MB's Articles of Interest - October 2001

ARTICLE TITLE: Thoracic epidural analgesia with morphine does not prevent postthoracotomy pain syndrome: a survey of 159 patients.
ARTICLE SOURCE: Acta Anaesthesiol Sin (China ( Republic:1949-)), Dec 2000, 38(4) p195-200
AUTHOR(S): Hu JS; Lui PW; Wang H; Chan KH; Luk HN; Tsou MY; Lee TY
AUTHOR'S ADDRESS: Department of Anesthesiology, Taipei Veterans General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C.
PUBLICATION TYPE: Journal Article
Most pain was mild or moderate and was usually described as being only a discomfort. Only 6.2% suffered severe pain with shooting, aching, burning or numbness. Patients with of postthoracotomy pain syndrome (PTPS) suffered more depression and insomnia. The incidence of PTPS was not different in patients who received GA alone or GA plus TEA (39% vs. 42%). CONCLUSIONS: Epidural morphine for postoperative analgesia that continued for 3 days appeared to have no effect in the prevention of PTPS.

ARTICLE TITLE: Failure of prevention against postoperative vomiting by ondansetron or prochlorperazine in patients undergoing gynecological laparoscopy.
ARTICLE SOURCE: Acta Anaesthesiol Sin (China ( Republic:1949-)), Dec 2000, 38(4) p201-5
AUTHOR(S): Lee TH; Lin CR; Lee TC; Buerkle H; Hsu TY; Mao CC; Yang LC
AUTHOR'S ADDRESS: Department of Anesthesiology, Kaohsiung Municipal Hsiaokang Hospital, Taiwan, R.O.C.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSIONS: The results of this study suggest that i.v. 4 or 8 mg ondansetron and 5 mg prochlorperazine were not effective in prevention of postoperative emesis in patients undergoing gynecological laparoscopy. Since the cost of ondansetron is high, its routine use for prevention against postoperative nausea and vomiting is not be recommended clinically because of its uncertain benefit.
MB: It appears that there is really no 'solution' to post-operative nausea & vomiting but hope seems to spring eternal. With all the 'improvements' that have occurred since the demise of ether the results seem to be the same.

ARTICLE TITLE: Treatment of chronic headache with antidepressants: a meta-analysis.
ARTICLE SOURCE: Am J Med (United States), Jul 2001, 111(1) p54-63
AUTHOR(S): Tomkins GE; Jackson JL; O'Malley PG; Balden E; Santoro JE
AUTHOR'S ADDRESS: Department of Medicine, Dwight David Eisenhower Army Medical Center, Augusta, Georgia, USA.
CONCLUSION: Antidepressants are effective in preventing chronic headaches. Whether this is independent of depression and whether there are differences in efficacy by class of agent needs further study.
MB: That is depressing.

ARTICLE TITLE: Assessing cardiac risk--how low (risk) should you go?
COMMENTS: : Am J Med. 2001 Jul; 111(1):18-23
ARTICLE SOURCE: Am J Med (United States), Jul 2001, 111(1) p73-4
AUTHOR(S): Picard MH; Dennis CA
PUBLICATION TYPE: Comment; Editorial
MB: About stress testing.

ARTICLE TITLE: Quality in managed care: promise versus reality.
COMMENTS: : Am J Med. 2001 Jul; 111(1):24-32
ARTICLE SOURCE: Am J Med (United States), Jul 2001, 111(1) p75-6
AUTHOR(S): Ellerbeck EF
PUBLICATION TYPE: Comment; Editorial
MB: It's about whether fee for service or managed care give better long term management for heart disease. It's not clear cut.

ARTICLE TITLE: The end of managed care.
ARTICLE SOURCE: JAMA (United States), May 23-30 2001, 285(20) p2622-8
AUTHOR(S): Robinson JC
AUTHOR'S ADDRESS: School of Public Health, University of California, Berkeley, CA 94720-7360, USA. jamie@socrates.berkeley.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: Managed care embodies an effort by employers, the insurance industry, and some elements of the medical profession to establish priorities and decide who gets what from the health care system. After a turbulent decade of trial and error, that experiment can be characterized as an economic success but a political failure. The strategy of giving with one hand while taking away with the other, of offering comprehensive benefits while restricting access through utilization review, has infuriated everyone involved. The protagonists of managed care now are in full retreat, broadening physician panels, removing restrictions, and reverting to fee-for-service payment. Governmental entities are avoiding politically volatile initiatives to balance limited resources and unlimited expectations. By default, if not by design, the consumer is emerging as the locus of priority setting in health care. The shift to consumerism is driven by a widespread skepticism of governmental, corporate, and professional dominance; unprecedented economic prosperity that reduces social tolerance for interference with individual autonomy; and the Internet technology revolution, which broadens access to information and facilitates the mass customization of insurance and delivery.

ARTICLE TITLE: Predicting and preventing physician burnout: results from the United States and the Netherlands
ARTICLE SOURCE: Am J Med (United States), Aug 2001, 111(2) p170-5
AUTHOR(S): Linzer M; Visser MR; Oort FJ; Smets EM; McMurray JE; de Haes HC
AUTHOR'S ADDRESS: Department of Medical Psychology at the Academic Medical Center, University of Amsterdam, The Netherlands; Collective Name: The Society of General Internal Medicine (SGIM) Career Satisfaction Study Group (CSSG).

ARTICLE TITLE: Low-molecular-weight heparin versus warfarin for secondary prophylaxis of venous thromboembolism: a cost-effectiveness analysis
ARTICLE SOURCE: Am J Med (United States), Aug 2001, 111(2) p130-9
AUTHOR(S): Marchetti M; Pistorio A; Barone M; Serafini S; Barosi G
AUTHOR'S ADDRESS: Laboratory of Medical Informatics (MM, GB), IRCCS Policlinico S. Matteo, Pavia, Italy.
PUBLICATION TYPE: Journal Article
When we included rebound recurrences after interruption of therapy, which were more common with low-molecular-weight heparin, treatment with low-molecular-weight heparin cost $53,166 per quality-adjusted years of life (QALY) in Italy and $177,166 per QALY in the United States.Low-molecular-weight heparin might be a cost-effective drug for secondary prophylaxis of venous thromboembolism, especially in patients at high risk of recurrence and where the drug's cost is lower. The apparent increase in recurrence after interruption of therapy needs to be investigated more thoroughly before low-molecular-weight heparin can be recommended routinely.
MB: I think the costs include cost of initial treatment.

ARTICLE TITLE: Prevention of venous thromboembolic disease following primary total knee arthroplasty. A randomized, multicenter, open-label, parallel-group comparison of enoxaparin and warfarin.
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Jun 2001, 83-A(6) p900-6
AUTHOR(S): Fitzgerald RH; Spiro TE; Trowbridge AA; Gardiner GA; Whitsett TL; O'Connell MB; Ohar JA; Young TR
AUTHOR'S ADDRESS: Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104, USA; Collective Name: Enoxaparin Clinical Trial Group.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: A fixed 30-mg subcutaneous dose of enoxaparin, administered twice daily, with the first dose administered within eight hours after the completion of surgery, was significantly more effective than adjusted-dose warfarin in reducing the occurrence of asymptomatic venous thromboembolism, including proximal deep-vein thrombosis, in patients undergoing total knee arthroplasty. With the numbers available, there was no significant difference between groups with regard to the occurrence of major hemorrhagic complications; however, the rate of overall hemorrhagic complications was higher in the enoxaparin group.

ARTICLE TITLE: Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. Warfarin Optimal Duration Italian Trial Investigators.
ARTICLE SOURCE: N Engl J Med (United States), Jul 19 2001, 345(3) p165-9
AUTHOR(S): Agnelli G; Prandoni P; Santamaria MG; Bagatella P; Iorio A; Bazzan M; Moia M; Guazzaloca G; Bertoldi A; Tomasi C; Scannapieco G; Ageno W
AUTHOR'S ADDRESS: Dipartimento di Medicina Interna, Universita di Perugia, Italy. agnellig@unipg.it; Collective Name: Warfarin Optimal Duration Italian Trial Investigators.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: In patients with idiopathic deep venous thrombosis, the clinical benefit associated with extending the duration of anticoagulant therapy to one year is not maintained after the therapy is discontinued.
MB: It seems that stopping the anticoagulaion at 3 months is associated with recurrence.

ARTICLE TITLE: Treatment of venous thromboembolism using only low-molecular-weight heparin?
ARTICLE SOURCE: Am J Med (United States), Aug 2001, 111(2) p159-60
AUTHOR(S): White RH
AUTHOR'S ADDRESS: Division of General Medicine, University of California at Davis, Sacramento, California, USA.
PUBLICATION TYPE: Journal Article
At the present time, extended oral anticoagulant therapy using warfarin remains the recommended method of treating venous thromboembolism. It is reassuring that the transition from therapeutic doses of low-molecular-weight heparin to lower, prophylactic doses does not lead to an immediate increase in the incidence of recurrent thromboembolism, as was the case with regular heparin. This finding suggests that for selected patients, extended treatment with prophylactic doses of low-molecular-weight heparin may be acceptable-for example, 6 weeks of therapy for a patient with calf vein thrombosis after trauma. Recurrent deep vein thrombosis may develop in some of these patients, however, soon after the low-molecular-weight heparin is discontinued.
MB:They want go give the heparin for only 6 weeks but admit that they can get recurrences on stopping. There does not seem to me much reason not to change to warfarin.

ARTICLE TITLE: Methemoglobinemia complicating topical lidocaine used during endoscopic procedures
ARTICLE SOURCE: Am J Med (United States), Aug 2001, 111(2) p150-3
AUTHOR(S): Karim A; Ahmed S; Siddiqui R; Mattana J
AUTHOR'S ADDRESS: Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
PUBLICATION TYPE: Journal Article
MB: They were giving overdoses of lignocaine. I have never heard of lignocaine causing methaemoglobinaemia. Prilocaine classically does.

ARTICLE TITLE: The clinical meaning of the third heart sound
ARTICLE SOURCE: Am J Med (United States), Aug 2001, 111(2) p157-8
AUTHOR(S): Wynne J
AUTHOR'S ADDRESS: Department of Internal Medicine, Division of Cardiology, Wayne State University, Detroit, Michigan, USA.
PUBLICATION TYPE: Journal Article
MB: They claim that it is quite important & talk about a 4 ^th sound too. I have only ever been able to hear 2. They have made suggestions to encourage acquisition of the auditory skills. I don't think that there is much hope.
I saw an older-than-me Professor of Cardiology at the Opera House. They have had to send him to New Guinea to make diagnosis of cardiac cases suitable to be transferred to oz for cardiac surgery, 'cause the young cannot do it.

ARTICLE TITLE: Medical therapy or coronary artery bypass graft surgery for chronic stable angina: an update using decision analysis
2001, 111(2) p89-95
AUTHOR(S): Kwok YS; Kim C; Heidenreich PA
AUTHOR'S ADDRESS: Division of General Internal Medicine (YSK), University of Washington Medical Center, Seattle, Washington, USA.
PUBLICATION TYPE: Journal Article
Advances in the treatment of chronic stable angina have improved the outcome both for patients treated initially with surgery and for those treated initially with medical therapy. The improvements were of similar magnitude in both groups, so the fundamental conclusions of the bypass trials are unchanged.
MB: I think that the conclusion should be checked in the empirical world. The paper represents a cyber experiment.

ARTICLE TITLE: A simplified open gastrostomy under local anesthesia
ARTICLE SOURCE: Am Surg (United States), Aug 2001, 67(8) p806-8
AUTHOR(S): Zickler RW; Barbagiovanni JT; Swan KG
AUTHOR'S ADDRESS: Department of Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Revision of the standard gastrostomy is often necessary in patients with neuromuscular disorders. These patients pose many anesthetic risks that frequently preclude the use of general anesthesia, intravenous sedation, or endoscopy. Modification of the Stamm gastrostomy enables it to be performed comfortably and readily under local anesthesia. The modification proposed passes the gastrostomy tube through the omentum en route to the abdominal wall. This ensures a seal to the surgical site, eliminates the need for tacking sutures, and allows for a smaller midline incision. These factors greatly reduce the discomfort of the procedure allowing it to be easily accomplished under local anesthesia. This technique of open gastrostomy under local anesthesia has been used in more than 35 patients over the past 10 years with no documented leaks.
MB: No patients have anaesthetic risk that precludes GA or endoscopy. IV sedation may be precluded.

ARTICLE TITLE: Routine perioperative pulmonary artery catheterization has no effect on rate of complications in vascular surgery: a meta-analysis.
ARTICLE SOURCE: Am Surg (United States), Jul 2001, 67(7) p674-9
AUTHOR(S): Barone JE; Tucker JB; Rassias D; Corvo PR
AUTHOR'S ADDRESS: Department of Surgery, The Stamford Hospital, CT 06902, USA.
PUBLICATION TYPE: Journal Article; Meta-Analysis
The use of a pulmonary artery catheter does not prevent morbidity or mortality. Of the studies providing data on the amount of intravenous fluid administered three reported that statistically significantly more fluid was given to patients who underwent pulmonary artery catheterization. Meta-analysis indicates that in moderate-risk vascular surgery patients routine preoperative pulmonary artery catheterization is not associated with improved outcomes.
MB: I don't think anyone would argue about moderate risk patients.

ARTICLE TITLE: Trauma attending in the resuscitation room: does it affect outcome?
ARTICLE SOURCE: Am Surg (United States), Jul 2001, 67(7) p611-4
AUTHOR(S): Porter JM; Ursic C
AUTHOR'S ADDRESS: Department of Surgery, Northeastern Ohio Universities College of Medicine and St. Elizabeth Health Center, Youngstown, USA.
PUBLICATION TYPE: Journal Article
The time to the OR is indicative of the decision-making process in the resuscitation room, and it is in this area that the attendings' presence is the most useful. Also, we believe that it is important that there were no missed injuries, delays to the OR, or inappropriate workups when the attendings were present in the resuscitation room. This again speaks to the decision-making process. We believe that these data support the need for the attending to be present in the resuscitation room to facilitate accurate and timely decisions regardless of whether they take the call from home or in-house.

ARTICLE TITLE: Theodor Billroth: surgeon and musician.
ARTICLE SOURCE: Am Surg (United States), Jun 2001, 67(6) p605-6
AUTHOR(S): Lewis JM; O'Leary JP
AUTHOR'S ADDRESS: Department of Surgery, Louisiana State University School of Medicine, New Orleans 70122, USA.
PUBLICATION TYPE: Biography; Historical Article; Journal Article
MB: I hoped this would tell me more than that Billroth was a good pianist and a frivolous medical student. He moved in the Musical circles of Vienna. He, Brahmes and the notorious Hanslich the pro-Brahmes, anti-Wagner music critic, were often seen together at concerts.
They did not mention that Brahmes initially scored his symphonies for piano 4 hands and he tried them out with Billroth supplying 2 of the hands.
It says that the first gastrectomy was done under chloroform. I worked with a surgeon who learnt in Vienna in the 1920s from Billroths successors. Until the early 1950s he did gastrectomies with infiltration with procaine. He was having GAs by 1958 when I was his intern.

ARTICLE TITLE: A comparison between topical and infiltrative bupivacaine and intravenous meperidine for post-operative analgesia after inguinal herniorrhaphy.
ARTICLE SOURCE: Am Surg (United States), May 2001, 67(5) p447-50
AUTHOR(S): Waechter FL; Sampaio JA; Pinto RD; Alvares-Da-Silva MR; Pereira-Lima L
AUTHOR'S ADDRESS: Department of General Surgery of Complexo Hospitalar Santa Casa de Porto Alegre, RS, Brazil.
PUBLICATION TYPE: Clinical Trial; Journal Article
We conclude that the instillation of local anesthesia provides analgesia during the immediate postoperative period comparable to local infiltration using the same anesthetic. Both regional analgesia methods are more effective analgesics during the first 6 hours than are intravenous opioids. Furthermore the simple instillation of local anesthetic allows better analgesic evolution of the surgical wound after the first 24 hours considering the lower rate of resulting complications.

ARTICLE TITLE: Laparoscopic versus conventional live donor nephrectomy: experience in a community transplant program.
ARTICLE SOURCE: Am Surg (United States), Apr 2001, 67(4) p342-5
AUTHOR(S): Hawasli A; Boutt A; Cousins G; Schervish E; Oh H
AUTHOR'S ADDRESS: Department of Surgery, St. John Hospital and Medical Center, St. Clair Shores, Michigan 48080, USA.
PUBLICATION TYPE: Journal Article
We conclude that the laparoscopic procurement of kidneys for transplantation compares well with the open method. It offers several advantages that may increase the living donor pool.

ARTICLE TITLE: Open versus percutaneous dilatational tracheostomy: efficacy and cost analysis.
ARTICLE SOURCE: Am Surg (United States), Apr 2001, 67(4) p297-301; discussion 301-2
AUTHOR(S): Grover A; Robbins J; Bendick P; Gibson M; Villalba M
AUTHOR'S ADDRESS: Department of Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA.
PUBLICATION TYPE: Journal Article
Both the open bedside and percutaneous dilatational methods are reasonable and safe options. However, the open bedside tracheostomy is a better utilization of resources and is more cost effective, and it is the procedure of choice at our institution.

ARTICLE TITLE: A systematic review of the peripheral analgesic effects of intraarticular morphine
ARTICLE SOURCE: Anesth Analg (United States), Sep 2001, 93(3) p761-70
AUTHOR(S): Gupta A; Bodin L; Holmstrom B; Berggren L
AUTHOR'S ADDRESS: Department of Anaesthesiology and Intensive Care and Unit of Biostatistics and Epidemiology, Orebro Medical Center Hospital, Orebro, Sweden.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: A metaanalysis was performed to study the effects of morphine, injected intraarticularly, on postoperative pain during 24 h. Nineteen studies could be identified in which data were presented in such a way that metaanalysis could be performed. The results indicate a mild analgesic effect that could be dose dependent, but a systemic effect could not be ruled out.

ARTICLE TITLE: Learning endotracheal intubation in a clinical skills learning center: a quantitative study
ARTICLE SOURCE: Anesth Analg (United States), Sep 2001, 93(3) p656-62
AUTHOR(S): Plummer JL; Owen H
AUTHOR'S ADDRESS: Department of Anaesthesia, Flinders University of South Australia and Flinders Medical Centre, Bedford Park, Australia.
PUBLICATION TYPE: Journal Article
ABSTRACT: This study aimed to develop statistical models describing the learning of endotracheal intubation (ETI). We collected data from 100 subjects undergoing ETI training with intubatable medical models and manikins (airway trainers). Trainees initially viewed a video about ETI and an instructor demonstrated the technique. Subjects then made up to 17 supervised trials. Each trial was scored as a success or failure; this score was the primary outcome used in analyses. Random effects and population-averaged logit models, and a learning model intended to quantify the relative contributions of failed and successful trials to the learning process, were fitted to the data. The logit models provided evidence of differences in difficulty between different airway trainers and differences in success rate related to previous ETI experience. Trainees became familiar with an airway trainer after multiple trials, as demonstrated by a 50% decrease in the odds of successful ETI when starting on a new trainer. The learning model indicated that a trainee learns about as much from 1 successful ETI as from 12 (95% confidence interval, 2-23) failed trials. The results demonstrate the feasibility of statistical modeling of the learning of ETI and provide insight into the learning process. IMPLICATIONS: Data were collected from trainees learning endotracheal intubation. Statistical modeling of the data enabled the identification of factors influencing learning and provided insight into the learning process. The knowledge gained can be used to improve teaching methods.
MB: I have never seen a manakin which is in any way realistic.

ARTICLE TITLE: Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket
ARTICLE SOURCE: Anesth Analg (United States), Sep 2001, 93(3) p647-8
AUTHOR(S): Frolich M; Giannotti A; Modell JH
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Florida Colleges of Medicine and Veterinary Medicine, Gainesville, Florida.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: This case describes the narcotic overdose associated with the use of a fentanyl transdermal patch in a patient being rewarmed with an external warming blanket during surgery. The clinical manifestation and the presumed pharmacokinetic mechanism responsible for the fentanyl overdose are discussed.
MB: Why would anyone think that you could not overdose with or without a warming blanket

ARTICLE TITLE: The effect of perioperative aspirin therapy in peripheral vascular surgery: a decision analysis
ARTICLE SOURCE: Anesth Analg (United States), Sep 2001, 93(3) p573-80
AUTHOR(S): Neilipovitz DT; Bryson GL; Nichol G
AUTHOR'S ADDRESS: Departments of Anesthesiology and Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: Decision analysis indicates that continued aspirin use in patients undergoing infrainguinal revascularization surgery is associated with a decreased perioperative mortality and increased life expectancy but may increase the likelihood of minor hemorrhagic complications.
MB: The effects are so slight that it is hardly worth while.

ARTICLE TITLE: A prospective randomized study of the potential benefits of thoracic epidural anesthesia and analgesia in patients undergoing coronary artery bypass grafting
ARTICLE SOURCE: Anesth Analg (United States), Sep 2001, 93(3) p528-35
AUTHOR(S): Scott NB; Turfrey DJ; Ray DA; Nzewi O; Sutcliffe NP; Lal AB; Norrie J; Nagels WJ; Ramayya GP
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, HCI International Medical Centre, Clydebank, Scotland, United Kingdom.
PUBLICATION TYPE: Journal Article
ABSTRACT: We performed an open, prospective, randomized, controlled study of the incidence of major organ complications in 420 patients undergoing routine coronary artery bypass graft surgery with or without thoracic epidural anesthesia and analgesia (TEA). <snip> of recovery after coronary artery bypass graft surgery compared with conventional narcotic analgesia. IMPLICATIONS: Many anesthesiologists believe that thoracic epidural anesthesia/analgesia (TEA) is contraindicated for cardiac surgery because of increased risk of paraplegia. However, this large prospective study confirms that perioperative morbidity is significantly less with TEA and suggests that the practical benefits may outweigh the unquantified risk of epidural hematoma.
MB: No one has suggested that the paraplegia rate is anything like 1 in 202. This article was hardly worth publishing

ARTICLE TITLE: Epidural anesthesia and analgesia for coronary artery bypass graft surgery: still forbidden territory?
ARTICLE SOURCE: Anesth Analg (United States), Sep 2001, 93(3) p523-5
AUTHOR(S): O'Connor CJ; Tuman KJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Rush Medical College, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois.
PUBLICATION TYPE: Editorial
MB: The previous article does not show dramatic benefit.

ARTICLE TITLE: An effective treatment of severe intractable bleeding after valve repair by one single dose of activated recombinant factor VII.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p287-9 , 2nd contents page
AUTHOR(S): Hendriks HG; van der Maaten JM; de Wolf J; Waterbolk TW; Slooff MJ; van der Meer J
AUTHOR'S ADDRESS: Department of Anesthesiology, University Hospital, Hanzeplein 1, 9700 RB Groningen, The Netherlands. h.g.d.hendriks@anest.azg.nl.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: The successful treatment with recombinant factor VIIa of a patient experiencing intractable bleeding after cardiac surgery is described.
MB: They were using a thromobelastogram. I don't think there is adequate theoretical underpinning.

ARTICLE TITLE: Prophylactic use of tranexamic acid and incidence of arterial thrombosis in liver transplantation.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p516
AUTHOR(S): Dalmau A; Sabate A; Koo M; Rafecas A; Figueras J; Jaurrieta E (Barcelona, Spain.)
PUBLICATION TYPE: Letter
MB: In 133 no 'increase' in hepatic artery thrombosis.

ARTICLE TITLE: More epidural than intravenous sufentanil is required to provide comparable postoperative pain relief.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p472-6 , 4th contents page
AUTHOR(S): Menigaux C; Guignard B; Fletcher D; Sessler DI; Levron JC; Chauvin M
AUTHOR'S ADDRESS: Department of Anesthesiology, Hopital Ambroise Pare, 9 Avenue Charles de Gaulle, Boulogne-Billancourt, 92100, France.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
IMPLICATIONS: More epidural than IV sufentanil was required to provide comparable postoperative pain relief and similar plasma sufentanil concentrations. These data suggest that when sufentanil is administered in small-dose boluses, much of the drug is absorbed into the epidural fat and that the primary mechanism by which epidurally administered sufentanil produces analgesia is via systemic absorption.
MB: Worse than useless putting the drug into the epidural space.

ARTICLE TITLE: The in vivo effects of general and epidural anesthesia on human immune function.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p460-5 , 4th contents page
AUTHOR(S): Procopio MA; Rassias AJ; De Leo JA; Pahl J; Hildebrandt L; Yeager MP
AUTHOR'S ADDRESS: Department of Anesthesiology, Dartmouth Medical School, Hanover, New Hampshire, USA. Marcia.A.Procopio@Hitchcock.org.
IMPLICATIONS: General or epidural anesthesia alone, in the absence of surgery, seems to have only transient and minor effects on human immune function.

ARTICLE TITLE: Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p405-9 , 3rd contents page
AUTHOR(S): Lang K; Boldt J; Suttner S; Haisch G
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: In patients undergoing major abdominal surgery, a colloid-based (with hydroxyethyl starch [HES] 130/0.4) and a crystalloid-based (with lactated Ringer's solution [RL]) volume replacement regimen was compared regarding tissue oxygen tension (ptiO(2)) measured continuously by microsensoric implantable catheters. The ptiO(2) increased in the HES-treated (+59%) but decreased in the RL-treated (-23%) patients. Improved microcirculation may be the mechanism for the better ptiO(2) in the HES group.

ARTICLE TITLE: A multicenter evaluation of the time-course of action of two doses of rapacuronium after early and late reversal with neostigmine.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p370-4 , 3rd contents page
AUTHOR(S): Larijani GE; Donati F; Bikhazi G; Bartkowski R; Kenaan CA; Plaud B; Goldberg ME
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Medicine and Dentistry of New Jersey, One Cooper Plaza, Camden, NJ 08103, USA. larijage@umdnj.edu.
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
the administration of neostigmine shortly after the administration of rapacuronium, may accelerate the return of spontaneous breathing (early recovery), but does not shorten the time to complete recovery of upper airway function.
MB: Thist was done to see if recovery would be made quicker so that it could be made more like sux.
Why do we persist in trying to replace sux? Phase 3 has been a disaster. The drug has been terminated.

ARTICLE TITLE: Unmasked residual neuromuscular block after administration of vecuronium for days.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p345-7 , 3rd contents page
AUTHOR(S): Fine GF; Brandom BW; Yellon RF
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA 15213-2583, USA. finegf@anes.upmc.edu.
PUBLICATION TYPE: Journal Article
ABSTRACT: IMPLICATIONS: Significant neuromuscular block may be present in patients who have received vecuronium for days.
MB: How surprising.

ARTICLE TITLE: Arterial and venous Thrombelastograph variables differ during cardiac surgery.
ARTICLE SOURCE: Anesth Analg (United States), Aug 2001, 93(2) p277-81 , 1st contents page
AUTHOR(S): Manspeizer HE; Imai M; Frumento RJ; Parides MK; Mets B; Bennett-Guerrero E
AUTHOR'S ADDRESS: Department of Anesthesiology, Columbia University College of Physicians & Surgeons, 630 W. 168th St., New York, NY 10032, USA.
PUBLICATION TYPE: Journal Article
IMPLICATIONS: Thrombelastograph (TEG) values obtained from venous blood samples differ from values obtained from arterial blood samples. When the TEG coagulation analyzer is used for clinical purposes, it is important to be consistent in the blood collection site.
MB: The absolute value of TEG readings is highly questionable.

ARTICLE TITLE: A randomized trial of tranexamic acid to reduce blood transfusion for scoliosis surgery.
ARTICLE SOURCE: Anesth Analg (United States), Jul 2001, 93(1) p82-7
AUTHOR(S): Neilipovitz DT; Murto K; Hall L; Barrowman NJ; Splinter WM
AUTHOR'S ADDRESS: Departments of Anaesthesiology and Critical Care, The Ottawa Hospital, Ottawa, Ontario. dneilipovitz@ottawahospital.on.ca.
Forty patients, 9-18 yr of age, were randomized to either tranexamic acid (initial dose of 10 mg/kg and infusion of 1 mg. kg(-1). h(-1)) or placebo (isotonic saline). Perioperative management was standardized. A uniform transfusion threshold for noncell saved red blood cells was 7.0 g/dL. The total amount of blood transfused in the perioperative period was significantly reduced in the Tranexamic group (P = 0.045). No thrombotic complications were detected in either group. The administration of prophylactic tranexamic acid in patients with scoliosis undergoing posterior spinal fusion surgery has the potential to reduce perioperative blood transfusion requirements. Implications: The administration of prophylactic tranexamic acid in patients with scoliosis who are undergoing posterior spinal fusion surgery has the potential to reduce perioperative blood transfusion requirements.
MB: Intravascular thrombosis is less common than 1 in 20.

ARTICLE TITLE: Sodium nitroprusside compared with isoflurane-induced hypotension: the effects on brain oxygenation and arteriovenous shunting.
ARTICLE SOURCE: Anesth Analg (United States), Jul 2001, 93(1) p166-70
AUTHOR(S): Hoffman WE; Edelman G; Ripper R; Koenig HM
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Illinois at Chicago, 60612, USA. whoffman@uic.edu.
PUBLICATION TYPE: Journal Article
Implications: We measured brain arteriovenous shunting and tissue oxygen pressure(PtO(2))during a 40% decrease in blood pressure induced by sodium nitroprusside (SNP)or 3% isoflurane. Large-dose isoflurane maintainedPtO(2) with no change in shunting. SNP infusion decreasedPtO(2) 50%and increased shunting 50%. This suggests that SNP-induced hypotension decreases PtO(2) because of a decrease in capillary perfusion.

ARTICLE TITLE: Maternal mortality during hospital admission for delivery: a retrospective analysis using a state-maintained database.
COMMENTS: : Anesth Analg. 2001 Jul; 93(1):1-3
ARTICLE SOURCE: Anesth Analg (United States), Jul 2001, 93(1) p134-41
AUTHOR(S): Panchal S; Arria AM; Labhsetwar SA
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. sumedhapanchal@hotmail.com.
PUBLICATION TYPE: Journal Article
Implications: This study reports the medical and demographic risk factors associated with maternal death during hospital admission for delivery by using a state-maintained database. This information could prove useful in the creation of initiatives aimed at decreasing the public health burden associated with maternal mortality.

ARTICLE TITLE: Maternal mortality in the United States: where are we going and how will we get there?
COMMENTS: : Anesth Analg. 2001 Jul; 93(1):134-41
ARTICLE SOURCE: Anesth Analg (United States), Jul 2001, 93(1) p1-3
AUTHOR(S): Hawkins JL; Birnbach DJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Understanding the mechanisms by which isoflurane modifies the hyperglycemic response to surgery.
ARTICLE SOURCE: Anesth Analg (United States), Jul 2001, 93(1) p121-7
AUTHOR(S): Lattermann R; Schricker T; Wachter U; Georgieff M; Goertz A
AUTHOR'S ADDRESS: Department of Anesthesia, McGill University, Montreal, Quebec, Canada.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
Implications: Epidural analgesia combined with general anesthesia prevented the hyperglycemic response to surgery by decreasing endogenous glucose production.The increased glucose plasma concentration in patients receiving fentanyl/midazolam anesthesia was caused by a decrease in whole-body glucose clearance. The hyperglycemic response observed during inhaled anesthesia with isoflurane was a consequence of both impaired glucose clearance and increased glucose production.

ARTICLE TITLE: Human bites of the hand: the Tasmanian experience
ARTICLE SOURCE: ANZ J Surg (Australia), Aug 2001, 71(8) p467-71
AUTHOR(S): Tonta K; Kimble FW
AUTHOR'S ADDRESS: University of Tasmania, Hobart, Australia.
PUBLICATION TYPE: Journal Article
MB: They are bit wild in Tassie.

ARTICLE TITLE: Art macabre: is anatomy necessary?
ARTICLE SOURCE: ANZ J Surg (Australia), Jun 2001, 71(6) p333-4
AUTHOR(S): Fahrer M
PUBLICATION TYPE: Editorial
MB: Surgeons have to actually dissect to learn operating anatomy.

ARTICLE TITLE: Attitudes to evidence-based practice in urology: results of a survey
ARTICLE SOURCE: ANZ J Surg (Australia), May 2001, 71(5) p297-300
AUTHOR(S): Stapleton AM; Cuncins-Hearn A; Pinnock C
AUTHOR'S ADDRESS: Centre of Clinical Excellence in Urological Research, Repatriation General Hospital, Australia. alan.stapleton@rgh.sa.gov.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Urologists express a need for evidence-based practice resources, in particular clinical guidelines. Nevertheless their clinical approach is not necessarily consistent with existing guidelines, particularly for lower urinary tract symptoms (LUTS). An alteration in the recommendation when the respondent is the patient of interest and endorses the recommendation that patients with prostate cancer should be involved in treatment decisions.

ARTICLE TITLE: Anal incontinence surgery: a small personal experience
ARTICLE SOURCE: ANZ J Surg (Australia), May 2001, 71(5) p290-1
AUTHOR(S): Isbister WH
AUTHOR'S ADDRESS: Department of Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia. wisbister@bigfoot.com.
PUBLICATION TYPE: Journal Article
MB: I thought it was the author's incontinence. It is 30 patients.

ARTICLE TITLE: Reducing overtriage without compromising outcomes in trauma patients.
ARTICLE SOURCE: Arch Surg (United States), Jul 2001, 136(7) p752-6
AUTHOR(S): Cook CH; Muscarella P; Praba AC; Melvin WS; Martin LC
AUTHOR'S ADDRESS: Department of Surgery, The Ohio State University Medical Center, Columbus, USA.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: There was a significant reduction in overtriage (over treating) of trauma patients demonstrated without an appreciable impact on patient outcome. Changing trauma response criteria to more physiologic and anatomic indicators allowed improved triage of trauma patients, which improves resource allocation.

ARTICLE TITLE: Spinal cord injury caused by direct damage by local anaesthetic infiltration needle
ARTICLE SOURCE: Br J Anaesth (England), Sep 2001, 87(3) p512-5
AUTHOR(S): Absalom AR; Martinelli G; Scott NB
AUTHOR'S ADDRESS: University Department of Anaesthesia, Glasgow Royal Infirmary, Alexandra Parade, Glasgow G31 2ER, UK. Department of Anaesthesia, HCI International Medical Centre, Clydebank, Glasgow G81 4HX, UKCorresponding author.
PUBLICATION TYPE: Journal Article
ABSTRACT: We describe a case of spinal cord injury caused by direct trauma from a local anaesthetic infiltration needle. During local anaesthetic infiltration before placement of an epidural catheter, the patient suddenly rolled over onto her back, causing the infiltrating needle to advance all the way to its hub. She immediately showed signs of spinal cord injury, confirmed by MRI scan. However, her neurological status gradually improved, and on discharge she was able to walk, with a sensory deficit localized to her left foot.

ARTICLE TITLE: Prophylactic ondansetron does not improve patient satisfaction in women using PCA after Caesarean section
ARTICLE SOURCE: Br J Anaesth (England), Sep 2001, 87(3) p502-4
AUTHOR(S): Cherian VT; Smith I
AUTHOR'S ADDRESS: Department of Anaesthesia, Christian Medical College and Hospital, Vellore 632 004, India and Department of Anaesthesia, North Staffordshire Hospital, Stoke-on-Trent, Staffordshire ST4 6QG, UKCorresponding author.
PUBLICATION TYPE: Journal Article
Although the ondansetron reduced the incidence of PONV and the need for further antiemetic medication, this did not affect patient's satisfaction regarding their postoperative care.
MB: How ungrateful.

ARTICLE TITLE: Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure?
ARTICLE SOURCE: Circulation (United States), Aug 14 2001, 104(7) p779-82
AUTHOR(S): Zile MR; Gaasch WH; Carroll JD; Feldman MD; Aurigemma GP; Schaer GL; Ghali JK; Liebson PR
AUTHOR'S ADDRESS: Medical University of South Carolina, Charleston (M.R.Z.).
PUBLICATION TYPE: Journal Article
ABSTRACT: Background- The diagnosis of diastolic heart failure is generally made in patients who have the signs and symptoms of heart failure and a normal left ventricular (LV) ejection fraction. Whether the diagnosis also requires an objective measurement of parameters that reflect the diastolic properties of the ventricle has not been established. Methods and Results- We hypothesized that the vast majority of patients with heart failure and a normal ejection fraction exhibit abnormal LV diastolic function. We tested this hypothesis by prospectively identifying 63 patients with a history of heart failure and an echocardiogram suggesting LV hypertrophy and a normal ejection fraction; we then assessed LV diastolic function during cardiac catheterization. All 63 patients had standard hemodynamic measurements; 47 underwent detailed micromanometer and echocardiographic-Doppler studies. The LV end-diastolic pressure was >16 mm Hg in 58 of the 63 patients; thus, 92% had elevated end-diastolic pressure (average, 24+/-8 mm Hg). The time constant of LV relaxation (average, 51+/-15 ms) was abnormal in 79% of the patients. The E/A ratio was abnormal in 48% of the patients. The E-wave deceleration time (average, 349+/-140 ms) was abnormal in 64% of the patients. One or more of the indexes of diastolic function were abnormal in every patient. Conclusions- Objective measurement of LV diastolic function serves to confirm rather than establish the diagnosis of diastolic heart failure. The diagnosis of diastolic heart failure can be made without the measurement of parameters that reflect LV diastolic function.
MB: Sounds as though they don't really know what they mean by diastolic failure.

ARTICLE TITLE: Maternal and paternal history of myocardial infarction and risk of cardiovascular disease in men and women
ARTICLE SOURCE: Circulation (United States), Jul 24 2001, 104(4) p393-8
AUTHOR(S): Sesso HD; Lee IM; Gaziano JM; Rexrode KM; Glynn RJ; Buring JE
AUTHOR'S ADDRESS: Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. hsesso@hsph.harvard.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: An early history of parental MI (<60 years) conferred a greater risk of CVD than did MI at older ages. However, an increased risk of CVD remained for maternal age at MI of 70 to 79 years in men and >/=60 years in women, which suggests that any maternal history of MI may be important.

ARTICLE TITLE: Rapid three-dimensional echocardiography : clinically feasible alternative for precise and accurate measurement of left ventricular volumes.
ARTICLE SOURCE: Circulation (United States), Jun 19 2001, 103(24) p2882-4
AUTHOR(S): Belohlavek M; Tanabe K; Jakrapanichakul D; Breen JF; Seward JB
AUTHOR'S ADDRESS: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
PUBLICATION TYPE: Clinical Trial; Journal Article
CONCLUSIONS:The rapid-acquisition 3D echocardiography extends the use of a multiplane, internally rotating handheld transducer so that it becomes a precise and clinically feasible tool for assessing left ventricular volumes and function. A rapid-image acquisition time of 6 s would allow repeated image collection during the course of a clinical echocardiographic examination. Additional work must address rapid and automated data processing.

ARTICLE TITLE: Tourniquet Use During Total Knee Arthroplasty Did Not Reduce Total Blood Loss : Tetro AM, Rudan JF. The effects of a pneumatic tourniquet on blood loss in total knee arthroplasty. Can J Surg. 2001 Feb; 44:33-8
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Aug 2001, 83-A(8) p1282
AUTHOR(S): Tetro AM; Rudan JF
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Prophylactic Low-Dose Aspirin Therapy in Patients Having Hip-Fracture Surgery or Elective Arthroplasty
ARTICLE SOURCE: J Bone Joint Surg Am (United States), Aug 2001, 83-A(8) p1277-8
AUTHOR(S): Grace DL; Bourne RB
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Anesthetic management of the exit (Ex Utero intrapartum treatment) procedure
ARTICLE SOURCE: J Clin Anesth (United States), Aug 2001, 13(5) p387-91
AUTHOR(S): Schwartz DA; Moriarty KP; Tashjian DB; Wool RS; Parker RK; Markenson GR; Rothstein RW; Shah BL; Connelly NR; Courtney RA
AUTHOR'S ADDRESS: Departments of Anesthesiology, Pediatric Surgery, Obstetrics and Gynecology, and Pediatrics, Baystate Medical Center and Baystate Medical Center Children's Hospital, 01199, Springfield, MA, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: The EXIT (ex utero intrapartum treatment) procedure is used to maintain fetal-placental circulation during partial delivery of a fetus with a potentially life-threatening upper airway obstruction. We performed the EXIT procedure on a fetus with a large intra-oral cyst. Sevoflurane was used as the anesthetic because of its rapid titratability. Sevoflurane provided excellent maternal and fetal anesthesia. Modifications to previously described monitoring techniques for the EXIT procedure were also used.

ARTICLE TITLE: Incidence and indications for reintubation during postoperative care following orthotopic liver transplantation
ARTICLE SOURCE: J Clin Anesth (United States), Aug 2001, 13(5) p377-82
AUTHOR(S): Glanemann M; Kaisers U; Langrehr JM; Schenk R; Stange BJ; Muller AR; Bechstein W; Falke K; Neuhaus P
AUTHOR'S ADDRESS: Department of General-, Visceral- & Transplantation Surgery, and Department of Anesthesiology and Intensive Care Medicine, Charite, Campus Virchow Klinikum, Humboldt University Berlin, Berlin, Germany.
PUBLICATION TYPE: Journal Article
ABSTRACT: Study Objective: To analyze the incidence and indications for reintubation during postoperative care following orthotopic liver transplantation (OLT).Design: Retrospective chart review.Setting: Large metropolitan teaching hospital.Patients: 546 adult liver transplant recipients.Measurements and Main Results: The medical charts of 546 patients who underwent OLT at our institution between January 1992 and September 1996 were reviewed for the incidence and indications of reintubation throughout primary hospitalization. Eighty-one of 546 patients (14.8%) required one or more episodes of reintubation after OLT. In the majority of cases, reintubation was performed for pulmonary complications (44.6%), followed by cerebral (19.1%) and surgical (14.5%) complications. Cardiac (9.1%) and peripheral neurologic (2.7%) complications were less frequent reasons for reintubation. Overall patient survival, according to the Kaplan-Meier estimates, was 89.9%, 87.5%, 86.5%, and 82.2% after 1, 2, 3, and 5 years, respectively. In patients with one or more episodes of reintubation, overall survival decreased to 62.5% after 1, 2, and 3 years, and to 56.4% after 5 years (p < 0.001).Conclusions: The main indications for reintubation after OLT were pulmonary, cerebral, and surgical complications. These reintubation events had a considerable influence on the patient's postoperative recovery, and were associated with a significantly higher rate of mortality, than for OLT patients who did not undo reintubation.

ARTICLE TITLE: Blood pressure cuff compression injury of the radial nerve
ARTICLE SOURCE: J Clin Anesth (United States), Jun 2001, 13(4) p306-8
AUTHOR(S): Lin C; Jawan B; de Villa MV; Chen F; Liu P
AUTHOR'S ADDRESS: Department of Surgery and Department of Anesthesiology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan.
PUBLICATION TYPE: Journal Article
ABSTRACT: We describe a 19-year-old man who underwent emergency laparotomy for perforated peptic ulcer. He was otherwise healthy before this admission with no history of diabetes mellitus or neuropathy. A standard-size adult blood pressure cuff connected to a Dinamap monitor, set to cycle automatically every 3 minutes was affixed to his left upper extremity during surgery. One day after the operation he complained of numbness over the dorsum of the left hand and wrist drop. Physical examination revealed 0/5 muscle power of the left wrist and finger extensor muscles with reduced sensation on the radial aspect of the dorsum of the same hand. A diagnosis of acute radial nerve injury was made and rehabilitation was started. The wrist numbness and sensation improved with physical therapy, and he was discharged 9 days after the operation with an active wrist splint. He continued with rehabilitation on an out-patient basis. The muscle power of the wrist extensors gradually improved after three months of physical therapy and reverted to completely normal one month later. Locating the cuff higher on the arm, away from the elbow joint, to avoid the most superficial portion of radial nerve, may prevent this type of compression injury especially in asthenic patients.

ARTICLE TITLE: Succinylcholine pretreatment using gallamine or mivacurium during rapid sequence induction in children: a randomized, controlled study
ARTICLE SOURCE: J Clin Anesth (United States), Jun 2001, 13(4) p287-92
AUTHOR(S): Theroux MC; Rose JB; Iyengar S; Katz MS
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care Medicine, Alfred I. duPont Hospital for Children, 19899, Wilmington, DE, USA.
PUBLICATION TYPE: Journal Article
.Conclusions: Administration of mivacurium 0.03 mg. kg(-1) intravenously 2 minutes before administration of succinylcholine 2 mg. kg(-1) in children is effective in reducing the increase in serum potassium at 5 minutes, the increase in myoglobin at 5 minutes and 15 minutes, and the increase in CPK at 24 hours.

ARTICLE TITLE: Factors influencing hospital implementation of acute pain management practice guidelines(6)
ARTICLE SOURCE: J Clin Anesth (United States), Jun 2001, 13(4) p268-76
AUTHOR(S): Jiang HJ; Lagasse RS; Ciccone K; Jakubowski MS; Kitain EM
AUTHOR'S ADDRESS: Healthcare Association of New York State, Albany, NY, USA.
PUBLICATION TYPE: Journal Article
Conclusions: Resource availability significantly influences the implementation of pain management practice guidelines in hospital settings. Implementation is often incomplete because various factors affect the feasibility of individual guideline elements and may explain the varying results that guidelines have had on clinical practices.

ARTICLE TITLE: New developments in Dutch legislation concerning euthanasia and physician-assisted suicide.
ARTICLE SOURCE: J Med Philos (Netherlands), Jun 2001, 26(3) p299-309
AUTHOR(S): Gordijn B; Janssens R
AUTHOR'S ADDRESS: Department of Ethics, Philosophy and History of Medicine, Katholieke Universiteit Nijmegen, Nijmegen, Netherlands. b.gordijn@efg.kun.nl.
PUBLICATION TYPE: Journal Article
ABSTRACT: Dutch euthanasia and physician-assisted suicide stand on the eve of important legal changes. In the summer of 1999, a new government bill concerning euthanasia and physician-assisted suicide was sent to Parliament for discussion. This bill legally embodies a ground for exemption from punishment for physicians who conduct euthanasia or physician-assisted suicide and comply with certain requirements. On November 28, 2000, the Dutch parliament approved an adapted version of this bill. Since the approval by the Dutch Senate can be regarded as a formality, it is expected that the bill will come into force in the course of this year (2001). In this paper we discuss these new developments.

ARTICLE TITLE: Why doctors get angry in Crown Courts
ARTICLE SOURCE: J R Soc Med (England), Aug 2001, 94(8) p426
AUTHOR(S): Whitton E
AUTHOR'S ADDRESS: 14/26 Cook Street, Glebe, NSW 2037, Australia.
PUBLICATION TYPE: Journal Article
MB: It is actually a letter. It asserts that the British derived legal systems embodies systematic untruth.

ARTICLE TITLE: A knife in the back: anaesthetic management
ARTICLE SOURCE: J R Soc Med (England), Aug 2001, 94(8) p407-8
AUTHOR(S): Downie P; Alcock E; Ashley E
AUTHOR'S ADDRESS: North Middlesex Hospital, London, UK. King's College Hospital, London, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: From convicts to founding fathers-three notable Sydney doctors.
ARTICLE SOURCE: J R Soc Med (England), Jul 2001, 94(7) p358-61
AUTHOR(S): Hull G
AUTHOR'S ADDRESS: West Carnliath, Strathtay, Pitlochry PH9 0PG, Scotland, UK.
PUBLICATION TYPE: Biography; Historical Article; Journal Article
MB: William Redfern for naval mutiny. D'arcy Wentworth almost convicted of highway robbery advised to go to oz. William Bland for duelling. Over all 100 doctors were transported. I wonder what for.

ARTICLE TITLE: Inhaled corticosteroid reduction and elimination in patients with persistent asthma receiving salmeterol: a randomized controlled trial.
ARTICLE SOURCE: JAMA (United States), May 23-30 2001, 285(20) p2594-603
AUTHOR(S): Lemanske RF; Sorkness CA; Mauger EA; Lazarus SC; Boushey HA; Fahy JV; Drazen JM; Chinchilli VM; Craig T; Fish JE; Ford JG; Israel E; Kraft M; Martin RJ; Nachman SA; Peters SP; Spahn JD; Szefler SJ
AUTHOR'S ADDRESS: University of Wisconsin Children's Hospital, 600 Highland Ave, K4/916-9988, Madison, WI 53792, USA. rfl@medicine.wisc.edu; Collective Name: Asthma Clinical Research Network for the National Heart, Lung, and Blood Institute. .
PUBLICATION TYPE: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
CONCLUSIONS: Our results indicate that in patients with persistent asthma suboptimally controlled by triamcinolone therapy alone but whose asthma symptoms improve after addition of salmeterol, a substantial reduction (50%) in triamcinolone dose can occur without a significant loss of asthma control. However, total elimination of triamcinolone therapy results in a significant deterioration in asthma control and, therefore, cannot be recommended.

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Influenza and pneumococcal vaccination levels among persons aged >/= 65 years--United States, 1999.
ARTICLE SOURCE: JAMA (United States), Jul 25 2001, 286(4) p413-4
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Estimating hospital deaths due to medical errors: preventability is in the eye of the reviewer.
ARTICLE SOURCE: JAMA (United States), Jul 25 2001, 286(4) p415-20
AUTHOR(S): Hayward RA; Hofer TP
PUBLICATION TYPE: Journal Article
ABSTRACT: CONTEXT: Studies using physician implicit review have suggested that the number of deaths due to medical errors in US hospitals is extremely high. However, some have questioned the validity of these estimates. OBJECTIVE: To examine the reliability of reviewer ratings of medical error and the implications of a death described as "preventable by better care" in terms of the probability of immediate and short-term survival if care had been optimal. DESIGN: Retrospective implicit review of medical records from 1995-1996. SETTING AND PARTICIPANTS: Fourteen board-certified, trained internists used a previously tested structured implicit review instrument to conduct 383 reviews of 111 hospital deaths at 7 Department of Veterans Affairs medical centers, oversampling for markers previously found to be associated with high rates of preventable deaths. Patients considered terminally ill who received comfort care only were excluded. MAIN OUTCOME MEASURES: Reviewer estimates of whether deaths could have been prevented by optimal care (rated on a 5-point scale) and of the probability that patients would have lived to discharge or for 3 months or more if care had been optimal (rated from 0%-100%). RESULTS: Similar to previous studies, almost a quarter (22.7%) of active-care patient deaths were rated as at least possibly preventable by optimal care, with 6.0% rated as probably or definitely preventable. Interrater reliability for these ratings was also similar to previous studies (0.34 for 2 reviewers). The reviewers' estimates of the percentage of patients who would have left the hospital alive had optimal care been provided was 6.0% (95% confidence interval [CI], 3.4%-8.6%). However, after considering 3-month prognosis and adjusting for the variability and skewness of reviewers' ratings, clinicians estimated that only 0.5% (95% CI, 0.3%-0.7%) of patients who died would have lived 3 months or more in good cognitive health if care had been optimal, representing roughly 1 patient per 10 000 admissions to the study hospitals. CONCLUSIONS: Medical errors are a major concern regardless of patients' life expectancies, but our study suggests that previous interpretations of medical error statistics are probably misleading. Our data place the estimates of preventable deaths in context, pointing out the limitations of this means of identifying medical errors and assessing their potential implications for patient outcomes.

ARTICLE TITLE: Right heart catheterization and cardiac complications in patients undergoing noncardiac surgery: an observational study.
COMMENTS: : JAMA. 2001 Jul 18; 286(3):348-50/21359754
ARTICLE SOURCE: JAMA (United States), Jul 18 2001, 286(3) p309-14
AUTHOR(S): Polanczyk CA; Rohde LE; Goldman L; Cook EF; Thomas EJ; Marcantonio ER; Mangione CM; Lee TH
AUTHOR'S ADDRESS: Partners Community HealthCare Inc, Suite 1150, Prudential Tower, 800 Boylston St, Boston, MA 02199, USA. thlee@partners.org.
PUBLICATION TYPE: Evaluation Studies; Journal Article
ABSTRACT: CONTEXT: Right heart catheterization (RHC) is commonly performed before high-risk noncardiac surgery, but the benefit of this strategy remains unproven. OBJECTIVE: To evaluate the relationship between use of perioperative RHC and postoperative cardiac complication rates in patients undergoing major noncardiac surgery. DESIGN: Prospective, observational cohort study. SETTING: Tertiary care teaching hospital in the United States. PATIENTS: Patients (n = 4059 aged >/=50 years) who underwent major elective noncardiac procedures with an expected length of stay of 2 or more days between July 18, 1989, and February 28, 1994. Two hundred twenty one patients had RHC and 3838 did not. CONCLUSIONS: No evidence was found of reduction in complication rates associated with use of perioperative RHC in this population. Because of the morbidity and the high costs associated with RHC, the impact of this intervention in perioperative care should be evaluated in randomized trials.

ARTICLE TITLE: Herbal medicines and perioperative care.
ARTICLE SOURCE: JAMA (United States), Jul 11 2001, 286(2) p208-16
AUTHOR(S): Ang-Lee MK; Moss J; Yuan CS
AUTHOR'S ADDRESS: Department of Anesthesia and Critical Care, University of Chicago, 5841 S Maryland Ave, MC 4028, Chicago, IL 60637, USA. cyuan@midway.uchicago.edu.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial

ARTICLE TITLE: No-fault compensation for medical injuries: the prospect for error prevention.
COMMENTS: : JAMA. 2001 Jul 11; 286(2):226-8/21342253
ARTICLE SOURCE: JAMA (United States), Jul 11 2001, 286(2) p217-23
AUTHOR(S): Studdert DM; Brennan TA
AUTHOR'S ADDRESS: Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: JAMA patient page. Organ donation. Share life by donating your organs and tissues.
ARTICLE SOURCE: JAMA (United States), Jul 4 2001, 286(1) p124
MAJOR SUBJECT HEADING(S): Tissue Donors
INDEXING CHECK TAG(S): Human
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Reporting financial conflicts of interest and relationships between investigators and research sponsors.
ARTICLE SOURCE: JAMA (United States), Jul 4 2001, 286(1) p89-91
AUTHOR(S): De Angelis CD; Fontanarosa PB; Flanagin A
PUBLICATION TYPE: Editorial

ARTICLE TITLE: Relationship between annual volume of patients treated by admitting physician and mortality after acute myocardial infarction.
ARTICLE SOURCE: JAMA (United States), Jun 27 2001, 285(24) p3116-22
AUTHOR(S): Tu JV; Austin PC; Chan BT
AUTHOR'S ADDRESS: Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5. tu@ices.on.ca.
PUBLICATION TYPE: Journal Article
CONCLUSION: Patients with AMI who are treated by high-volume admitting physicians are more likely to survive at 30 days and 1 year.
MB: Remember the objections to a study where ambulances were to bypass low level hospitals to deposit potential AMI patients into a study of immediate intervention at the Royal North Shore Hospital in Sydney? If I lived in the North Shore area of Sydney I would ordinarily by-pass RNSH for RPAH but if I thought I had an MI I would make an exception.

ARTICLE TITLE: msJAMA: residency selection process and the match: does anyone believe anybody?
ARTICLE SOURCE: JAMA (United States), Jun 6 2001, 285(21) p2784-5
AUTHOR(S): Carek PJ; Anderson KD
AUTHOR'S ADDRESS: Department of Family Medicine, Medical University of South Carolina, Charleston, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial.
ARTICLE SOURCE: JAMA (United States), Aug 8 2001, 286(6) p700-7
AUTHOR(S): Merrer J; De Jonghe B; Golliot F; Lefrant JY; Raffy B; Barre E; Rigaud JP; Casciani D; Misset B; Bosquet C; Outin H; Brun-Buisson C; Nitenberg G
AUTHOR'S ADDRESS: Service de Reanimation Medicale, Hopital de Poissy/St Germain-en-Laye, 10 Rue du Champ-Gaillard, 78303 Poissy, France. jmerrer@chi-poissy-st-germain.fr; Collective Name: French Catheter Study Group in Intensive Care.
CONCLUSION: Femoral venous catheterization is associated with a greater risk of infectious and thrombotic complications than subclavian catheterization in ICU patients.

ARTICLE TITLE: Liver transplantation in patients with severe portopulmonary hypertension treated with preoperative chronic intravenous epoprostenol
ARTICLE SOURCE: Liver Transpl (United States), Aug 2001, 7(8) p745-9
AUTHOR(S): Tan HP; Markowitz JS; Montgomery RA; Merritt WT; Klein AS; Thuluvath PJ; Poordad FF; Maley WR; Winters B; Akinci SB; Gaine SP
AUTHOR'S ADDRESS: Division of Transplant Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
PUBLICATION TYPE: Journal Article
ABSTRACT: Portopulmonary hypertension (PPHTN) is no longer an absolute contraindication to orthotopic liver transplantation (OLT). The pre-OLT management of patients with PPHTN requires early diagnosis and chronic therapy with intravenous epoprostenol to decrease pulmonary vascular resistance (PVR). Close follow-up is necessary to reassess pulmonary artery pressures (PAPs) and evaluate right ventricular (RV) function. This assists in the optimal timing of OLT. Successful management also necessitates reassessment of pulmonary artery hemodynamics just before OLT, with clearly defined parameters used to determine whether to proceed. Even with the intraoperative and postoperative availability of potent pulmonary vasodilators, clinical management may be suboptimal in reducing PAP. Adequate reduction in PVR and improvement in RV function in response to chronic epoprostenol therapy may facilitate successful OLT. We present a case report and review the limited experience with this treatment.

ARTICLE TITLE: Transplant legislation: Ethical and practical issues in liver allocation-The case of Switzerland
ARTICLE SOURCE: Liver Transpl (United States), Jul 2001, 7(7) p658-60
AUTHOR(S): Kadry Z; Renner EL; Clavien PA
AUTHOR'S ADDRESS: Department of Visceral and Transplantation Surgery, University Hospital Zurich, Switzerland.
PUBLICATION TYPE: Journal Article
ABSTRACT: Ethical and practical issues relating to liver allocation have been discussed in many countries. Several governments, including the United States, have attempted over the past few years to impose new legislation, which has resulted in virulent debates among individual centers, organ procurement agencies, states, and various groups of interest. This report discusses the current ongoing legislative process in Switzerland. In 1999, the people of Switzerland voted to develop transplant legislation. This reflected the need to regulate poorly defined practices to adapt to the rapid progress within the field of transplantation. The main issue facing the Swiss transplant community is whether new legislation will allow medical evolution in organ allocation criteria without creating regulations that may become outdated with time. In addition, public debate has been shown to have a negative impact on organ donation, thus emphasizing an ever-present penury in cadaveric allografts. This article discusses these issues within the context of liver transplantation in Switzerland and also raises the uniform ethical and practical constraints placed on the medical transplant community in the face of an organ shortage.

ARTICLE TITLE: Stenosis of the suprahepatic inferior vena cava as a complication of transjugular intrahepatic portosystemic shunt in Budd-Chiari patients
ARTICLE SOURCE: Liver Transpl (United States), Jul 2001, 7(7) p649-51
AUTHOR(S): Turnes J; Garcia-Pagan JC; Gonzalez-Abraldes J; Real M; Moitinho E; Gilabert R; Escorsell A; Muntanya X; Gines P; Bosch J; Rodes J
AUTHOR'S ADDRESS: Hepatic Hemodynamic Laboratory, Liver Unit, Institut de Malaties Digestives, Centre De Diagnostic per La Imatge Hospital Clinic, Institut D'Investigacions Biomediques August Pi Sunyer (IDIBAPS), University of Barcelona, Spain.
PUBLICATION TYPE: Journal Article
ABSTRACT: We report 2 patients with Budd-Chiari (BC) syndrome secondary to thrombogenic conditions who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement because of refractory ascites and impending liver failure. After TIPS placement, there was marked symptomatic relief and improvement in liver function, but the courses of both patients were complicated by the development of an inferior vena cava (IVC) syndrome caused by segmental stenosis of the suprahepatic IVC just at the outflow jet of the TIPS at 11 and 9 months later. One patient underwent liver transplantation, and the other patient, caval angioplasty and stenting. Stenosis of the IVC represents an unrecognized complication of TIPS in patients with BC syndrome.

ARTICLE TITLE: Allocation of transplantable organs: Do people want to punish patients for causing their illness?
Liver Transplant (United States), Jul 2001, 7(7) p600-7
AUTHOR(S): Ubel PA; Jepson C; Baron J; Mohr T; McMorrow S; Asch DA
AUTHOR'S ADDRESS: Veterans Affairs Medical Center, University of Michigan, Ann Arbor, MI.
PUBLICATION TYPE: Journal Article
The public's transplantation allocation preferences are influenced by whether patients' behaviors are said to have caused their organ failure.

ARTICLE TITLE: Characteristics of patients with uncontrolled hypertension in the United States
ARTICLE SOURCE: N Engl J Med (United States), Aug 16 2001, 345(7) p479-86
AUTHOR(S): Hyman DJ; Pavlik VN
AUTHOR'S ADDRESS: Department of Medicine, Baylor College of Medicine, Houston, TX, USA. dhyman@bcm.tmc.edu.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Most cases of uncontrolled hypertension in the United States consist of isolated, mild systolic hypertension in older adults, most of whom have access to health care and relatively frequent contact with physicians.

ARTICLE TITLE: Control of hypertension--an important national priority
ARTICLE SOURCE: N Engl J Med (United States), Aug 16 2001, 345(7) p534-5
AUTHOR(S): Chobanian AV
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Sacred secrets--the privacy of medical records.
COMMENTS: : N Engl J Med. 2001 Aug 2; 345(5):385-8/21358142
ARTICLE SOURCE: N Engl J Med (United States), Aug 2 2001, 345(5) p371-2
AUTHOR(S): Welch CA
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: What's happening to Britain's National Health Service?
ARTICLE SOURCE: N Engl J Med (United States), Jul 26 2001, 345(4) p305-8
AUTHOR(S): Klein R
AUTHOR'S ADDRESS: London School of Economics.
MB: The proposed methods of reform are too complex and will be easily be avoided. I have thought the NHS looks quite good to me as an occasional vistor.

ARTICLE TITLE: Ready or not--preparedness for bioterrorism.
COMMENTS: : N Engl J Med. 2001 Jul 26; 345(4):256-8/21342637
ARTICLE SOURCE: N Engl J Med (United States), Jul 26 2001, 345(4) p287-9
AUTHOR(S): Khan AS; Ashford DA
PUBLICATION TYPE: Comment; Editorial
MB: Note the date! It's from the CDC. We are nowhere as well prepared as the US. The article criticises the US. It suggests I ask, "Does my institution have a well-rehearsed plan if the next case --represents--bioterrorism?" We have no plan.

ARTICLE TITLE: A comparison of visual analog scale and categorical ratings of headache pain in a randomized controlled clinical trial with migraine patients
ARTICLE SOURCE: Pain (Netherlands), Aug 2001, 93(2) p185-90
AUTHOR(S): Lines CR; Vandormael K; Malbecq W
AUTHOR'S ADDRESS: Merck & Co., Inc., P.O. Box 4, 19486, West Point, PA, USA.
PUBLICATION TYPE: Journal Article
In analyses using data combined across all treatment groups, visual analog scale (VAS) and categorical four-grade scale (4GS) scores were highly correlated. Use of the VAS imposed additional administrative burdens. These findings suggest that the (4GS) may be the preferred scale for assessing headache pain in clinical trials involving adult migraineurs.

ARTICLE TITLE: Leucotomy: a qualified defence of 'then'
ARTICLE SOURCE: QJM (England), Aug 2001, 94(8) p451
AUTHOR(S): Pippard JS
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Asthma admissions and thunderstorms: a study of pollen, fungal spores, rainfall, and ozone
ARTICLE SOURCE: QJM (England), Aug 2001, 94(8) p429-33
AUTHOR(S): Anderson W; Prescott GJ; Packham S; Mullins J; Brookes M; Seaton A
AUTHOR'S ADDRESS: Departments of Environmental & Occupational Medicine and. Public Health, University Medical School, Aberdeen, Royal Gwent Hospital, Newport, and. Asthma and Allergy Unit, Sully Hospital, Sully, UK.
PUBLICATION TYPE: Journal Article
Asthma admissions are increased during thunderstorms. The effect is more marked in warmer weather, and is not explained by increases in grass pollen, total pollen or fungal spore counts, nor by an interaction between these and rainfall. There was an independent, positive association between ozone concentrations and asthma admissions.
.

ARTICLE TITLE: Euthanasia and assisted suicide: what does the Dutch vote mean?
ARTICLE SOURCE: Lancet (England), Apr 21 2001, 357(9264) p1221-2
AUTHOR(S): Horton R
AUTHOR'S ADDRESS: The Lancet, WC1X 8RR, London, UK.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Public hospital-based level I trauma centers: financial survival in the new millennium
ARTICLE SOURCE: J Trauma (United States), Aug 2001, 51(2) p301-7
AUTHOR(S): Selzer D; Gomez G; Jacobson L; Wischmeyer T; Sood R; Broadie T
AUTHOR'S ADDRESS: Department of Surgery, Trauma Surgery Division, Indiana University School of Medicine, Indianapolis 46202, USA. djselzer@aol.com.
PUBLICATION TYPE: Journal Article
CONCLUSION: The financial stability of urban public Level I trauma centers without additional funding is tenuous because of a high proportion of uninsured and underinsured patients. Government tax dollars and Disproportionate Share Hospital (DSH) funds are required for their continued solvency.

ARTICLE TITLE: A statewide analysis of level I and II trauma centers for patients with major injuries
ARTICLE SOURCE: J Trauma (United States), Aug 2001, 51(2) p346-51
AUTHOR(S): Clancy TV; Gary Maxwell J; Covington DL; Brinker CC; Blackman D
AUTHOR'S ADDRESS: Department of Surgery, The University of North Carolina at Chapel Hill, USA. tclancy@med.unc.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: Case fatality was similar in Level I and Level II trauma centers in North Carolina, and hospital charges were comparable in patients with comparable injuries not requiring transfer. This suggests that patients with major injuries may be optimally cared for in both Level I and Level II trauma centers.

ARTICLE TITLE: Admission base deficit in pediatric trauma: a study using the national trauma data bank
ARTICLE SOURCE: J Trauma (United States), Aug 2001, 51(2) p332-5
AUTHOR(S): Kincaid EH; Chang MC; Letton RW; Chen JG; Meredith JW
AUTHOR'S ADDRESS: Departments of General Surgery and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
PUBLICATION TYPE: Journal Article
CONCLUSION: In injured children, the admission base deficit reflects injury severity and predicts mortality. The probability of mortality increases precipitously in children with a base deficit less than -8 mEq/L, and should alert the clinician to the presence of potentially lethal injuries or uncompensated shock.

ARTICLE TITLE: Preparation and achievement of american college of surgeons level i trauma verification raises hospital performance and improves patient outcome
ARTICLE SOURCE: J Trauma (United States), Aug 2001, 51(2) p294-300
AUTHOR(S): Di Russo S; Holly C; Kamath R; Cuff S; Sullivan T; Scharf H; Tully T; Nealon P; Savino JA
AUTHOR'S ADDRESS: Department of Surgery, New York Medical College and Westchester Medical Center (S.M.D., C.H., S.C., T.S., H.S., T.T., P.N., J.A.S.), Valhalla, New York, and University Hospital, University of Missouri Hospital-Columbia (R.K.), Columbia, Missouri.
PUBLICATION TYPE: Journal Article
CONCLUSION: Trauma system improvement as related to achieving American College of Surgeons (ACS) Level I trauma verification appeared to have a positive impact on survival and patient care. There were cost savings realized that helped alleviate the added expense of this system improvement. The process of achieving ACS Level I verification is worthwhile and can be cost effective.

ARTICLE TITLE: Excessive use of normal saline in managing traumatized patients in shock: a preventable contributor to acidosis.
ARTICLE SOURCE: J Trauma (United States), Jul 2001, 51(1) p173-7
AUTHOR(S): Ho AM; Karmakar MK; Contardi LH; Ng SS; Hewson JR
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, People's Republic of China. hoamh@hotmail.com.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
MB: It might be preventable but is it harmful?

ARTICLE TITLE: Trauma outcome analysis of a Jakarta University Hospital using the TRISS method: validation and limitation in comparison with the major trauma outcome study. Trauma and Injury Severity Score.
ARTICLE SOURCE: J Trauma (United States), Jul 2001, 51(1) p134-40
AUTHOR(S): Joosse P; Soedarmo S; Luitse JS; Ponsen KJ
AUTHOR'S ADDRESS: Department of Traumatology, Academic Medical Centre, University of Amsterdam, the Netherlands. pieterjoosse@hotmail.com.
PUBLICATION TYPE: Journal Article
CONCLUSION: We conclude that in developing countries both institution-bound factors and specific limitations in the TRISS methodology are responsible for the difference between predicted and observed mortality, indicating the need for a regional database.

ARTICLE TITLE: Survival among injured geriatric patients during construction of a statewide trauma system.
ARTICLE SOURCE: J Trauma (United States), Jun 2001, 50(6) p1111-6
AUTHOR(S): Mann NC; Cahn RM; Mullins RJ; Brand DM; Jurkovich GJ
AUTHOR'S ADDRESS: Intermountain Injury Control Research Center, Department of Pediatrics, University of Utah School of Medicine, 410 Chipeta Way, Salt Lake City, UT 84108-9161, USA. clay.mann@hsc.utah.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: This study demonstrates improved survival for seriously injured geriatric trauma patients during construction of the Washington State trauma system.

ARTICLE TITLE: Shark attack: review of 86 consecutive cases.
ARTICLE SOURCE: J Trauma (United States), May 2001, 50(5) p887-91
AUTHOR(S): Woolgar JD; Cliff G; Nair R; Hafez H; Robbs JV
AUTHOR'S ADDRESS: Department of Surgery, University of Natal, Private Bag 7, Congela, Durban 4013, South Africa. Jwoolgar@netactive.co.za.
PUBLICATION TYPE: Journal Article
ABSTRACT: BACKGROUND: On average there are approximately 50 confirmed shark attacks worldwide annually. Despite their rarity, such incidents often generate much public and media attention. METHODS: The injuries of 86 consecutive victims of shark attack were reviewed from 1980 to 1999. Clinical data retrieved from the South African Shark Attack Files, maintained by the Natal Sharks Board, were retrospectively analyzed to determine the nature, treatment, and outcome of injuries. RESULTS: The majority of victims (n = 68 [81%]) had relatively minor injuries that required simple primary suture. Those patients (n = 16 [19%]) with more extensive limb lacerations longer than 20 cm or with soft-tissue loss of more than one myofascial compartment were associated with higher morbidity and limb loss. In 8 of the 10 fatalities, death occurred as a result of exsanguinating hemorrhage from a limb vascular injury. CONCLUSION: Victims of shark attack usually sustain only minor injuries. In more serious cases, particularly if associated with a major vascular injury, hemorrhage control and early resuscitation are of utmost importance during the initial management if these patients are to survive.
MB: They don't just occur in Oz.

ARTICLE TITLE: Payer status: the unspoken triage criterion.
ARTICLE SOURCE: J Trauma (United States), May 2001, 50(5) p776-83
AUTHOR(S): Nathens AB; Maier RV; Copass MK; Jurkovich GJ
AUTHOR'S ADDRESS: Division of General and Trauma Surgery, Department of Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. anathans@u.washington.edu.
PUBLICATION TYPE: Journal Article
CONCLUSION: Insurance status influences the decision to transfer to higher levels of care. These findings suggest that the financial burden of a trauma system may be inequitably distributed. This inequitable distribution may be necessary for trauma system sustainability and calls for the development of disproportionate reimbursement strategies to support regional referral centers.

ARTICLE TITLE: Comparison of outcomes of coronary stenting versus conventional coronary angioplasty in the department of veterans affairs medical centers.
ARTICLE SOURCE: Am J Cardiol (United States), Jun 1 2001, 87(11) p1240-5
AUTHOR(S): Maynard C; Wright SM; Every NR; Ritchie JL
AUTHOR'S ADDRESS: Department of Medicine and Health Services Research and Development, Department of Veterans Affairs, Seattle, Washington 98108, USA. cmaynard@u.washington.edu.
PUBLICATION TYPE: Journal Article
Veterans who underwent stenting had lower hospital mortality, reduced rates of same-admission bypass surgery, marginally better survival, and lower rates of rehospitalization than their counterparts who had conventional coronary angioplasty.

ARTICLE TITLE: Noninvasive determination of pulmonary artery wedge pressure in patients with chronic heart failure.
ARTICLE SOURCE: Am J Cardiol (United States), May 15 2001, 87(10) p1213-5; A7
AUTHOR(S): Givertz MM; Slawsky MT; Moraes DL; McIntyre KM; Colucci WS
AUTHOR'S ADDRESS: Cardiomyopathy Program and Cardiovascular Section, Boston Medical Center, Boston University School of Medicine, Massachusetts 02118, USA.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Effect of beta blockers on incidence of new coronary events in older persons with prior myocardial infarction and symptomatic peripheral arterial disease.
ARTICLE SOURCE: Am J Cardiol (United States), Jun 1 2001, 87(11) p1284-6
AUTHOR(S): Aronow WS; Ahn C
AUTHOR'S ADDRESS: Hebrew Hospital Home, and the Department of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York, New York 10475, USA. WSAronow@aol.com.
PUBLICATION TYPE: Journal Article
MB: Maybe everyone should have beta- blockers from birth.

ARTICLE TITLE: Acute myocardial infarction after manual or automated snow removal.
ARTICLE SOURCE: Am J Cardiol (United States), Jun 1 2001, 87(11) p1282-3
AUTHOR(S): Franklin BA; George P; Henry R; Gordon S; Timmis GC; O'Neill WW
AUTHOR'S ADDRESS: Department of Medicine, Division of Cardiology (Cardiac Rehabilitation), William Beaumont Hospital, Royal Oak, Michigan, USA. bfranklin@beaumont.edu.
PUBLICATION TYPE: Journal Article
MB: Even the automatic snow thrower was being used in some AMIs.

ARTICLE TITLE: Heart failure in 2001: a prophecy revisited.
ARTICLE SOURCE: Am J Cardiol (United States), Jun 15 2001, 87(12) p1383-6
AUTHOR(S): Katz AM
PUBLICATION TYPE: Editorial
MB: MUST READ. Brilliantly describes the reversal of view & why.

ARTICLE TITLE: Are we aggressive enough in lowering cholesterol?
ARTICLE SOURCE: Am J Cardiol (United States), Aug 16 2001, 88(4 Suppl) p10-5
AUTHOR(S): Waters DD
AUTHOR'S ADDRESS: Cardiology Division, Department of Medicine, San Francisco General Hospital, San Francisco, California, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: To date, 5 major randomized, placebo-controlled statin trials-the Scandinavian Simvastatin Survival Study, West of Scotland Coronary Prevention Study, Cholesterol and Recurrent Events trial, Long-term Intervention with Pravastatin in Ischaemic Disease, and Air Force/Texas Coronary Atherosclerosis Prevention Study-have convincingly shown that total mortality and major coronary events can be significantly reduced by lowering levels of low-density lipoprotein cholesterol (LDL-C) with statin therapy. These results were achieved in a broad range of patients including those with and without a history of coronary artery disease and with elevated or average LDL-C levels. The results also support the large body of epidemiologic evidence demonstrating that the lower the cholesterol level, the lower the cardiovascular risk. Evidence now substantially supports the urgency of physicians to aggressively target the lowering of LDL-C levels for the primary and secondary prevention of coronary disease.

ARTICLE TITLE: Making practical sense of clinical trial data in decreasing cardiovascular risk.
ARTICLE SOURCE: Am J Cardiol (United States), Aug 16 2001, 88(4 Suppl) p16-20
AUTHOR(S): Castelli WP
AUTHOR'S ADDRESS: Framingham Cardiovascular Institute, Framingham, Massachusetts, USA.
PUBLICATION TYPE: Journal Article
ABSTRACT: Clinical studies now affirm what epidemiologic evidence has long suggested-that a broad range of patients can benefit from lipid reduction, including those without overt coronary artery disease and only moderate lipid elevations. Together, these studies suggest that current goals for cholesterol reduction may not be sufficiently stringent to slow the epidemic of heart disease in this country and that aggressive lipid lowering may be just what the doctor should order.
MB: How depressing. One of my few pleasures is eating.

ARTICLE TITLE: Usefulness of serial electrocardiograms for diagnosis of acute myocardial infarction
ARTICLE SOURCE: Am J Cardiol (United States), Sep 1 2001, 88(5) p478-81
AUTHOR(S): Ohlsson M; Ohlin H; Wallerstedt SM; Edenbrandt L
AUTHOR'S ADDRESS: Department of Theoretical Physics, Lund University, Lund, Sweden.
PUBLICATION TYPE: Journal Article
ABSTRACT: The purpose of this study was to determine whether the automated detection of acute myocardial infarction (AMI) by utilizing artificial neural networks was improved by using a previous electrocardiogram (ECG) in addition to the current ECG. <snip> Thus, the performance of a neural network, detecting acute myocardial infarction (AMI) in an ECG, is improved when a previous ECG is used as an additional input.
MB: How surprising.

ARTICLE TITLE: Comparison of two aspirin doses on ischemic stroke in post-myocardial infarction patients in the warfarin (Coumadin) Aspirin Reinfarction Study (CARS)
ARTICLE SOURCE: Am J Cardiol (United States), Sep 1 2001, 88(5) p541-6
AUTHOR(S): O'Connor CM; Gattis WA; Hellkamp AS; Langer A; Larsen RL; Harrington RA; Berkowitz SD; O'Gara PT; Kopecky SL; Gheorghiade M; Daly R; Califf RM; Fuster V
AUTHOR'S ADDRESS: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
PUBLICATION TYPE: Journal Article
The results of this secondary analysis suggest that aspirin 160 mg is more effective than aspirin 80 mg + warfarin 1 mg in preventing ischemic stroke in post-myocardial infarction patients.
MB: It used to be that aspirin reduced MI problems but increased strokes with benefit on balance.

ARTICLE TITLE: Point-of-care testing apparatus. Measurement of coagulation
ARTICLE SOURCE: Anaesthesia (England), Aug 2001, 56(8) p760-3
AUTHOR(S): Hirsch J; Wendt T; Kuhly P; Schaffartzik W
AUTHOR'S ADDRESS: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Unfallkrankenhaus Berlin, Teaching Hospital of the Free University of Berlin, Warener Str. 7, 12683 Berlin, Germany.
PUBLICATION TYPE: Journal Article
ABSTRACT: Point-of-care testing of coagulation parameters provides a more rapid assessment of test results compared with laboratory testing. A new coagulation monitor (GEM PCL, Instrumentation Laboratory, Kirchheim, Germany) was evaluated. Point-of-care data for activated partial thromboplastin time and prothrombin time (expressed as the international normalised ratio) and turn-around-time were compared. Coagulation parameters were compared in the blood of 57 patients with and without heparin therapy. The point-of-care and laboratory test results showed a bias (SD) of -0.26 (4.55) s for activated partial thromboplastin time and -0.011 (0.150) s for prothrombin time. The average turn-around-time was 3 min for point-of-care testing vs. 52 min for laboratory testing. We conclude that the reliability of point-of-care testing is sufficient for clinical use.
MB: The problem is that they may not be the appropriate tests. What are you supposed to do with the results that you get quickly?

ARTICLE TITLE: Prevention and management of hypotension during spinal anaesthesia for elective Caesarean section: a survey of practice
ARTICLE SOURCE: Anaesthesia (England), Aug 2001, 56(8) p777-98
AUTHOR(S): Burns SM; Cowan CM; Wilkes RG
AUTHOR'S ADDRESS: 1Specialist Registrar in Anaesthesia and 2Consultant Anaesthetist, Liverpool Women's Hospital, Crown Street, Liverpool L8 7SS, UK.
PUBLICATION TYPE: Journal Article
ABSTRACT: Hypotension during obstetric spinal anaesthesia has traditionally been managed by such measures as fluid preloading, positioning of the patient and the use of vasoconstrictors. However, studies and reports have regularly appeared in the literature disputing the value of conventional management, in particular, the fluid preload. With this in mind, we surveyed UK consultant obstetric anaesthetists to determine current practice in this area. Of the 558 respondents, 486 (87.1%) stated that they routinely give a fluid preload. The fluid chosen by 405 (83.3%) of the preloaders was Hartmann's solution and the usual volume, chosen by 194 (39.9%), was 1000 ml. A simple left lateral position was preferred by 221 respondents (39.6%) overall and in the treatment of hypotension, ephedrine was the sole vasoconstrictor selected by 531 (95.2%). Heavy bupivacaine 0.5% was the local anaesthetic chosen by 545 (97.7%) and 407 (72.9%) respondents indicated the use of additional spinal drugs.
MB: This is recipe type thinking.

ARTICLE TITLE: Spinal anaesthesia and conus damage.
ARTICLE SOURCE: Anaesthesia (England), Jul 2001, 56(7) p707-8
AUTHOR(S): Dressner M; Riad T; Keep M
PUBLICATION TYPE: Letter
MB: Probably much commoner than has been thought. The author says that he knows of several cases which have been settled. Text books play down the risk.

ARTICLE TITLE: Severe hypokalaemia causing acute respiratory failure.
ARTICLE SOURCE: Anaesthesia (England), Jul 2001, 56(7) p694-5
AUTHOR(S): Davies RG; Gemmell L
PUBLICATION TYPE: Letter
MB: Probably related to severe total depletion.

ARTICLE TITLE: Peri-operative silent myocardial ischaemia and long-term adverse outcomes in non-cardiac surgical patients.
ARTICLE SOURCE: Anaesthesia (England), Jul 2001, 56(7) p630-7
AUTHOR(S): Higham H; Sear JW; Neill F; Sear YM; Foex P
AUTHOR'S ADDRESS: Nuffield Department of Anaesthetics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. helen.higham@nda.ox.ac.uk.
ABSTRACT: Two hundred and seventy-five non-cardiac surgical patients were recruited to determine risk factors associated with the development of postoperative cardiovascular complications during the first year after surgery. Patients underwent ambulatory electrocardiography pre- and postoperatively. There were 34 adverse events over the whole study period. Twenty-four occurred within 6 months and the remaining 10 occurred between 6 and 12 months postoperatively. Silent myocardial ischaemia was associated with adverse outcome over both the first 6 months [OR 4.44 (95% CI 1.77-11.13)] and the whole study period [OR 2.81 (1.26-6.07)]. Other risk factors were: vascular surgery [OR 17.09 (2.67-351.44)], history of angina [OR 6.29 (2.21-17.62)], concurrent treatment with calcium entry blockers [OR 2.68 (1.03-6.93)] and smoking [OR 4.93 (2.00-12.02)]. None of these was a useful predictor of long-term outcome (between 6 and 12 months postsurgery). These results are at variance with other published data, but we conclude that monitoring for peri-operative silent myocardial ischaemia does not aid the prediction of long-term cardiovascular complications.
MB: Studies with Peirre Foex are usually sensible.

ARTICLE TITLE: When is a standard, not a standard? When it is a recommendation.
ARTICLE SOURCE: Anaesthesia (England), Jul 2001, 56(7) p611-2
AUTHOR(S): Harmer M
PUBLICATION TYPE: Editorial
MB: Complaining that acute pain services recommendations are waffle.

ARTICLE TITLE: The arterial tourniquet: pathophysiological consequences and anaesthetic implications.
ARTICLE SOURCE: Anaesthesia (England), Jun 2001, 56(6) p534-45
AUTHOR(S): Kam PC; Kavanaugh R; Yoong FF
AUTHOR'S ADDRESS: Department of Anaesthesia and Pain Management, University of Sydney at the Royal North Shore Hospital, St Leonards, NSW 2065, Australia. pkam@med.usyd.edu.au.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: The arterial tourniquet is widely used in upper and lower extremity surgery and in intravenous regional anaesthesia. The local and systemic physiological effects and the anaesthetic implications are reviewed. Localised complications result from either tissue compression beneath the cuff or tissue ischaemia distal to the tourniquet. Systemic effects are related to the inflation or deflation of the tourniquet. Safe working guidelines for the application of an arterial tourniquet have not been clearly defined.

ARTICLE TITLE: Isolated systolic hypertension: pressure on the anaesthetist?
ARTICLE SOURCE: Anaesthesia (England), Jun 2001, 56(6) p505-10
AUTHOR(S): Prys-Roberts C
PUBLICATION TYPE: Editorial; Review; Review, Tutorial

ARTICLE TITLE: Acute respiratory acidosis does not increase plasma potassium in normokalaemic anaesthetized patients. A controlled randomized trial.
ARTICLE SOURCE: Eur J Anaesthesiol (England), Jun 2001, 18(6) p394-400
AUTHOR(S): Natalini G; Seramondi V; Fassini P; Foccoli P; Toninelli C; Cavaliere S; Candiani A
AUTHOR'S ADDRESS: Department of Anaesthesia and Intensive Care, Spedali Civili Hospital, Brescia, Italy.
PUBLICATION TYPE: Clinical Trial; Journal Article; Randomized Controlled Trial
CONCLUSION: Acute respiratory acidosis does not affect plasma potassium concentration.
MB: What about alkalosis.

ARTICLE TITLE: The hyperdynamic circulation in cirrhosis. an overview
ARTICLE SOURCE: Pharmacol Ther (England), Mar 2001, 89(3) p221-31
AUTHOR(S): Blendis L; Wong F
AUTHOR'S ADDRESS: Institute of Gastroenterology, Sourasky Tel Aviv Medical Center, 6 Weizman Street, 64239, Tel Aviv, Israel.
PUBLICATION TYPE: Journal Article
ABSTRACT: The hyperdynamic circulation begins in the portal venous bed as a consequence of portal hypertension due to the increased resistance to flow from altered hepatic vascular morphology of chronic liver disease. Dilatation of the portal vein is associated with increased blood flow, as well as the opening up or formation of veno-venous shunts and splenomegaly. At the same time, portal hypertension leads to subclinical sodium retention resulting in expansion of all body fluid compartments, including the systemic and central blood volumes. This blood volume expansion is associated with vasorelaxation, as manifested by suppression of the renin-angiotensin-aldosterone system, initially only when the patient is in the supine position. Acute volume depletion in such patients results in normalisation of the hyperdynamic circulation, whilst acute volume expansion results in exaggerated natriuresis. As liver disease progresses and liver function deteriorates, the systemic hyperdynamic circulation becomes more manifest with activation of the renin-angiotensin-aldosterone system. The presence of vasodilatation in the presence of highly elevated levels of circulating vasoconstrictors may be explained by vascular hyporesponsiveness due to increased levels of vasodilators such as nitric oxide, as well as the development of an autonomic neuropathy. However, vasodilatation is not generalised, but confined to certain vascular beds, such as the splanchnic and pulmonary beds. Even here, the status may change with the natural history of the disease, since even portal blood flow may decrease and become reversed with advanced disease. The failure of these changes to reverse following liver transplantation may be due to remodelling and angiogenesis.

ARTICLE TITLE: Redefining medical students' disease to reduce morbidity
AUTHOR(S): Moss-Morris R; Petrie KJ
AUTHOR'S ADDRESS: Health Psychology Research Group, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: The results support the separation of medical students' disease into perceptual and emotional components. This conceptualization of medical students' disease as a normal process rather than a form of hypochondriasis may be used to brief medical students when they enter medical school, in order to reduce the distress associated with the condition. Medical students' disease can also be used as a personally relevant example in teaching about how patients make sense of symptoms.

ARTICLE TITLE: Has the ban on smoking in New South Wales restaurants worked? A comparison of restaurants in Sydney and Melbourne.
ARTICLE SOURCE: Med J Aust (Australia), May 21 2001, 174(10) p512-5
AUTHOR(S): Chapman S; Borland R; Lal A
AUTHOR'S ADDRESS: Department of Public Health and Community Medicine, University of Sydney, NSW. simonc@health.usyd.edu.au.
PUBLICATION TYPE: Journal Article
ABSTRACT: OBJECTIVE: To evaluate compliance with a legislative ban on smoking inside restaurants by comparing smoking in Sydney restaurants (where it is legally banned) with smoking in Melbourne restaurants (not subject to a legal ban). <snip> CONCLUSIONS: Smoke-free restaurants do not require "smoking police" to enforce bans, present few ongoing difficulties for staff, attract many more favourable than unfavourable comments from patrons, and do not adversely affect trade. h

ARTICLE TITLE: Appendicectomy--becoming a rare event?
COMMENTS: : Med J Aust. 2001 Jul 2; 175(1):15-8/21368436
ARTICLE SOURCE: Med J Aust (Australia), Jul 2 2001, 175(1) p7-8
AUTHOR(S): Hugh TB; Hugh TJ
PUBLICATION TYPE: Comment; Editorial

ARTICLE TITLE: Allowing the medical use of cannabis.
ARTICLE SOURCE: Med J Aust (Australia), Jul 2 2001, 175(1) p39-40
AUTHOR(S): Hall WD; Degenhardt LJ; Currow D
AUTHOR'S ADDRESS: The National Drug and Alcohol Research Centre, University of New South Wales, Sydney. w.hall@unsw.edu.au.
PUBLICATION TYPE: Journal Article

ARTICLE TITLE: Confidentiality in health records: evidence of current performance from a population survey in South Australia.
ARTICLE SOURCE: Med J Aust (Australia), Jun 18 2001, 174(12) p637-40
AUTHOR(S): Mulligan EC
AUTHOR'S ADDRESS: Flinders University of South Australia, Adelaide. ea.mulligan@flinders.edu.au.
PUBLICATION TYPE: Journal Article
CONCLUSIONS: Healthcare providers have lost the confidence of a minority of patients. For some, this mistrust is based on experience of unauthorised information release. Some disclosures are mandated by legislation. These findings provide baseline performance measures for benchmarking trends in patient confidence and prevalence of unauthorised release of patient information.

ARTICLE TITLE: Evidence-based obstetrics in Australia: can we put away the wooden spoon?
ARTICLE SOURCE: Med J Aust (Australia), Jun 4 2001, 174(11) p588-9
AUTHOR(S): Searle J
AUTHOR'S ADDRESS: Department of Obstetrics, Gynaecology and Reproductive Medicine, Flinders Medical Centre, Adelaide, SA. J.Searle@exeter.ac.uk.
PUBLICATION TYPE: Journal Article; Review; Review, Tutorial
ABSTRACT: In the evidence-based medicine stakes, obstetrics has risen from being the holder of the "wooden spoon" to being a world leader in the pursuit of best evidence and the use of formal systematic reviews. A prime example of evidence-based obstetric practice is the use of corticosteroids to reduce respiratory distress syndrome in preterm infants. However, in other areas, such as the rising caesarean section rates, providing best evidence to guide practice has proven difficult. The availability of evidence has not always resulted in changed clinical practice and improved patient care. Researchers in Australia are now examining strategies to maximise dissemination of available best evidence into obstetric practice. Without reflective practice and effective dissemination of evidence, the present litigation phobia surrounding obstetric care could lead to evidence-based medicine being replaced by "nervousness-based medicine"
MB: Maybe it's popular press driven.