidelines, IE prophylaxis
overuse among negligible-risk patients and underuse among
moderate-risk patients was common. Continued physician and patient
education may lead to improved adherence to the current American
Heart Association recommendations. JAMA. 2000; 284:68-71.
ARTICLE TITLE: Effects of exercise training on left ventricular
function and peripheral resistance in patients with chronic heart
failure: A randomized trial.
ARTICLE SOURCE: JAMA (United States), Jun 21 2000, 283(23)
p3095-101
AUTHOR(S): Hambrecht R; Gielen S; Linke A; Fiehn E; Yu J; Walther C;
Schoene N; Schuler G
AUTHOR'S ADDRESS: Klinik fur Innere Medizin/Kardiologie, Universitat
Leipzig, Herzzentrum GmbH, Russenstrasse 19, 04289 Leipzig, Germany.
hamr@server3.medizin.uni-leipzig.de.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
CONCLUSIONS: In patients with stable chronic heart failure, exercise
training is associated with reduction of peripheral resistance and
results in small but significant improvements in stroke volume and
reduction in cardiomegaly. JAMA. 2000.
ARTICLE TITLE: Where should women deliver babies in Japan?
[editorial; comment]
COMMENTS: Comment on: JAMA 2000 May 24-31; 283(20):2661-7
ARTICLE SOURCE: JAMA (United States), May 24-31 2000, 283(20)
p2712-4
AUTHOR(S): Ikegami N; Yoshimura Y
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Use of the pulmonary artery catheter in critically ill
patients: was invention the mother of necessity? [editorial;
comment]
COMMENTS: Comment on: JAMA 2000 May 17; 283(19):2559-67; Comment on:
JAMA 2000 May 17; 283(19):2568-72
ARTICLE SOURCE: JAMA (United States), May 17 2000, 283(19)
p2577-8
AUTHOR(S): Hall JB
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Pulmonary artery catheterization and clinical
outcomes: National Heart, Lung, and Blood Institute and Food and Drug
Administration Workshop Report. Consensus Statement [see
comments]
COMMENTS: Comment in: JAMA 2000 May 17; 283(19):2577-8
ARTICLE SOURCE: JAMA (United States), May 17 2000, 283(19)
p2568-72
AUTHOR(S): Bernard GR; Sopko G; Cerra F; Demling R; Edmunds H; Kaplan
S; Kessler L; Masur H; Parsons P; Shure D; Webb C; Weidemann H;
Weinmann G; Williams D
AUTHOR'S ADDRESS: Room T-1219 Medical Center North, Vanderbilt
University School of Medicine, Nashville, TN 37232, USA.
Gordon.Bernard@mcmail.vanderbilt.edu.
PUBLICATION TYPE: CONSENSUS DEVELOPMENT CONFERENCE; JOURNAL ARTICLE;
REVIEW (33 references)
CONCLUSIONS: A need exists for collaborative education of physicians
and nurses in performing, obtaining, and interpreting information
from the use of pulmonary artery catheters. This effort should be led
by professional societies, in collaboration with federal agencies,
with the purpose of developing and disseminating standardized
educational programs. Areas given high priority for clinical trials
were pulmonary artery catheter use in persistent/refractory
congestive heart failure, acute respiratory distress syndrome, severe
sepsis and septic shock, and low-risk coronary artery bypass graft
surgery.
ARTICLE TITLE: Patient characteristics and ICU organizational factors
that influence frequency of pulmonary artery catheterization [see
comments]
COMMENTS: Comment in: JAMA 2000 May 17; 283(19):2577-8
ARTICLE SOURCE: JAMA (United States), May 17 2000, 283(19)
p2559-67
AUTHOR(S): Rapoport J; Teres D; Steingrub J; Higgins T; McGee W;
Lemeshow S
AUTHOR'S ADDRESS: Mount Holyoke College, 50 College St, South Hadley,
MA 01075, USA. rapoport@mtholyoke.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: CONTEXT: Hemodynamic monitoring of patients with a
pulmonary artery catheter is controversial because there are few data
confirming its effectiveness, and patient and intensive care unit
(ICU) organizational factors associated with its use are unknown.
OBJECTIVE: To determine pulmonary artery catheter use in relationship
to type of ICU organization and staffing, and patient
characteristics, including severity of illness and insurance
coverage. DESIGN, SETTING, AND PATIENTS: Retrospective database study
of 10,217 nonoperative patients who received treatment at 34 medical,
mixed medical and surgical, and surgical ICUs at 27 hospitals during
1998 (patients were enrolled in Project IMPACT). MAIN OUTCOME
MEASURES: Pulmonary artery catheter use based on severity of illness
measured by the Simplified Acute Physiology Score, resuscitation
status at ICU admission, and ICU organizational variables, including
type, size, and model. RESULTS: A pulmonary artery catheter was used
for 831 patients (8.1%) in the ICU. In multivariate analysis adjusted
for severity of illness, age, diagnosis, and do-not-resuscitate
status, full-time ICU physician staffing was associated with a
two-thirds reduction in the probability of catheter use (odds ratio
[OR], 0.36; 95% confidence interval [CI], 0.28-0.45).
Higher catheter use was associated with white race (OR, 1.38; 95% CI,
1.10-1.72) and private insurance coverage (OR, 1.33; 95% CI,
1.10-1.60). Admission to a surgical ICU was associated with a 2-fold
increase in probability of catheter use (OR, 2.17; 95% CI, 1.70-2.76)
compared with either medical or mixed medical and surgical ICUs.
CONCLUSION: Organizational characteristics of ICUs, insurance
reimbursement, and race, as well as clinical variables, are
associated with variation in practice patterns regarding pulmonary
artery catheter use. Understanding such influences, combined with
studies measuring clinical and economic outcomes, can contribute to
the development of policies for the rational use of pulmonary artery
catheters. JAMA. 2000; 283:2559-2567.
ARTICLE TITLE: The plight of academic health centers
[editorial]
ARTICLE SOURCE: JAMA (United States), May 10 2000, 282(18)
p2438-9
AUTHOR(S): De Angelis CD
PUBLICATION TYPE: EDITORIAL
MB: Read full text. It is all pretty hopeless.
ARTICLE TITLE: Is academic medicine for sale? [editorial;
comment]
COMMENTS: Comment on: N Engl J Med 2000 May 18; 342(20):1462-70;
Comment on: N Engl J Med 2000 May 18; 342(20):1539-44
ARTICLE SOURCE: N Engl J Med (United States), May 18 2000, 342(20)
p1516-8
AUTHOR(S): Angell M
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: It's too late. They are already sold.
ARTICLE TITLE: The pharmaceutical industry--to whom is it
accountable? [editorial]
ARTICLE SOURCE: N Engl J Med (United States), Jun 22 2000, 342(25)
p1902-4
AUTHOR(S): Angell M
PUBLICATION TYPE: EDITORIAL
MB: they are obviously accountable to no one, but the author would
like to make them give something away.
ARTICLE TITLE: Doctors in the NHS: the restless many and the
squabbling few.
ARTICLE SOURCE: Lancet (England), Jun 10 2000, 355(9220) p2010-2
AUTHOR(S): Horton R
AUTHOR'S ADDRESS: The Lancet, London, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
MB: Read the full text. The whole English system seems doomed. They
are trying to make sure that things don't go wrong but all the
suggestions are unsatisfactory.
ARTICLE TITLE: Electrophysiologic testing to identify patients with
coronary artery disease who are at risk for sudden death. Multicenter
Unsustained Tachycardia Trial Investigators.
ARTICLE SOURCE: N Engl J Med (United States), Jun 29 2000, 342(26)
p1937-45
AUTHOR(S): Buxton AE; Lee KL; Di Carlo L; Gold MR; Greer GS;
Prystowsky EN; O'Toole MF; Tang A; Fisher JD; Coromilas J; Talajic M;
Hafley G
AUTHOR'S ADDRESS: Brown University School of Medicine and Division of
Cardiology, Rhode Island Hospital, Providence 02905, USA.
MAJOR SUBJECT HEADING(S): Coronary Disease [complications];
Death, Sudden, Cardiac [etiology]; Tachycardia, Ventricular
[etiology]
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Patients with coronary artery disease, left ventricular
dysfunction, and asymptomatic, unsustained ventricular tachycardia in
whom sustained ventricular tachyarrhythmias cannot be induced have a
significantly lower risk of sudden death or cardiac arrest and lower
overall mortality than similar patients with inducible sustained
tachyarrhythmias.
ARTICLE TITLE: The end of barium enemas? [editorial;
comment]
COMMENTS: Comment on: N Engl J Med 2000 Jun 15; 342(24):1766-72
ARTICLE SOURCE: N Engl J Med (United States), Jun 15 2000, 342(24)
p1823-4
AUTHOR(S): Fletcher RH
PUBLICATION TYPE: COMMENT; EDITORIAL
MB: I thought it ended about 20y ago when I had my last one.
ARTICLE TITLE: Erectile dysfunction.
ARTICLE SOURCE: N Engl J Med (United States), Jun 15 2000, 342(24)
p1802-13
AUTHOR(S): Lue TF
AUTHOR'S ADDRESS: University of California School of Medicine, San
Francisco, USA. tlue@urol.ucsf.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (73 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Health advice and immunizations for travelers.
ARTICLE SOURCE: N Engl J Med (United States), Jun 8 2000, 342(23)
p1716-25
AUTHOR(S): Ryan ET; Kain KC
AUTHOR'S ADDRESS: Tropical and Geographic Medicine Center, Division
of Infectious Diseases, Massachusetts General Hospital, and Harvard
Medical School, Boston 02114, USA. etryan@partners.org.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (67 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Patients' rights bills and other futile gestures
[editorial]
ARTICLE SOURCE: N Engl J Med (United States), Jun 1 2000, 342(22)
p1663-4
AUTHOR(S): Angell M
PUBLICATION TYPE: EDITORIAL
ARTICLE TITLE: Hyponatremia.
ARTICLE SOURCE: N Engl J Med (United States), May 25 2000, 342(21)
p1581-9
AUTHOR(S): Adrogue HJ; Madias NE
AUTHOR'S ADDRESS: Department of Medicine, Baylor College of Medicine
and Methodist Hospital, Houston, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (60 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Hypernatremia.
ARTICLE SOURCE: N Engl J Med (United States), May 18 2000, 342(20)
p1493-9
AUTHOR(S): Adrogue HJ; Madias NE
AUTHOR'S ADDRESS: Department of Medicine, Baylor College of Medicine
and Methodist Hospital, Houston, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (28 references); REVIEW,
TUTORIAL
ARTICLE TITLE: Daily interruption of sedative infusions in critically
ill patients undergoing mechanical ventilation [see
comments]
COMMENTS: Comment in: N Engl J Med 2000 May 18; 342(20):1520-2
ARTICLE SOURCE: N Engl J Med (United States), May 18 2000, 342(20)
p1471-7
AUTHOR(S): Kress JP; Pohlman AS; O'Connor MF; Hall JB
AUTHOR'S ADDRESS: Department of Medicine, University of Chicago, IL,
USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED
CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Conous infusions of sedative drugs in the
intensive care unit may prolong the duration of mechanical
ventilation, prolong the length of stay in the intensive care unit
and the hospital, impede efforts to perform daily neurologic
examinations, and increase the need for tests to assess alterations
in mental status. Whether regular interruption of such infusions
might accelerate recovery is not known. METHODS: We conducted a
randomized, controlled trial involving 128 adult patients who were
receiving mechanical ventilation and continuous infusions of sedative
drugs in a medical intensive care unit. In the intervention group,
the sedative infusions were interrupted until the patients were
awake, on a daily basis; in the control group, the infusions were
interrupted only at the discretion of the clinicians in the intensive
care unit. RESULTS: The median duration of mechanical ventilation was
4.9 days in the intervention group, as compared with 7.3 days in the
control group (P=0.004), and the median length of stay in the
intensive care unit was 6.4 days as compared with 9.9 days,
respectively (P=0.02). Six of the patients in the intervention group
(9 percent) underwent diagnostic testing to assess changes in mental
status, as compared with 16 of the patients in the control group (27
percent, P=0.02). Complications (e.g., removal of the endotracheal
tube by the patient) occurred in three of the patients in the
intervention group (4 percent) and four of the patients in the
control group (7 percent, P=0.88). CONCLUSIONS: In patients who are
receiving mechanical ventilation, daily interruption of sedative-drug
infusions decreases the duration of mechanical ventilation and the
length of stay in the intensive care unit.
MB: The sedation is for the observers not the patient. When I was
solely responsible for a series of ventilated patients before we had
an ICU ward between 1964 and 1972 although I was prepared to sedate
&/or paralyse them, I never did. (Note that I did not say---'I
never had to'. Giving drugs to a patient is the result of a decision
by the doctor. There is no compulsive necessity).
ARTICLE TITLE: A wake-up call in the intensive care unit
[editorial; comment]
COMMENTS: Comment on: N Engl J Med 2000 May 18; 342(20):1471-7
ARTICLE SOURCE: N Engl J Med (United States), May 18 2000, 342(20)
p1520-2
AUTHOR(S): Heffner JE
PUBLICATION TYPE: COMMENT; EDITORIAL
ARTICLE TITLE: Ventilation with lower tidal volumes as compared with
traditional tidal volumes for acute lung injury and the acute
respiratory distress syndrome. The Acute Respiratory Distress
Syndrome Network [see comments]
COMMENTS: Comment in: N Engl J Med 2000 May 4; 342(18):1360-1
ARTICLE SOURCE: N Engl J Med (United States), May 4 2000, 342(18)
p1301-8
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Traditional approaches to mechanical
ventilation use tidal volumes of 10 to 15 ml per kilogram of body
weight and may cause stretch-induced lung injury in patients with
acute lung injury and the acute respiratory distress syndrome. We
therefore conducted a trial to determine whether ventilation with
lower tidal volumes would improve the clinical outcomes in these
patients. METHODS: Patients with acute lung injury and the acute
respiratory distress syndrome were enrolled in a multicenter,
randomized trial. The trial compared traditional ventilation
treatment, which involved an initial tidal volume of 12 ml per
kilogram of predicted body weight and an airway pressure measured
after a 0.5-second pause at the end of inspiration (plateau pressure)
of 50 cm of water or less, with ventilation with a lower tidal
volume, which involved an initial tidal volume of 6 ml per kilogram
of predicted body weight and a plateau pressure of 30 cm of water or
less. The primary outcomes were death before a patient was discharged
home and was breathing without assistance and the number of days
without ventilator use from day 1 to day 28. RESULTS: The trial was
stopped after the enrollment of 861 patients because mortality was
lower in the group treated with lower tidal volumes than in the group
treated with traditional tidal volumes (31.0 percent vs. 39.8
percent, P=0.007), and the number of days without ventilator use
during the first 28 days after randomization was greater in this
group (mean [+/-SD], 12+/-11 vs. 10+/-11; P=0.007). The mean
tidal volumes on days 1 to 3 were 6.2+/-0.8 and 11.8+/-0.8 ml per
kilogram of predicted body weight (P<0.001), respectively, and the
mean plateau pressures were 25+/-6 and 33+/-8 cm of water
(P<0.001), respectively. CONCLUSIONS: In patients with acute lung
injury and the acute respiratory distress syndrome, mechanical
ventilation with a lower tidal volume than is traditionally used
results in decreased mortality and increases the number of days
without ventilator use.
ARTICLE TITLE: The acute respiratory distress syndrome.
ARTICLE SOURCE: N Engl J Med (United States), May 4 2000, 342(18)
p1334-49
AUTHOR(S): Ware LB; Matthay MA
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW (146
references); REVIEW, TUTORIAL
MB: A big review. They noticed decreased mortalities over short
periods but do not really entertain the idea that the 'syndrome' may
be iatrogenic or that the treatments are detrimental. From my
historical perspective the incidence is a fraction of what it was
25-30 years ago.
ARTICLE TITLE: Rectal methohexital sedation for computed tomography
imaging of stable pediatric emergency department patients.
ARTICLE SOURCE: Pediatrics (United States), May 2000, 105(5)
p1110-4
AUTHOR(S): Pomeranz ES; Chudnofsky CR; Deegan TJ; Lozon MM; Mitchiner
JC; Weber JE
AUTHOR'S ADDRESS: University of Michigan/St Joseph Mercy
Hospital-Emergency Medicine Residency Program, Children's Emergency
Services, Ann Arbor, MI 48106-0718, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSION: Rectal MXT compares favorably to other methods of
nonintravenous sedation for CT scanning of stable pediatric ED
patients in terms of rapidity of onset and reliability but does cause
a significant amount of transient respiratory depression. Its use
requires careful monitoring of oxygen saturation and should be used
only in a setting where physicians skilled in airway management are
present. If these requirements are met, it may be a good choice for
the relatively noninvasive sedation of pediatric ED patients
undergoing painless but anxiety-provoking procedures.methohexital,
pediatric procedure sedation, rectal administration, computerized
tomography imaging.
MB: This article is about anasethesia --- not sedation
ARTICLE TITLE: Blood substitutes in surgery.
ARTICLE SOURCE: Surgery (United States), Jun 2000, 127(6)
p599-602
AUTHOR(S): Cohn SM
AUTHOR'S ADDRESS: Department of Surgery, University of Miami School
of Medicine, Miami, FL 33101, USA.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW (7
references); REVIEW, TUTORIAL
ARTICLE TITLE: Platelets.
ARTICLE SOURCE: Lancet (England), Apr 29 2000, 355(9214) p1531-9
AUTHOR(S): George JN
AUTHOR'S ADDRESS: Department of Medicine, University of Oklahoma
Health Sciences Center, Oklahoma City 73190, USA.
Jim-George@OUHSC.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (51 references); REVIEW,
TUTORIAL
ARTICLE TITLE: When primum non nocere fails [editorial]
ARTICLE SOURCE: Lancet (England), Jun 10 2000, 355(9220) p2007
MAJOR SUBJECT HEADING(S): Medical Errors [statistics &
numerical data]; Quality of Health Care
PUBLICATION TYPE: EDITORIAL
MB: Comment on the US Institute of medicine noticing thousands of
error related deaths each year. Their suggestions are more sensible
than they seem to be thinking for the NHS at present.
ARTICLE TITLE: Early use of non-invasive ventilation for acute
exacerbations of chronic obstructive pulmonary disease on general
respiratory wards: a multicentre randomised controlled trial.
ARTICLE SOURCE: Lancet (England), Jun 3 2000, 355(9219) p1931-5
AUTHOR(S): Plant PK; Owen JL; Elliott MW
AUTHOR'S ADDRESS: Department of Respiratory Medicine, St James's
University Hospital, Leeds, UK.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY;
RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Within the intensive-care unit, non-invasive
ventilation (NIV) can prevent the need for intubation and the
mortality associated with severe episodes of chronic obstructive
pulmonary disease (COPD). The aim of this study was to find whether
the introduction of NIV, early after the admission on a general
respiratory ward, was effective at reducing the need for intubation
and the mortality associated with acute exacerbations of COPD.
METHODS: We did a prospective multicentre randomised controlled study
comparing NIV with standard therapy in patients with mild to moderate
acidosis. NIV was administered on the ward with a simple non-invasive
ventilator and a standardised predefined protocol. Patients were
recruited from 14 UK hospitals over 22 months. FINDINGS: 236 patients
were recruited, 118 received standard therapy alone and 118
additional NIV. The two groups had similar characteristics at
enrolment. The use of NIV significantly reduced the need for
intubation as defined by the failure criteria. 32/118 (27%) of the
standard group failed compared with 18/118 (15%) of the NIV group
(p=0.02). In-hospital mortality was also reduced by NIV, 24/118 (20%)
died in the standard group compared with 12/118 (10%) in the NIV
group (p=0.05). In both groups pH, PaCO2, and respiratory rate
improved at 4 h (p<0.01). However, NIV led to a more rapid
improvement in pH in the first hour (p=0.02) and a greater fall in
respiratory rate at 4 h (p=0.035). The duration of breathlessness was
also reduced by NIV (p=0.025). INTERPRETATION: The early use of NIV
for mildly and moderately acidotic patients with COPD in the general
ward setting leads to more rapid improvement of physiological
variables, a reduction in the need for invasive mechanical
ventilation (with objective criteria), and a reduction in in-hospital
mortality.
ARTICLE TITLE: Anaesthetist: the wrong name for the right doctor
[news]
ARTICLE SOURCE: Lancet (England), May 27 2000, 355(9218) p1892
AUTHOR(S): Simini B
PUBLICATION TYPE: NEWS
MB: I have no problem being called an anaesthetist. The vast majority
of anaesthetists give anaesthetics most of the time. Few do other
things. The proportion of anaesthetists staying in ICU is
falling.
ARTICLE TITLE: Blood coagulation.
ARTICLE SOURCE: Lancet (England), May 6 2000, 355(9215) p1627-32
AUTHOR(S): Dahlback B
AUTHOR'S ADDRESS: Department of Clinical Chemistry, Lund University,
University Hospital, Malmo, Sweden.
bjorn.dahlback@klkemi.mas.lu.se.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (44 references); REVIEW,
TUTORIAL
ABSTRACT: Under normal circumstances, the coagulation system is
balanced in favour of anticoagulation. Thrombin is the key effector
enzyme of the clotting cascade. Antagonists of vitamin K inhibit a
vitamin-K-dependent post-translational modification of several
coagulation proteins, which is required for these proteins to attain
a phospholipid-binding conformation. Heparin stimulates the activity
of antithrombin, a serine-protease inhibitor. Analysis of knock-out
mice has shown the relative importance of the coagulation factors in
vivo. Gene therapy may soon be a therapeutic option for inherited
deficiencies of factors VIII and IX.