MB's Articles of Interest - September 2000

ARTICLE TITLE: The effects of propranolol on cognitive function and quality of life: a randomized trial among patients with diastolic hypertension [see comments]
COMMENTS: Comment in: Am J Med 2000 Apr 1; 108(5):429-30
ARTICLE SOURCE: Am J Med (United States), Apr 1 2000, 108(5) p359-65
AUTHOR(S): Perez-Stable EJ; Halliday R; Gardiner PS; Baron RB; Hauck WW; Acree M; Coates TJ
AUTHOR'S ADDRESS: Department of Medicine, University of California, San Francisco, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Treatment of hypertension with propranolol had limited adverse effects on tests of cognitive function that were of questionable clinical relevance, and there were no documented adverse effects on depressive symptoms or sexual function. Selection of beta-blockers for treatment of hypertension should be based on other factors.

ARTICLE TITLE: Do residents need unions?
ARTICLE SOURCE: Am J Med (United States), Feb 15 2000, 108(3) p264-6
AUTHOR(S): Luke RG
AUTHOR'S ADDRESS: Department of Internal Medicine, University of Cincinnati College of Medicine, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
MB. The author could well have looked at what has happened here with residents and registrars having unions. He would not have to have speculated about some aspects.

ARTICLE TITLE: Generalists and specialists caring for patients with heart disease: united we stand, divided we fall [editorial; comment]
COMMENTS: Comment on: Am J Med 2000 Feb 15; 108(3):216-26
ARTICLE SOURCE: Am J Med (United States), Feb 15 2000, 108(3) p259-61
AUTHOR(S): Ayanian JZ
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: A systematic review of the effects of physician specialty on the treatment of coronary disease and heart failure in the United States [see comments]
COMMENTS: Comment in: Am J Med 2000 Feb 15; 108(3):259-60
ARTICLE SOURCE: Am J Med (United States), Feb 15 2000, 108(3) p216-26
AUTHOR(S): Go AS; Rao RK; Dauterman KW; Massie BM
AUTHOR'S ADDRESS: Division of Research, Kaiser Permanente Medical Care Program (Northern California), Oakland, California 94611-5714, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Patients with coronary disease or heart failure in the United States who are treated by cardiologists appear more likely to receive evidence-based care and probably have better outcomes. Investigation of collaborative models of care and innovative efforts to improve the use of proven therapies by physicians are needed.

ARTICLE TITLE: The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on postoperative renal function: a meta-analysis.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 1999, 27(6) p574-80
AUTHOR(S): Lee A; Cooper MG; Craig JC; Knight JF; Keneally JP
AUTHOR'S ADDRESS: Department of Anaesthesia, Royal Alexandra Hospital for Children, Sydney, New South Wales, Australia.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
ABSTRACT: The aim of this systematic review was to assess the effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on post-operative renal function. Eight randomized placebo-controlled double-blinded trials (n = 345) were identified from searches of MEDLINE, EMBASE and the Cochrane Controlled Trials Register databases. The summary effect size and 95% confidence intervals (95% CI) were calculated by a weighted mean difference analysis using a random-effects model. The NSAIDs (diclofenac, ketorolac, indomethacin, ibuprofen) were used for up to three-days after surgery. There were no reported cases of postoperative renal failure requiring dialysis. NSAIDs reduced creatinine clearance by 22 ml.min-1 (95% CI: 7 to 37), sodium output by 54 mmol.day-1 (95% CI: 5 to 103) and potassium output by 38 mmol.day-1 (95% CI: 19 to 56) on Day 1 but not on Day 2. Serum creatinine increased on Day 2 by 15 mumol.l-1 (95% CI: 2 to 28). Urine volume did not change significantly at any time. There was therefore a clinically unimportant transient reduction in renal function. NSAIDs should not be withheld from patients with normal preoperative renal function because of concerns about postoperative renal impairment.
MB. This implies that only the material from the 8 randomised studies should be used in deciding whether to use NSAIDS or not.

ARTICLE TITLE: Data collection by acute pain services in Australia and New Zealand.
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Dec 1999, 27(6) p632-5
AUTHOR(S): Turner GA; Halliwell R
AUTHOR'S ADDRESS: Department of Anaesthesia, Royal Perth Hospital, W.A.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: Forty-three Acute Pain Service units in Australia and New Zealand were surveyed regarding data they collected on their daily rounds. The survey sought to determine what data each unit actually collected and what they considered to be a set of data that would be an acceptable minimal standard for the purpose of audit. The scoring or scaling mechanisms that were used in auditing the various parameters were also ascertained in an attempt to derive a consistent means of comparing data from the various Acute Pain Service groups. The Acute Pain Special Interest Group is currently developing suggestions for a standard data set and associated scoring mechanisms in line with the results of this survey.

ARTICLE TITLE: Hyperkalaemia and massive transfusion [letter]
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Feb 2000, 28(1) p111
AUTHOR(S): Board J
PUBLICATION TYPE: LETTER
MB. Board advocates washing bank blood as he and we do in liver trasnplantation. He thinks that the post revacularisation hypokalaemia is due to that. It is not.

ARTICLE TITLE: Fatal epidural infusion [letter]
ARTICLE SOURCE: Anaesth Intensive Care (Australia), Feb 2000, 28(1) p112
AUTHOR(S): Sayers P
PUBLICATION TYPE: LETTER
MB. The nurse accelerated an epidural infusion to fix oliguria. I have heard of an identical case. Sayers says that the management was as recommended by the NH & MRC. I don't think that they would have recommended this.
Patients do not die from pain.

ARTICLE TITLE: Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo [see comments]
COMMENTS: Comment in: Anesthesiology 2000 Apr; 92(4):931-3
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p958-67
AUTHOR(S): Hill RP; Lubarsky DA; Phillips-Bute B; Fortney JT; Creed MR; Glass PS; Gan TJ
AUTHOR'S ADDRESS: Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: The use of prophylactic antiemetic therapy in high-risk ambulatory surgical patients was more effective in preventing PONV and achieved greater patient satisfaction at a lower cost compared with placebo. The use of 1.25 mg droperidol intravenously was associated with greater effectiveness, lower costs, and similar patient satisfaction compared with 0.625 mg droperidol intravenously and 4 mg ondansetron intravenously.

ARTICLE TITLE: The cost-effective management of postoperative nausea and vomiting [editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 Apr; 92(4):958-67
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p931-3
AUTHOR(S): Watcha MF
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. This questions and thus disagrees with the implied conclusion of the preceding article

ARTICLE TITLE: Prophylactic ondansetron in prevention of postoperative nausea and vomiting following pediatric strabismus surgery: a dose-response study.
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p1035-42
AUTHOR(S): Sadhasivam S; Shende D; Madan R
AUTHOR'S ADDRESS: Department of Anesthesiology and Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: The routine prophylactic use of ondansetron at a dose of 75 microg/kg is as effective as 150 microg/kg in preventing PONV and improving the "true" outcome measures after strabismus repair in children.

ARTICLE TITLE: The effect of anesthetic technique on postoperative outcomes in hip fracture repair [see comments]
COMMENTS: Comment in: Anesthesiology 2000 Apr; 92(4):928-30
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p947-57
AUTHOR(S): O'Hara DA; Duff A; Berlin JA; Poses RM; Lawrence VA; Huber EC; Noveck H; Strom BL; Carson JL
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick 08903-0019, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE
.CONCLUSIONS: The authors were unable to demonstrate that regional anesthesia was associated with better outcome than was general anesthesia in this large observational study of elderly patients with hip fracture. These results suggest that the type of anesthesia used should depend on factors other than any associated risks of mortality or morbidity.

ARTICLE TITLE: Randomized and nonrandomized clinical studies: statistical considerations [editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 Apr; 92(4):947-57
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p928-30
AUTHOR(S): Baker SG; Lindeman KS
INDEXING CHECK TAG(S): Human

ARTICLE TITLE: Anxiolysis--by the parent or for the parent? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 Apr; 92(4):939-46
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p925-7
AUTHOR(S): Lerman J
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. Mainly about parents being there during induction.

ARTICLE TITLE: Real-time intraoperative monitoring of myocardial ischemia in noncardiac surgery.
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p1183-8
AUTHOR(S): Fleisher LA
AUTHOR'S ADDRESS: Department of Anesthesiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. lfleishe@jhmi.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (20 references); REVIEW, TUTORIAL

ARTICLE TITLE: Practice advisory for the prevention of perioperative peripheral neuropathies: a report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies.
ARTICLE SOURCE: Anesthesiology (United States), Apr 2000, 92(4) p1168-82
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE

ARTICLE TITLE: Xenon anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), Mar 2000, 92(3) p865-8
AUTHOR(S): Lynch C 3rd; Baum J; Tenbrinck R
AUTHOR'S ADDRESS: Department of Anesthesiology, University of Virginia Health System, Charlottesville 22906-0010, USA. carllynch@virginia.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (22 references); REVIEW, TUTORIAL

ARTICLE TITLE: Comparison of conventional surgical versus Seldinger technique emergency cricothyrotomy performed by inexperienced clinicians.
ARTICLE SOURCE: Anesthesiology (United States), Mar 2000, 92(3) p687-90
AUTHOR(S): Eisenburger P; Laczika K; List M; Wilfing A; Losert H; Hofbauer R; Burgmann H; Bankl H; Pikula B; Benumof JL; Frass M
AUTHOR'S ADDRESS: Department of Internal Medicine I, University of Vienna, Austria.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Cricothyrotomy is the ultimate option for a patient with a life-threatening airway problem. METHODS: The authors compared the first-time performance of surgical (group 1) versus Seldinger technique (group 2) cricothyrotomy in cadavers. Intensive care unit physicians (n = 20) performed each procedure on two adult human cadavers. Methods were compared with regard to ease of use and anatomy of the neck of the cadaver. Times to location of the cricothyroid membrane, to tracheal puncture, and to the first ventilation were recorded. Each participant was allowed only one attempt per procedure. A pathologist dissected the neck of each patient and assessed correctness of position of the tube and any injury inflicted. Subjective assessment of technique and cadaver on a visual analog scale from 1 (easiest) to 5 (worst) was conducted by the performer. RESULTS: Age, height, and weight of the cadavers were not different. Subjective assessment of both methods (2.2 in group 1 vs. 2.4 in group 2) and anatomy of the cadavers (2.2 in group 1 vs. 2.4 in group 2) showed no statistically significant difference between both groups. Tracheal placement of the tube was achieved in 70% (n = 14) in group 1 versus 60% (n = 12) in group 2 (P value not significant). Five attempts in group 2 had to be aborted because of kinking of the guide wire. Time intervals (mean +/- SD) were from start to location of the cricothyroid membrane 7 +/- 9 s (group 1) versus 8 +/- 7s (group 2), to tracheal puncture 46 +/- 37s (group 1) versus 30 +/- 28s (group 2), and to first ventilation 102 +/- 42s (group 1) versus 100 +/- 46s (group 2) (P value not significant). CONCLUSIONS: The two methods showed equally poor performance.

ARTICLE TITLE: Percutaneous (Portex) tracheostomy: an audit of the Newcastle experience.
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Mar 2000, 82(2) p137-40
AUTHOR(S): Jeannon JP; Mathias D
AUTHOR'S ADDRESS: Department of Otolaryngology, Freeman Hospital, Newcastle, UK. Jean-Pierre.Jeannon@ncl.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The purpose of this study was to audit the results of percutaneous tracheostomies performed by ENT surgeons in Newcastle. During a 3-year period, 298 tracheostomies: 196 percutaneous and 102 open were studied. A complication rate for percutaneous tracheostomy was found to be 10% compared to 8% for open, this difference was not statistically significant chi 2 = 0.279, P = 0.598 (DF = 1). The indications for percutaneous tracheostomy were mainly limited to respiratory support for intensive care unit patients, whereas the majority of open tracheostomies were performed in the operating theatre. The results of this audit suggest that percutaneous tracheostomy is the method of choice for respiratory support in the intensive care unit and is as safe as the open technique.
MB. Other studies have suggested the opposite.

ARTICLE TITLE: How do we measure (the cost of) pain relief? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 Mar; 92(3):841-50
ARTICLE SOURCE: Anesthesiology (United States), Mar 2000, 92(3) p643-5
AUTHOR(S): Chestnut DH
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. Important. See full text

ARTICLE TITLE: Avoiding latrogenic hyperchloremic acidosis--call for a new crystalloid fluid [letter]
ARTICLE SOURCE: Anesthesiology (United States), Feb 2000, 92(2) p625-6
AUTHOR(S): Dorje P; Adhikary G; Tempe DK
PUBLICATION TYPE: LETTER
MB. They want a non-K containing solution

ARTICLE TITLE: Saline infusion, acidosis, and the Stewart approach [letter]
ARTICLE SOURCE: Anesthesiology (United States), Feb 2000, 92(2) p624; discussion 626
AUTHOR(S): Story DA; Liskaser F; Bellomo R
PUBLICATION TYPE: LETTER
MB. Very confused chemistry.
Vide: http://www.usyd.edu.au/su/anaes/lectures/acidbase_mjb/acidbase.html

ARTICLE TITLE: Awareness during anesthesia.
ARTICLE SOURCE: Anesthesiology (United States), Feb 2000, 92(2) p597-602
AUTHOR(S): Ghoneim MM
AUTHOR'S ADDRESS: Department of Anesthesia, College of Medicine, The University of Iowa, Iowa City 52242, USA. mohamed-ghoneim@uiowa.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (18 references); REVIEW, TUTORIAL

ARTICLE TITLE: Perioperative heat balance.
ARTICLE SOURCE: Anesthesiology (United States), Feb 2000, 92(2) p578-96
AUTHOR(S): Sessler DI
AUTHOR'S ADDRESS: Department of Anesthesia, University of California-San Francisco 94143-0648, USA. sessler@anesthesia.ucsf.edu.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (139 references); REVIEW, ACADEMIC
ABSTRACT: Hypothermia during general anesthesia develops with a characteristic three-phase pattern. The initial rapid reduction in core temperature after induction of anesthesia results from an internal redistribution of body heat. Redistribution results because anesthetics inhibit the tonic vasoconstriction that normally maintains a large core-to-peripheral temperature gradient. Core temperature then decreases linearly at a rate determined by the difference between heat loss and production. However, when surgical patients become sufficiently hypothermic, they again trigger thermoregulatory vasoconstriction, which restricts core-to-peripheral flow of heat. Constraint of metabolic heat, in turn, maintains a core temperature plateau (despite continued systemic heat loss) and eventually reestablishes the normal core-to-peripheral temperature gradient. Together, these mechanisms indicate that alterations in the distribution of body heat contribute more to changes in core temperature than to systemic heat imbalance in most patients. Just as with general anesthesia, redistribution of body heat is the major initial cause of hypothermia in patients administered spinal or epidural anesthesia. However, redistribution during neuraxial anesthesia is typically restricted to the legs. Consequently, redistribution decreases core temperature about half as much during major conduction anesthesia. As during general anesthesia, core temperature subsequently decreases linearly at a rate determined by the inequality between heat loss and production. The major difference, however, is that the linear hypothermia phase is not discontinued by reemergence of thermoregulatory vasoconstriction because constriction in the legs is blocked peripherally. As a result, in patients undergoing large operations with neuraxial anesthesia, there is the potential of development of serious hypothermia. Hypothermic cardiopulmonary bypass is associated with enormous changes in body heat content. Furthermore, rapid cooling and rewarming produces large core-to-peripheral, longitudinal, and radial tissue temperature gradients. Inadequate rewarming of peripheral tissues typically produces a considerable core-to-peripheral gradient at the end of bypass. Subsequently, redistribution of heat from the core to the cooler arms and legs produces an afterdrop. Afterdrop magnitude can be reduced by prolonging rewarming, pharmacologic vasodilation, or peripheral warming. Postoperative return to normothermia occurs when brain anesthetic concentration decreases sufficiently to again trigger normal thermoregulatory defenses. However, residual anesthesia and opioids given for treatment of postoperative pain decreases the effectiveness of these responses. Consequently, return to normothermia often needs 2-5 h, depending on the degree of hypothermia and the age of the patient.

ARTICLE TITLE: Comparison of intravenous or epidural patient-controlled analgesia in the elderly after major abdominal surgery.
ARTICLE SOURCE: Anesthesiology (United States), Feb 2000, 92(2) p433-41
AUTHOR(S): Mann C; Pouzeratte Y; Boccara G; Peccoux C; Vergne C; Brunat G; Domergue J; Millat B; Colson P
AUTHOR'S ADDRESS: Department of Anesthesia, Centre Hospitalier Universitaire Montpellier, France. c-mann@chu-montpellier.fr.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: After major abdominal surgery in the elderly patient, patient-controlled analgesia, regardless of the route (epidural or parenteral), is effective. The epidural route using local anesthetics and an opioid provides better pain relief and improves mental status and bowel activity.

ARTICLE TITLE: Preemptive hyperalgesia, not analgesia? [editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 Feb; 92(2):465-72
ARTICLE SOURCE: Anesthesiology (United States), Feb 2000, 92(2) p308-9
AUTHOR(S): Eisenach JC
PUBLICATION TYPE: COMMENT; EDITORIAL
MB. How delightful.

ARTICLE TITLE: Left-molar approach improves the laryngeal view in patients with difficult laryngoscopy.
ARTICLE SOURCE: Anesthesiology (United States), Jan 2000, 92(1) p70-4
AUTHOR(S): Yamamoto K; Tsubokawa T; Ohmura S; Itoh H; Kobayashi T
AUTHOR'S ADDRESS: Department of Anesthesiology and Intensive Care Medicine, School of Medicine, Kanazawa University, Japan. kenyam@med.kanazawa-u.ac.jp.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: The molar approach of laryngoscopy is reported to improve glottic view in sporadic cases of difficult laryngoscopy. The authors studied the effect of molar approaches and optimal external laryngeal manipulation (OELM) using the Macintosh blade. METHODS: A series of 1,015 adult patients who underwent general anesthesia and tracheal intubation was studied. Laryngoscopy was carried out using a Macintosh no. 3 or 4 standard blade. Three consecutive trials of direct laryngoscopy using the midline and left- and right-molar approaches were carried out under full muscle relaxation with optimal head and neck positioning. The best glottic views were recorded for each approach with and without OELM. RESULTS: Difficult laryngoscopy with a midline approach accounted for 6.5% (66 cases) before OELM and 1.97% (20 cases) after OELM. A left-molar approach with OELM further reduced difficult laryngoscopy to seven cases (P < 0.001 vs. midline approach with OELM); a right-molar approach with OELM reduced difficult laryngoscopy to 18 cases (P = 0.48). CONCLUSIONS: The left-molar approach with OELM improves the laryngeal view in patients with difficult laryngoscopy.
MB. These people seem to have no idea how to put in a laryngoscope. I think they are advocating what I have always done ie go in the side of the mouth and make sure that the tongue is beside not anterior to the blade.

ARTICLE TITLE: Halogenated anesthetics and human myocardium [editorial; comment]
COMMENTS: Comment on: Anesthesiology 2000 Jan; 92(1):116-24
ARTICLE SOURCE: Anesthesiology (United States), Jan 2000, 92(1) p1-2
AUTHOR(S): Riou B
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Low-dose continuous infusion of human atrial natriuretic peptide during and after cardiac surgery.
ARTICLE SOURCE: Ann Thorac Surg (United States), Mar 2000, 69(3) p732-8
AUTHOR(S): Sezai A; Shiono M; Orime Y; Hata H; Hata M; Negishi N; Sezai Y
AUTHOR'S ADDRESS: Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: We evaluated the effects of human atrial natriuretic peptide (hANP) during cardiopulmonary bypass (CPB). METHODS: Forty patients undergoing coronary artery bypass grafting were investigated. A group of patients given hANP for 24 hours from the start of CPB (hANP group) was compared with a non-hANP group. Parameters examined were hemodynamics, urine volume, dosage of furosemide, respiratory index, pleural effusion, ANP, cyclic guanosine monophosphate, renin activity (renin), angiotensin-II, aldosterone, and glomerular filtration rate. RESULTS: Central venous pressure, systemic vascular resistance index, and pulmonary vascular resistance index were significantly lower in the hANP group than in the non-hANP group. The hANP group showed significantly higher levels of ANP, cyclic guanosine monophosphate, glomerular filtration rate, and respiratory index, and significantly lower levels of renin, angiotensin-II, aldosterone, and pleural effusion, as compared with the non-hANP group. The dosage of furosemide was significantly lower and the urine volume was significantly larger in the hANP group. CONCLUSIONS: hANP can satisfactorily compensate for the shortcomings of CPB by decreasing the peripheral vascular resistance, suppressing the renin-angiotensin-aldosterone system, and exerting a strong diuretic effect.

ARTICLE TITLE: Lessons to be learnt from the Bristol affair [editorial]
ARTICLE SOURCE: Ann Thorac Surg (United States), Mar 2000, 69(3) p674-5
AUTHOR(S): Monro
PUBLICATION TYPE: EDITORIAL
MB. This editorial is a big muddle. They have not yet learnt. L

ARTICLE TITLE: Joint statement on redundant (duplicate) publication by the editors of the undersigned cardiothoracic journals [editorial]
ARTICLE SOURCE: Ann Thorac Surg (United States), Feb 2000, 69(2) p663
AUTHOR(S): Cho BK; Rosenfeldt F; Turina MI; Karp RB; Ferguson TB; Bodnar E; Waldhausen JA
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery.
ARTICLE SOURCE: Ann Thorac Surg (United States), Feb 2000, 69(2) p501-6
AUTHOR(S): Sirivella S; Gielchinsky I; Parsonnet V
AUTHOR'S ADDRESS: Department of Cardiovascular and Thoracic Surgery, Newark Beth Israel Medical Center, New Jersey 07112, USA.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
ABSTRACT: BACKGROUND: Acute renal failure occurring in the postoperative period, requiring dialysis after cardiac surgery is an important risk factor for an early mortality, and the overall mortality of this complication is as high as 40% to 60%. Dialysis in the early postoperative period is often complicated by acute hemodynamic, metabolic, and hematologic effects that adversely affect cardiopulmonary function in patients stabilizing from recent surgery. The purpose of this study was to avoid the need for dialysis by infusion of the solution of mannitol, furosemide, and dopamine in the early postoperative period in oliguric renal failure. METHODS: One hundred patients with postoperative oliguric or anuric renal failure despite adequate postoperative cardiac output and hemodynamic function were randomized. Forty patients (group A) were given intermittent doses of diuretics (furosemide, bumetadine, and ethracrynic acid) and fluids. Sixty patients (group B) were given continuous infusion of the solution of mannitol, furosemide, and dopamine; the infusion was started within 6 hours (mean 3.5 hours) in subgroup B1 (n = 30), and later than 6 hours (mean 7.5 hours) in subgroup B2 (n = 30) after the onset of renal failure. RESULTS: Diuresis occurred in 93.3% of group B (n = 56) versus 10% in group A (n = 4; patients with preop normal renal function). Ninety percent of group A (n = 36) required dialysis versus only 6.7% of group B (n = 4; patients with preexisting renal disease of subgroup B2). Renal function returned to preoperative normal (serum creatinine 0.9 +/- 0.05, p < 0.0001) or baseline value (serum creatinine 2.5 +/- 0.01, p < 0.0001) after first postoperative week in subgroup B1 and third postoperative week in subgroup B2. CONCLUSIONS: Infusion of solution of mannitol, furosemide, and dopamine promoted diuresis in patients with acute postoperative renal failure with adequate postoperative cardiac output and had decreased the need for dialysis in the majority of patients. Early administration of this solution in acute renal failure caused early restoration of renal function to normal or baseline status. It remains to be determined whether routine administration of this solution in the early postoperative period for oliguric renal failure influences the long-term mortality and morbidity in those patients who do require dialysis
MB. Not a very satisfactory study. I does not look as though it was properly blinded. They dialysed 40% of the 100 patients having cardiac surgery in the study. It was 90% in those not given an infusion of a concocoction on frusemide, manniitol & dopamine. Those given the concoction after developing oliguria had a much lower dialysis rate. I wonder what they are doing wrong.

ARTICLE TITLE: Low-dose aprotinin is ineffective to treat excessive bleeding after cardiopulmonary bypass.
ARTICLE SOURCE: Ann Thorac Surg (United States), Feb 2000, 69(2) p452-6
AUTHOR(S): Forestier F; Belisle S; Robitaille D; Martineau R; Perrault LP; Hardy JF
AUTHOR'S ADDRESS: Department of Anesthesia, Montreal Heart Institute, Quebec, Canada.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Routine administration of low-dose aprotinin as part of the treatment protocol to control hemorrhage after CPB does not reduce bleeding or transfusion requirements and, therefore, cannot be recommended.

ARTICLE TITLE: Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies.
ARTICLE SOURCE: Arch Intern Med (United States), Apr 10 2000, 160(7) p939-44
AUTHOR(S): Wilson K; Gibson N; Willan A; Cook D
AUTHOR'S ADDRESS: Department of Medicine, McMaster University, Hamilton, Ontario, Canada. kwilson@lri.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSION: Results of several cohort studies suggest that smoking cessation after myocardial infarction is associated with a significant decrease in mortality.

ARTICLE TITLE: Autopsy consent practice at US teaching hospitals: results of a national survey.
ARTICLE SOURCE: Arch Intern Med (United States), Feb 14 2000, 160(3) p374-80
AUTHOR(S): Rosenbaum GE; Burns J; Johnson J; Mitchell C; Robinson M; Truog RD
AUTHOR'S ADDRESS: Department of Medicine, Children's Hospital, Boston, Mass 02115-5724, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSIONS: Chief residents at US teaching hospitals reported substantial deficiencies in their knowledge about autopsy and desire more training on the consent process. Autopsy consent forms are often lacking information that might help physicians and families in making an educated choice about autopsy. Teaching institutions need to reevaluate the training for the autopsy consent practice.
MB. Autopsies have practically stopped at RPAH as a cost cutting measure. The coroner's big room is close by. Ours are supposed to be done there.

ARTICLE TITLE: A nationwide study of decisions to forego life-prolonging treatment in Dutch medical practice.
ARTICLE SOURCE: Arch Intern Med (United States), Feb 14 2000, 160(3) p357-63
AUTHOR(S): Groenewoud JH; van der Heide A; Kester JG; de Graaff CL; van der Wal G; van der Maas PJ
AUTHOR'S ADDRESS: Department of Public Health, Erasmus University, Rotterdam, The Netherlands. groenewoud@mgz.fgg.eur.nl.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Decisions to forego life-prolonging treatment are frequently made end-of-life decisions in the Netherlands and may be increasing. Most of these decisions do not involve high-technology treatments, and the consequences, in terms of shortening of life, are relatively small.

ARTICLE TITLE: Congestive heart failure in the United States: is there more than meets the I(CD code)? The Corpus Christi Heart Project.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 24 2000, 160(2) p197-202
AUTHOR(S): Goff DC Jr; Pandey DK; Chan FA; Ortiz C; Nichaman MZ
AUTHOR'S ADDRESS: Department of Public Health Science, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA. dgoff@rc.phs.wfubmc.edu.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Reliance on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD) codes results in the exclusion of one third of the patients with clinical evidence of acute Congestive heart failure (CHF). This underenumeration is compounded by the typical reliance on the first listed diagnosis. Congestive heart failure may be a greater public health problem than currently recognized. The allocation of resources for relevant surveillance, research, medical care, and preventive efforts should be reevaluated.

ARTICLE TITLE: A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 24 2000, 160(2) p181-8
AUTHOR(S): Dolovich LR; Ginsberg JS; Douketis JD; Holbrook AM; Cheah G
AUTHOR'S ADDRESS: Centre for Evaluation of Medicines, Department of Pharmacy, St Joseph's Hospital, Hamilton, Ontario, Canada. ldolovic@fhs.csu.mcmaster.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Low-molecular-weight heparins are at least as effective as UFH in preventing recurrent VTE. It is unlikely that LMWHs are superior in the treatment of VTE, but they do show a statistically significant decrease in total mortality. No differences were seen in the development of recurrent VTE dependent on treatment setting. There were no apparent differences between once-daily and twice-daily therapy or among products. Inpatient therapy may be associated with less major bleeding; therefore, if LMWHs are given in the outpatient setting, patients should be rigorously monitored.

ARTICLE TITLE: Oregon's Death with Dignity Act: fourteen months and counting.
ARTICLE SOURCE: Arch Intern Med (United States), Jan 10 2000, 160(1) p21-3
AUTHOR(S): Wineberg H
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: ABC of heart failure.
ARTICLE SOURCE: BMJ (England), Jan 29 2000, 320(7230) p297-300
AUTHOR(S): Davies MK; Gibbs CR; Lip GY
AUTHOR'S ADDRESS: Department of Cardiology, Selly Oak Hospital, Birmingham, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: NHS owes pounds 2.8bn in negligence cases [news]
ARTICLE SOURCE: BMJ (England), Jan 29 2000, 320(7230) p270
AUTHOR(S): Dyer C
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Psychosocial factors in selection for liver transplantation. Need to be explicitly assessed and managed [editorial]
ARTICLE SOURCE: BMJ (England), Jan 29 2000, 320(7230) p263-4
AUTHOR(S): Masterton G
PUBLICATION TYPE: EDITORIAL
MB. I thought they were talking about the recipients' psychological state. Masterton is talking about prejudice in allocating scarce livers to worthier recipients.

ARTICLE TITLE: ABC of heart failure. Clinical features and complications.
ARTICLE SOURCE: BMJ (England), Jan 22 2000, 320(7229) p236-9
AUTHOR(S): Watson RD; Gibbs CR; Lip GY
AUTHOR'S ADDRESS: University Department of Medicine and cardiology, City Hospital, Birmingham.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: Why can't GPs follow guidelines on depression? We must question the basis of the guidelines themselves [editorial]
ARTICLE SOURCE: BMJ (England), Jan 22 2000, 320(7229) p200-1
AUTHOR(S): Kendrick T
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: ABC of heart failure. Pathophysiology.
ARTICLE SOURCE: BMJ (England), Jan 15 2000, 320(7228) p167-70
AUTHOR(S): Jackson G; Gibbs CR; Davies MK; Lip GY
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: Penicillin for acute sore throat: randomised double blind trial of seven days versus three days treatment or placebo in adults [see comments]
COMMENTS: Comment in: BMJ 2000 Jan 15; 320(7228):130-1
ARTICLE SOURCE: BMJ (England), Jan 15 2000, 320(7228) p150-4
AUTHOR(S): Zwart S; Sachs AP; Ruijs GJ; Gubbels JW; Hoes AW; de Melker RA
AUTHOR'S ADDRESS: Julius Center for General Practice and Patient-oriented Research, University Medical Center Utrecht, 3584 CG Utrecht, Netherlands. szwart@med.uu.nl.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSION: Penicillin treatment for seven days was superior to treatment for three days or placebo in resolving symptoms of sore throat in patients with group A streptococcal pharyngitis and, possibly, in those with non-group A streptococcal pharyngitis.

ARTICLE TITLE: Psychologists question "debriefing" for traumatised employees [news]
ARTICLE SOURCE: BMJ (England), Jan 15 2000, 320(7228) p140
AUTHOR(S): Yamey G
PUBLICATION TYPE: NEWS
MB. It may make things worse.

ARTICLE TITLE: Recent advances: nephrology.
ARTICLE SOURCE: BMJ (England), Jan 8 2000, 320(7227) p98-101
AUTHOR(S): Tomson CR
AUTHOR'S ADDRESS: North Bristol NHS Trust, Richard Bright Renal Unit, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB. tomson_c@southmead.swest.nhs.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (43 references); REVIEW, TUTORIAL

ARTICLE TITLE: Difficulties with anonymous shortlisting of medical school applications and its effects on candidates with non-European names: prospective cohort study.
ARTICLE SOURCE: BMJ (England), Jan 8 2000, 320(7227) p82-5
AUTHOR(S): Lumb AB; Vail A
AUTHOR'S ADDRESS: School of Medicine, University of Leeds, Worsley Medical and Dental Building, Leeds LS2 9NL. medal@leeds.ac.uk.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To assess the feasibility of anonymous shortlisting of applications for medical school and its effect on those with non-European names. DESIGN: Prospective cohort study. SETTING: Leeds school of medicine, United Kingdom. SUBJECTS: 2047 applications for 1998 entry from the United Kingdom and the European Union. INTERVENTION: Deletion of all references to name and nationality from the application form. MAIN OUTCOME MEASURES: Scoring by two admissions tutors at shortlisting. RESULTS: Deleting names was cumbersome as some were repeated up to 15 times. Anonymising application forms was ineffective as one admissions tutor was able to identify nearly 50% of candidates classed as being from an ethnic minority group. Although scores were lower for applicants with non-European names, anonymity did not improve scores. Applicants with non-European names who were identified as such by tutors were significantly less likely to drop marks in one particular non-academic area (the career insight component) than their European counterparts. CONCLUSIONS: There was no evidence of benefit to candidates with non-European names of attempting to blind assessment. Anonymising application forms cannot be recommended.
MB. The full text is worth looking at. They admit that only academic achievement has been shown to correlate with early success in a medical course they are obviously committed to essential continuation of their present selection system. The system I experienced of selection during the course worked.

ARTICLE TITLE: ABC of heart failure. History and epidemiology.
ARTICLE SOURCE: BMJ (England), Jan 1 2000, 320(7226) p39-42
AUTHOR(S): Davis RC; Hobbs FD; Lip GY
AUTHOR'S ADDRESS: Department of Primary Care and General Practice, University of Birmingham.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW (8 references); REVIEW, TUTORIAL

ARTICLE TITLE: ABC of heart failure: aetiology.
ARTICLE SOURCE: BMJ (England), Jan 8 2000, 320(7227) p104-7
AUTHOR(S): Lip GY; Gibbs CR; Beevers DG
AUTHOR'S ADDRESS: University Department of Medicine and the Department of Cardiology, City Hospital, Birmingham.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: ABC of heart failure. Non-drug management.
ARTICLE SOURCE: BMJ (England), Feb 5 2000, 320(7231) p366-9
AUTHOR(S): Gibbs CR; Jackson G; Lip GY
AUTHOR'S ADDRESS: University Department of Medicine, City Hospital, Birmingham, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: ABC of heart failure. Management: diuretics, ACE inhibitors, and nitrates.
ARTICLE SOURCE: BMJ (England), Feb 12 2000, 320(7232) p428-31
AUTHOR(S): Davies MK; Gibbs CR; Lip GY
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: ABC of heart failure. Management: digoxin and other inotropes, beta blockers, and antiarrhythmic and antithrombotic treatment.
ARTICLE SOURCE: BMJ (England), Feb 19 2000, 320(7233) p495-8
AUTHOR(S): Gibbs CR; Davies MK; Lip GY
AUTHOR'S ADDRESS: University Department of Medicine and the Department of Cardiology, City Hospital, Birmingham.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: ABC of heart failure. Acute and chronic management strategies.
ARTICLE SOURCE: BMJ (England), Feb 26 2000, 320(7234) p559-62
AUTHOR(S): Millane T; Jackson G; Gibbs CR; Lip GY
AUTHOR'S ADDRESS: Department of Cardiology, City Hospital, Birmingham, UK.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: ABC of heart failure: Heart failure in general practice.
ARTICLE SOURCE: BMJ (England), Mar 4 2000, 320(7235) p626-9
AUTHOR(S): Hobbs FD; Davis RC; Lip GY
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (0 references); REVIEW, TUTORIAL

ARTICLE TITLE: For and against. Should steroids be the first line treatment for asthma?
ARTICLE SOURCE: BMJ (England), Jan 1 2000, 320(7226) p47-9
AUTHOR(S): Strube G; Rudolf M
AUTHOR'S ADDRESS: Department of Respiratory Medicine, Ealing Hospital NHS Trust, Southall, Middlesex. mrudolf@eht.org.uk.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (21 references); REVIEW, TUTORIAL

ARTICLE TITLE: Conviction by mathematical error? Doctors and lawyers should get probability theory right editorial]
ARTICLE SOURCE: BMJ (England), Jan 1 2000, 320(7226) p2-3
AUTHOR(S): Watkins SJ
PUBLICATION TYPE: JOURNAL ARTICLE
MB. Use and abuse of probability in convictions. Read full text.

ARTICLE TITLE: Magnetic resonance imaging of male and female genitals during coitus and female sexual arousal.
ARTICLE SOURCE: BMJ (England), Dec 18-25 1999, 319(7225) p1596-600
AUTHOR(S): Schultz WW; van Andel P; Sabelis I; Mooyaart E
AUTHOR'S ADDRESS: Department of Gynaecology, University Hospital Groningen, PO Box 30 001, 9700 RB Groningen, Netherlands. w.c.m.weymar.schultz@oprit.rug.nl.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: OBJECTIVE: To find out whether taking images of the male and female genitals during coitus is feasible and to find out whether former and current ideas about the anatomy during sexual intercourse and during female sexual arousal are based on assumptions or on facts. DESIGN: Observational study. SETTING: University hospital in the Netherlands. METHODS: Magnetic resonance imaging was used to study the female sexual response and the male and female genitals during coitus. Thirteen experiments were performed with eight couples and three single women. RESULTS: The images obtained showed that during intercourse in the "missionary position" the penis has the shape of a boomerang and 1/3 of its length consists of the root of the penis. During female sexual arousal without intercourse the uterus was raised and the anterior vaginal wall lengthened. The size of the uterus did not increase during sexual arousal. CONCLUSION: Taking magnetic resonance images of the male and female genitals during coitus is feasible and contributes to understanding of anatomy.

ARTICLE TITLE: Systematic reviews and meta-analyses on treatment of asthma: critical evaluation.
ARTICLE SOURCE: BMJ (England), Feb 26 2000, 320(7234) p537-40
AUTHOR(S): Jadad AR; Moher M; Browman GP; Booker L; Sigouin C; Fuentes M; Stevens R
AUTHOR'S ADDRESS: Department of Clinical Epidemiology, McMaster University, Hamilton, Canada L8N 3Z5. jadada@fhs.mcmaster.ca.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Most reviews published in peer reviewed journals or funded by industry have serious methodological flaws that limit their value to guide decisions. Cochrane reviews are more rigorous and better reported than those published in peer reviewed journals.

ARTICLE TITLE: Internal and external morality of medicine: lessons from New Zealand.
ARTICLE SOURCE: BMJ (England), Feb 19 2000, 320(7233) p499-503
AUTHOR(S): Paul C
AUTHOR'S ADDRESS: Department of Preventive and Social Medicine, University of Otago Medical School, PO Box 913, Dunedin, New Zealand. charlotte.paul@stonebow.ac.nz.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (36 references); REVIEW, TUTORIAL
MB. Read full text

ARTICLE TITLE: Oral sex may be important risk factor for HIV infection [news]
ARTICLE SOURCE: BMJ (England), Feb 12 2000, 320(7232) p400
AUTHOR(S): Gottlieb S
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Should doctors get CME points for reading? [editorial]
ARTICLE SOURCE: BMJ (England), Feb 12 2000, 320(7232) p394-5
AUTHOR(S): Holm HA
PUBLICATION TYPE: EDITORIAL
MB. It is about getting CME points for reading. I would have to get very high points for all this stuff for you.

ARTICLE TITLE: From CME to CPD: getting better at getting better? [editorial]
ARTICLE SOURCE: BMJ (England), Feb 12 2000, 320(7232) p393-4
AUTHOR(S): du Boulay C
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Doctor as murderer. Death certification needs tightening up, but it still might not have stopped Shipman [editorial]
ARTICLE SOURCE: BMJ (England), Feb 5 2000, 320(7231) p329-30
AUTHOR(S): O'Neill B
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Antenatal corticosteroids to prevent neonatal respiratory distress syndrome. We do not know whether repeated doses are better than a single dose [editorial]
ARTICLE SOURCE: BMJ (England), Feb 5 2000, 320(7231) p325-6
AUTHOR(S): Spencer C; Neales K
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Replacing the mercury sphygmomanometer. Requires clinicians to demand better automated devices [editorial]
ARTICLE SOURCE: BMJ (England), Mar 25 2000, 320(7238) p815-6
AUTHOR(S): O'Brien E
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Detecting and reporting medical errors: why the dilemma?
ARTICLE SOURCE: BMJ (England), Mar 18 2000, 320(7237) p794-6
AUTHOR(S): Pietro DA; Shyavitz LJ; Smith RA; Auerbach BS
AUTHOR'S ADDRESS: Sturdy Memorial Hospital, 211 Park Street, PO Box 2963, Attleboro, MA 02703-0963, USA. Dpietro407@aol.com.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Anaesthesiology as a model for patient safety in health care.
ARTICLE SOURCE: BMJ (England), Mar 18 2000, 320(7237) p785-8
AUTHOR(S): Gaba DM
AUTHOR'S ADDRESS: Patient Safety Center of Inquiry, 112PSCI, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA. gaba@stanford.edu.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Epidemiology of medical error.
ARTICLE SOURCE: BMJ (England), Mar 18 2000, 320(7237) p774-7
AUTHOR(S): Weingart SN; Wilson RM; Gibberd RW; Harrison B
AUTHOR'S ADDRESS: Division of General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. sweingar@caregroup.harvard.edu.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Let's talk about error [editorial]
ARTICLE SOURCE: BMJ (England), Mar 18 2000, 320(7237) p730
AUTHOR(S): Reinertsen JL
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Medical error: the second victim. The doctor who makes the mistake needs help too [editorial]
ARTICLE SOURCE: BMJ (England), Mar 18 2000, 320(7237) p726-7
AUTHOR(S): Wu AW
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Safe health care: are we up to it? [editorial]
ARTICLE SOURCE: BMJ (England), Mar 18 2000, 320(7237) p725-6
AUTHOR(S): Leape LL; Berwick DM
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Guidelines on preventing cardiovascular disease in clinical practice [editorial; comment]
COMMENTS: Comment on: BMJ 2000 Mar 11; 320(7236):671-6; Comment on: BMJ 2000 Mar 11; 320(7236):676-7; Comment on: BMJ 2000 Mar 11; 320(7236):677-8; Comment on: BMJ 2000 Mar 11; 320(7236):702-4; Comment on: BMJ 2000 Mar 11; 320(7236):705-8; Comment on: BMJ 2000 Mar 11; 320(7236):709-10
ARTICLE SOURCE: BMJ (England), Mar 11 2000, 320(7236) p659-61
AUTHOR(S): Jackson R
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Bullying in school: are short pupils at risk? Questionnaire study in a cohort.
ARTICLE SOURCE: BMJ (England), Mar 4 2000, 320(7235) p612-3
AUTHOR(S): Voss LD; Mulligan J
AUTHOR'S ADDRESS: University Child Health, Southampton General Hospital, Southampton SO21 16YD. linda.voss@phnt.swest.nhs.uk.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Scotland to ban general anaesthesia in dental surgeries [news]
ARTICLE SOURCE: BMJ (England), Mar 4 2000, 320(7235) p598
AUTHOR(S): Christie B
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Clinton acts to reduce medical mistakes [news]
ARTICLE SOURCE: BMJ (England), Mar 4 2000, 320(7235) p597
AUTHOR(S): Charatan F
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Reviving academic medicine in britain. We now have a management plan, but who will make it happen? [editorial; comment]
COMMENTS: Comment on: BMJ 2000 Mar 4; 320(7235):630-3; Comment on: BMJ 2000 Mar 4; 320(7235):633-6; Comment on: BMJ 2000 Mar 4; 320(7235):636-9
ARTICLE SOURCE: BMJ (England), Mar 4 2000, 320(7235) p591-2
AUTHOR(S): Goldbeck-Wood S
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Anesthetic management of surgical neuroendoscopies: usefulness of monitoring the pressure inside the neuroendoscope.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jan 2000, 12(1) p21-8
AUTHOR(S): Fabregas N; Lopez A; Valero R; Carrero E; Caral L; Ferrer E
AUTHOR'S ADDRESS: Department of Anesthesiology, Hospital Clinic Barcelona, Universitat de Barcelona, Spain.
PUBLICATION TYPE: JOURNAL ARTICLE
We conclude that there may be a high rate of postoperative complications after neuroendoscopies, namely, new neurologic deficits. High pressure levels inside the endoscope during neuroendoscopic procedures can occur without hemodynamic warning signs. Pressure values >30 mm Hg are associated with postoperative morbidity, especially unexpected delayed recovery. Measuring the pressure inside the endoscope is technically easy and might be beneficial if performed in all neuroendoscopic procedures. Reducing the incidence of episodes of high peak pressure values might decrease the rate of postoperative complications.

ARTICLE TITLE: Effects of neck position and head elevation on intracranial pressure in anaesthetized neurosurgical patients: preliminary results.
ARTICLE SOURCE: J Neurosurg Anesthesiol (United States), Jan 2000, 12(1) p10-4
AUTHOR(S): Mavrocordatos P; Bissonnette B; Ravussin P
AUTHOR'S ADDRESS: Department of Anesthesiology and Critical Care, Hopital de Sion, Switzerland.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
These observations suggest that patients with known compromised cerebral compliance would benefit from monitoring intracranial pressure (ICP) during positioning, if the use of a lumbar drainage is planed to improve venous return, cerebral blood volume, ICP, and overall operating conditions.

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Suicide prevention among active duty Air Force personnel--United States, 1990-1999.
ARTICLE SOURCE: JAMA (United States), Jan 12 2000, 283(2) p193-4
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial.
ARTICLE SOURCE: JAMA (United States), Jan 12 2000, 283(2) p235-41
AUTHOR(S): Antonelli M; Conti G; Bufi M; Costa MG; Lappa A; Rocco M; Gasparetto A; Meduri GU
AUTHOR'S ADDRESS: Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore Rome, Italy. max.antonelli@flashnet.it.
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: These results indicate that transplantation programs should consider Noninvasive ventilation (NIV) in the treatment of selected recipients of transplantation with acute respiratory failure.

ARTICLE TITLE: Physicians and the pharmaceutical industry: is a gift ever just a gift?[see comments]
COMMENTS: Comment in: JAMA 2000 Jan 19; 283(3):391-3
ARTICLE SOURCE: JAMA (United States), Jan 19 2000, 283(3) p373-80
AUTHOR(S): Wazana A
AUTHOR'S ADDRESS: McGill University, Montreal, Quebec, Canada. cxwz@musica.mcgill.ca.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSION: The present extent of physician-industry interactions appears to affect prescribing and professional behavior and should be further addressed at the level of policy and education.

ARTICLE TITLE: Interactions between physicians and the health care technology industry [comment]
COMMENTS: Comment on: JAMA 2000 Jan 19; 283(3):373-80
ARTICLE SOURCE: JAMA (United States), Jan 19 2000, 283(3) p391-3
AUTHOR(S): Tenery RM Jr
AUTHOR'S ADDRESS: Council on Ethical and Judicial Affairs, American Medical Association, Chicago, Ill 60610, USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Reducing fatal crash risk among teenaged drivers: structuring an effective graduated licensing system [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Mar 22-29; 283(12):1578-82
ARTICLE SOURCE: JAMA (United States), Mar 22-29 2000, 283(12) p1617-8
AUTHOR(S): Foss RD
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: The origins of Alzheimer disease: a is for amyloid [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Mar 22-29; 283(12):1571-7
ARTICLE SOURCE: JAMA (United States), Mar 22-29 2000, 283(12) p1615-7
AUTHOR(S): Selkoe DJ
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Multiple potential risks for stroke [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Mar 15; 283(11):1429-36
ARTICLE SOURCE: JAMA (United States), Mar 15 2000, 283(11) p1479-80
AUTHOR(S): Caplan LR
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Time to reevaluate risk stratification guidelines for medically supervised exercise training in patients with coronary artery disease.
ARTICLE SOURCE: JAMA (United States), Mar 15 2000, 283(11) p1476-8
AUTHOR(S): Merz CN; Paul-Labrador M; Vongvanich P
AUTHOR'S ADDRESS: Preventive and Rehabilitative Cardiac Center, Department of Medicine, and the Burns and Allen Research Institute, University of California School of Medicine, Los Angeles 90048, USA. merz@cshs.org.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Sedation in the intensive care unit: a systematic review.
ARTICLE SOURCE: JAMA (United States), Mar 15 2000, 283(11) p1451-9
AUTHOR(S): Ostermann ME; Keenan SP; Seiferling RA; Sibbald WJ
AUTHOR'S ADDRESS: Department of Medicine, University of Western Ontario, Canada.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (75 references); REVIEW, ACADEMIC
CONCLUSION: Considering the widespread use of sedation for critically ill patients, more large, high-quality, randomized controlled trials of the effectiveness of different agents for short-term and long-term sedation are warranted.
MB. These were respiratory failures occurring at various times after trasnplanation.

ARTICLE TITLE: Beta-blocker therapy for heart failure: the evidence is in, now the work begins [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Mar 8; 283(10):1295-1302
ARTICLE SOURCE: JAMA (United States), Mar 8 2000, 283(10) p1335-7
AUTHOR(S): Califf RM; O'Connor CM
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Expanding the treatment options for influenza [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Feb 23; 283(8):1016-24
ARTICLE SOURCE: JAMA (United States), Feb 23 2000, 283(8) p1057-9
AUTHOR(S): Wenzel RP
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Update: influenza activity--United States, 1999-2000 season.
ARTICLE SOURCE: JAMA (United States), Feb 16 2000, 283(7) p879-80
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Update: influenza activity--United States, 1999-2000 season.
ARTICLE SOURCE: JAMA (United States), Apr 5 2000, 283(13) p1681-2
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Estrogen and Alzheimer disease: plausible theory, negative clinical trial [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Feb 23; 283(8):1007-15
ARTICLE SOURCE: JAMA (United States), Feb 23 2000, 283(8) p1055-6
AUTHOR(S): Shaywitz BA; Shaywitz SE
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: From the Centers for Disease Control and Prevention. Hypothermia-related deaths--Alaska, October 1998-April 1999, and trends in the United States, 1979-1996.
ARTICLE SOURCE: JAMA (United States), Feb 16 2000, 283(7) p878-9
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Indications for emergent MRI of the central nervous system.
ARTICLE SOURCE: JAMA (United States), Feb 16 2000, 283(7) p853-5
AUTHOR(S): Quint DJ
AUTHOR'S ADDRESS: Department of Neuroradiology, University of Michigan Medical Center, Ann Arbor 48109-0030, USA. djquint@umich.edu.
PUBLICATION TYPE: JOURNAL ARTICLE

ARTICLE TITLE: Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial [see comments]
COMMENTS: Comment in: JAMA 2000 Feb 9; 283(6):797-8
ARTICLE SOURCE: JAMA (United States), Feb 9 2000, 283(6) p783-90
AUTHOR(S): Gausche M; Lewis RJ; Stratton SJ; Haynes BE; Gunter CS; Goodrich SM; Poore PD; McCollough MD; Henderson DP; Pratt FD; Seidel JS
AUTHOR'S ADDRESS: Department of Emergency Medicine, Harbor-UCLA Medical Center, and Harbor-UCLA Research and Education Institute, Torrance, Calif 90509, USA. mgausche@emedharbor.edu.
PUBLICATION TYPE: CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE
CONCLUSION: These results indicate that the addition of out-of-hospital endotracheal intubation (ETI) to a paramedic scope of practice that already includes bag-valve-mask ventilation (BVM) did not improve survival or neurological outcome of pediatric patients treated in an urban emergency medical services (EMS) system.

ARTICLE TITLE: Out-of-hospital intubation of children [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Feb 9; 283(6):783-90
ARTICLE SOURCE: JAMA (United States), Feb 9 2000, 283(6) p797-8
AUTHOR(S): Glaeser P
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: The feminization of medicine [editorial]
ARTICLE SOURCE: JAMA (United States), Feb 2 2000, 283(5) p666
AUTHOR(S): Paik JE
PUBLICATION TYPE: EDITORIAL

ARTICLE TITLE: Sex bias in cardiovascular care: should women be treated more like men? [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Feb 2; 283(5):646-52
ARTICLE SOURCE: JAMA (United States), Feb 2 2000, 283(5) p659-61
AUTHOR(S): Mark DB
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Some men who take Viagra die--why? [news]
ARTICLE SOURCE: JAMA (United States), Feb 2 2000, 283(5) p590, 593
AUTHOR(S): Mitka M
PUBLICATION TYPE: NEWS

ARTICLE TITLE: Is untreated sleep apnea a contributing factor for chronic hypertension? [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Apr 12; 283(14):1829-8
ARTICLE SOURCE: JAMA (United States), Apr 12 2000, 283(14) p1880-1
AUTHOR(S): Zwillich CW
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study. Sleep Heart Health Study [see comments]
COMMENTS: Comment in: JAMA 2000 Apr 12; 283(14):1880-1
ARTICLE SOURCE: JAMA (United States), Apr 12 2000, 283(14) p1829-36
AUTHOR(S): Nieto FJ; Young TB; Lind BK; Shahar E; Samet JM; Redline S; D'Agostino RB; Newman AB; Lebowitz MD; Pickering TG
AUTHOR'S ADDRESS: Department of Epidemiology, Johns Hopkins School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSION: Our findings from the largest cross-sectional study to date indicate that sleep-disordered breathing (SDB) is associated with systemic hypertension in middle-aged and older individuals of different sexes and ethnic backgrounds.

ARTICLE TITLE: A public health approach to reducing error: medical malpractice as a barrier [editorial; comment]
COMMENTS: Comment on: JAMA 2000 Apr 5; 283(13):1731-7
ARTICLE SOURCE: JAMA (United States), Apr 5 2000, 283(13) p1742-3
AUTHOR(S): Gostin L
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: American medical malpractice litigation in historical perspective [see comments]
COMMENTS: Comment in: JAMA 2000 Apr 5; 283(13):1742-3
ARTICLE SOURCE: JAMA (United States), Apr 5 2000, 283(13) p1731-7
AUTHOR(S): Mohr JC
AUTHOR'S ADDRESS: Department of History, University of Oregon, Eugene 97403-1288, USA. jmohr@oregon.uoregon.edu.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE
ABSTRACT: Medical malpractice and the problems associated with it remain an important issue in the US medical community. Yet relatively little information regarding the long-term history of malpractice litigation can be found in the literature. This article addresses 2 questions: (1) when and why did medical malpractice litigation originate in the United States and (2) what historical factors best explain its subsequent perpetuation and growth? Medical malpractice litigation appeared in the United States around 1840 for reasons specific to that period. Those reasons are discussed in the context of marketplace professionalism, an environment that provided few quality controls over medical practitioners. Medical malpractice litigation has since been sustained for a century and a half by an interacting combination of 6 principal factors. Three of these factors are medical: the innovative pressures on American medicine, the spread of uniform standards, and the advent of medical malpractice liability insurance. Three are legal factors: contingent fees, citizen juries, and the nature of tort pleading in the United States. Knowledge of these historical factors may prove useful to those seeking to reform the current medical malpractice litigation system.

ARTICLE TITLE: A concise review of the cost-effectiveness of coronary heart disease prevention.
ARTICLE SOURCE: Med Clin North Am (United States), Jan 2000, 84(1) p279-97, xi
AUTHOR(S): Brown AI; Garber AM
AUTHOR'S ADDRESS: Department of Public Health and Primary Care, University of Oxford, England.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (93 references); REVIEW, TUTORIAL
ABSTRACT: Coronary heart disease is one of the largest sources of morbidity, mortality, and health care expenditure in the United States. This article reviews a number of studies that estimate the cost per unit of health benefits associated with different primary and secondary prevention strategies for coronary heart disease. Although prevention does not provide a panacea for rising health care spending, many preventive strategies are cost-effective when compared to other common clinical interventions. Prevention should be incorporated into regular clinical practice.

ARTICLE TITLE: Systemic corticosteroids in infant bronchiolitis: A meta-analysis.
ARTICLE SOURCE: Pediatrics (United States), Apr 2000, 105(4) pE44
AUTHOR(S): Garrison MM; Christakis DA; Harvey E; Cummings P; Davis RL
AUTHOR'S ADDRESS: Department of Epidemiology, University of Washington, Seattle, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; META-ANALYSIS
CONCLUSIONS: Combined, published reports of the effect of systemic corticosteroids on the course of bronchiolitis suggest a statistically significant improvement in clinical symptoms, length of stay (LOS), and duration of symptoms (DOS).
MB. I think you would need more that a suggestion.

ARTICLE TITLE: Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task Force on Infant Sleep Position and Sudden Infant Death Syndrome.
ARTICLE SOURCE: Pediatrics (United States), Mar 2000, 105(3 Pt 1) p650-6
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (120 references); REVIEW, TUTORIAL
ABSTRACT: The American Academy of Pediatrics has recommended since 1992 that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since that time, the frequency of prone sleeping has decreased from >70% to approximately 20% of US infants, and the SIDS rate has decreased by >40%. However, SIDS remains the highest cause of infant death beyond the neonatal period, and there are still several potentially modifiable risk factors. Although some of these factors have been known for many years (eg, maternal smoking), the importance of other hazards, such as soft bedding and covered airways, has been demonstrated only recently. The present statement is intended to review the evidence about prone sleeping and other risk factors and to make recommendations about strategies that may be effective for further reducing the risk of SIDS. This statement is intended to consolidate and supplant previous statements made by this Task Force.
MB. Sounds pretty hopeless as to mechanism

ARTICLE TITLE: Circumcision debate. Task Force on Circumcision, 1999-2000 [comment]
COMMENTS: Comment on: Pediatrics 2000 Mar; 105(3 Pt 1):620-3
ARTICLE SOURCE: Pediatrics (United States), Mar 2000, 105(3 Pt 1) p641-2
AUTHOR(S): Lannon CM; Bailey A; Fleischman A; Shoemaker C; Swanson J
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: New policy on circumcision-cause for concern [see comments]
COMMENTS: Comment in: Pediatrics 2000 Mar; 105(3 Pt 1):641-2
ARTICLE SOURCE: Pediatrics (United States), Mar 2000, 105(3 Pt 1) p620-3
AUTHOR(S): Schoen EJ; Wiswell TE; Moses S
AUTHOR'S ADDRESS: Department of Pediatrics and Genetics, Kaiser Permanente Medical Center, Oakland, CA 94611-5693, USA. edgar.schoen@ncal.kaiperm.org.
MINOR SUBJECT HEADING(S): HIV Infections [prevention & control]; Infant, Newborn; Risk Factors; Sexually Transmitted Diseases [prevention & control]; United States; Urinary Tract Infections [prevention & control]
PUBLICATION TYPE: JOURNAL ARTICLE
MB. This is like arguing about any other form of cosmetic surgery.

ARTICLE TITLE: Sports injuries: An important cause of morbidity in urban youth. District of Columbia Child/Adolescent Injury Research Network.
ARTICLE SOURCE: Pediatrics (United States), Mar 2000, 105(3) pE32
AUTHOR(S): Cheng TL; Fields CB; Brenner RA; Wright JL; Lomax T; Scheidt PC
AUTHOR'S ADDRESS: Department of General Pediatrics and Adolescent Medicine, Children's National Medical Center, Washington, District of Columbia 20010, USA. tcheng@cnmc.org.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: INTRODUCTION: Sports injuries account for substantial morbidity and medical cost. To direct intervention, a population-based study of the causes and types of sports injuries was undertaken. METHOD: An injury surveillance system was established at all trauma center hospitals that treat residents 10 to 19 years old in the District of Columbia and the Chief Medical Examiner's Office. Medical record abstractions were completed for those seen in an emergency department, admitted to the hospital, or who died from injury June 1996 through June 1998. FINDINGS: Seventeen percent (n = 2563) of all injuries occurred while participating in 1 of 6 sports (baseball/softball, basketball, biking, football, skating, and soccer) resulting in an event-based injury rate of 25.0 per 1000 adolescents or 25.0/1000 population year. Rates were higher in males for all sports. The most common mechanisms were falls (E880-888) and being struck by or against objects (E916-918). Hospitalization was required in 2% of visits and there were no deaths. Of those requiring hospitalization, 51% involved other persons, 12% were equipment-related, and 8% involved poor field/surface conditions. Of all baseball injuries, 55% involved ball or bat impact often of the head. Basketball injuries included several injuries from striking against the basketball pole or rim or being struck by a falling pole or backboard. Biking injuries requiring admission included 2 straddle injuries onto the bike center bar and collision with motor vehicles. Of all football injuries, 48 (7%) involved being struck by an opponent's helmet and 63 (9%) involved inappropriate field conditions including falls on or against concrete, glass, or fixed objects. In soccer there were 4 goal post injuries and a large proportion of intracranial injuries. There were 51 probable or clear assaults during sports and an additional 30 to 41 injuries from baseball bat assaults. CONCLUSIONS: Many sports including noncontact sports involved injuries of the head suggesting the need for improved head protection. Injuries involving collisions with others and assaults point to the need for supervision and enforcement of safety rules. The 16% of sports injury visits and 20% of hospitalizations related to equipment and environmental factors suggest that at least this proportion of injury may be amenable to preventive strategies. Design change may be warranted for prevention of equipment-related injuries. The many injuries involving inappropriate sports settings suggest the need for and use of available and safe locations for sports.
MB. How about just stopping all this barbaric activity? Computer sports would give the same thrills without any injury except to the hands.

ARTICLE TITLE: Prevention and management of pain and stress in the neonate. American Academy of Pediatrics. Committee on Fetus and Newborn. Committee on Drugs. Section on Anesthesiology. Section on Surgery. Canadian Paediatric Society. Fetus and Newborn Committee.
ARTICLE SOURCE: Pediatrics (United States), Feb 2000, 105(2) p454-61
PUBLICATION TYPE: GUIDELINE; JOURNAL ARTICLE; PRACTICE GUIDELINE
ABSTRACT: This statement is intended for health care professionals caring for neonates (preterm to 1 month of age). The objectives of this statement are to: 1. Increase awareness that neonates experience pain; 2. Provide a physiological basis for neonatal pain and stress assessment and management by health care professionals; 3. Make recommendations for reduced exposure of the neonate to noxious stimuli and to minimize associated adverse outcomes; and 4. Recommend effective and safe interventions that relieve pain and stress.
MB. Why should this be necessary? It was always obvious that there was pain when circumcisions are done without anaesthesia in the neonatal period. It was just thought that it did not matter and there is no evidence that it does or does not.

ARTICLE TITLE: Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes [see comments]
COMMENTS: Comment in: Pediatrics 2000 Feb; 105(2):420-2; Comment in: Pediatrics 2000 Feb; 105(2):424-5
ARTICLE SOURCE: Pediatrics (United States), Feb 2000, 105(2) p295-310
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
CONCLUSIONS: Use of supplemental oxygen at pulse oximetry saturations of 96% to 99% did not cause additional progression of prethreshold retinopathy of prematurity (ROP) but also did not significantly reduce the number of infants requiring peripheral ablative surgery. A subgroup analysis suggested a benefit of supplemental oxygen among infants who have prethreshold ROP without plus disease, but this finding requires additional study. Supplemental oxygen increased the risk of adverse pulmonary events including pneumonia and/or exacerbations of chronic lung disease and the need for oxygen, diuretics, and hospitalization at 3 months of corrected age. Although the relative risk/benefit of supplemental oxygen for each infant must be individually considered, clinicians need no longer be concerned that supplemental oxygen, as used in this study, will exacerbate active prethreshold ROP.

ARTICLE TITLE: Oxygen therapy, oxygen toxicity, and the STOP-ROP trial [comment]
COMMENTS: Comment on: Pediatrics 2000 Feb; 105(2):295-310
ARTICLE SOURCE: Pediatrics (United States), Feb 2000, 105(2) p424-5
AUTHOR(S): Hay WW Jr; Bell EF
MAJOR SUBJECT HEADING(S): Oxygen Inhalation Therapy; Retinopathy of Prematurity [therapy]
MINOR SUBJECT HEADING(S): Infant, Newborn; Oxygen Inhalation Therapy [adverse effects] [methods]; Oxygen [blood]; Retinopathy of Prematurity [blood]
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: What can We learn from STOP-ROP and earlier studies? [comment]
COMMENTS: Comment on: Pediatrics 2000 Feb; 105(2):295-310
ARTICLE SOURCE: Pediatrics (United States), Feb 2000, 105(2) p420-1
AUTHOR(S): Gaynon MW; Stevenson DK
MAJOR SUBJECT HEADING(S): Oxygen Inhalation Therapy; Retinopathy of Prematurity [therapy]
MINOR SUBJECT HEADING(S): Disease Progression; Infant, Newborn; Infant; Oxygen Inhalation Therapy [methods]; Oxygen [blood]; Retinopathy of Prematurity [blood]
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Sepsis after major visceral surgery is associated with sustained and interferon-gamma-resistant defects of monocyte cytokine production.
ARTICLE SOURCE: Surgery (United States), Mar 2000, 127(3) p309-15
AUTHOR(S): Weighardt H; Heidecke CD; Emmanuilidis K; Maier S; Bartels H; Siewert JR; Holzmann B
AUTHOR'S ADDRESS: Department of Surgery, Klinikum rechts der Isar, Technische Universitat Munchen, Germany.
MAJOR SUBJECT HEADING(S): Cytokines [biosynthesis]; Interferon Type II [pharmacology]; Monocytes [immunology]; Postoperative Complications [immunology]; Sepsis [immunology]
MINOR SUBJECT HEADING(S): Interleukin-12 [biosynthesis]; Interleukin-1 [biosynthesis]; Tumor Necrosis Factor [biosynthesis]; Viscera [surgery]
INDEXING CHECK TAG(S): Female; Human; Male; Support, Non-U.S. Gov't
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: Recent clinical trials failed to demonstrate beneficial effects of anti-inflammatory sepsis therapy. The present study therefore asked the following questions: Is there evidence for immunosuppression during postoperative sepsis? When, during the septic course, may immunosuppression develop? Can defective cellular functions be restored by in vitro treatment with interferon-gamma (IFN-gamma)? <snip> CONCLUSIONS: Postoperative sepsis was associated with immediate monocyte defects that affected both pro- and anti-inflammatory cytokine secretion, which suggests that immunosuppression is a primary rather than a compensatory response to a septic challenge. Sepsis survival correlated with the recovery of the proinflammatory, but not the anti-inflammatory, response. The treatment of monocytes with IFN-gamma did not reconstitute defective proinflammatory cytokine production.

ARTICLE TITLE: The influence of female gender on the outcome of carotid endarterectomy: a challenge to the ACAS findings.
ARTICLE SOURCE: Surgery (United States), Mar 2000, 127(3) p272-5
AUTHOR(S): Sternbach Y; Perler BA
AUTHOR'S ADDRESS: Department of Surgery, Johns Hopkins Hospital, Baltimore, Md. 21205, USA.
PUBLICATION TYPE: JOURNAL ARTICLE; MULTICENTER STUDY
CONCLUSIONS: These findings indicate that female gender does not adversely influence the outcome of carotid endarterectomy (CEA) when performed for treatment of asymptomatic disease. Gender should not be a consideration in the decision to perform CEA because of asymptomatic disease.

ARTICLE TITLE: Carotid endarterectomy in women: early and long-term results.
ARTICLE SOURCE: Surgery (United States), Mar 2000, 127(3) p264-71
AUTHOR(S): Ballotta E; Renon L; Da Giau G; Sarzo G; Abbruzzese E; Saladini M; Baracchini C; Meneghetti G
AUTHOR'S ADDRESS: Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Italy.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: These findings show that perioperative stroke risk and mortality rates, as well as late stroke-free, mortality, and recurrence rates, in patients undergoing CEA, are comparable in men and women. Further, larger comparative studies are necessary to provide more information on the benefit and durability of CEA in asymptomatic patients, but the results of this study suggest that the early and late outcomes are excellent and comparable in symptomatic and asymptomatic men and women.

ARTICLE TITLE: Invited commentary: fuzzy logic, clear reasoning [comment]
COMMENTS: Comment on: Surgery 2000 Mar; 127(3):245-53
ARTICLE SOURCE: Surgery (United States), Mar 2000, 127(3) p257
AUTHOR(S): Buchman T
AUTHOR'S ADDRESS: Department of Surgery, Washington University School of Medicine, St Louis, Mo., USA.
PUBLICATION TYPE: COMMENT; JOURNAL ARTICLE

ARTICLE TITLE: Invited commentary: fuzzy logic--an introduction.
ARTICLE SOURCE: Surgery (United States), Mar 2000, 127(3) p254-6
AUTHOR(S): Sawyer MD
AUTHOR'S ADDRESS: Mayo Clinic, Rochester, Minn. 55905, USA.
PUBLICATION TYPE: JOURNAL ARTICLE
MB. I think I have been doing what they seem to be talking about forever.

ARTICLE TITLE: Improvement in the information content of the Glasgow Coma Scale for the prediction of full cognitive recovery after head injury using fuzzy logic [see comments]
COMMENTS: Comment in: Surgery 2000 Mar; 127(3):257
ARTICLE SOURCE: Surgery (United States), Mar 2000, 127(3) p245-53
AUTHOR(S): Amin AP; Kulkarni HR
AUTHOR'S ADDRESS: Department of Preventive and Social Medicine, Government Medical College, Nagpur, India.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: BACKGROUND: The objective of this study was to modify the existing Glasgow Coma Scale (GCS) into a fuzzy GCS by using fuzzy information representation and fuzzy inferencing. The study compared the information content of the existing GCS with the new fuzzy GCS for prediction of full cognitive recovery in patients with head injury. METHODS: A record-based study was conducted at the Government Medical College and Hospital, a tertiary care facility in Nagpur, India. The study, which covered the period from January 1 to December 31, 1997, included 253 patients with head injuries. Opinions of 17 clinical experts who routinely deal with head injury cases were used for the construction of the fuzzy GCS. RESULTS: By using the max operator for summarization, eye, motor, and verbal stimuli were all significantly associated with the possibility of full cognitive recovery with the fuzzy GCS (P < .001). Nonspecificity of the classical GCS, the min-operated fuzzy GCS, and the max-operated fuzzy GCS was comparable. A reduction in Shannon entropy was maximum with the max-operated fuzzy GCS. Min-operated fuzzy GCS better predicted a lack of full cognitive recovery. CONCLUSIONS: Fuzzy Glasgow Coma Scale (GCS) substantially improves the information content for prediction of the possibility of full cognitive recovery after head injury. Eye, motor, and verbal stimuli all uniquely and significantly contribute to prediction of this possibility. We recommend the use of fuzzy GCS for prediction of the possibility of full cognitive recovery in patients with head injuries.

ARTICLE TITLE: A surgeon is an amalgam of many elements.
ARTICLE SOURCE: Surgery (United States), Feb 2000, 127(2) p227
AUTHOR(S): Beahrs OH
AUTHOR'S ADDRESS: Department of Surgery, Mayo Clinic, Rochester, Minn. 55905, USA.
PUBLICATION TYPE: HISTORICAL ARTICLE; JOURNAL ARTICLE

ARTICLE TITLE: Usefulness of autologous blood transfusion for avoiding allogenic transfusion and infectious complications after esophageal cancer resection.
ARTICLE SOURCE: Surgery (United States), Feb 2000, 127(2) p185-92
AUTHOR(S): Kinoshita Y; Udagawa H; Tsutsumi K; Ueno M; Nakamura T; Akiyama H; Takahashi K; Kajiyama Y; Tsurumaru M
AUTHOR'S ADDRESS: Department of Surgery, Toranomon Hospital, Tokyo, Japan.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: Autologous blood collection reduces the need for allogenic transfusion in patients undergoing resection of esophageal cancer, and avoidance of allogenic transfusion may reduce the risk of postoperative infection.
MB. ---& it may not.

ARTICLE TITLE: Invited commentary: surgical residency training [editorial; comment]
COMMENTS: Comment on: Surgery 2000 Jan; 127(1):14-8
ARTICLE SOURCE: Surgery (United States), Jan 2000, 127(1) p12-3
AUTHOR(S): Harken A; Hartford CE
AUTHOR'S ADDRESS: University of Colorado Health Sciences Center, Denver, USA
PUBLICATION TYPE: COMMENT; EDITORIAL

ARTICLE TITLE: Pulmonary and hemodynamic changes during laparoscopy--are they important?
ARTICLE SOURCE: Surgery (United States), Mar 2000, 127(3) p241-4
AUTHOR(S): Hardacre JM; Talamini MA
AUTHOR'S ADDRESS: Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md., USA.
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (13 references); REVIEW, TUTORIAL
MB. Quite good for 2 surgeons.

ARTICLE TITLE: Elective abdominal aortic aneurysm operations--the results of a single surgeon series of 243 consecutive operations from a district general hospital.
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Jan 2000, 82(1) p64-8
AUTHOR(S): Humphreys WV; Byrne J; James W
AUTHOR'S ADDRESS: Department of Vascular Surgery and Anaesthetics, Ysbyty Gwynedd, Bangor, Gwynedd, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
CONCLUSIONS: An acceptable and comparable mortality rate can be achieved in a district general hospital. The complication rate is high indicating the need for very intense medical and nursing care for these patients postoperatively. There is a considerable variance in mortality rates with age and risk even in the practice of one surgeon, indicating a need to be very knowledgeable and cautious in interpreting postoperative mortality data. This is the largest single surgeon series to date in the UK.
MB. What is the point in publishing such an article?

ARTICLE TITLE: Does the introduction of of a high dependency unit (HDU) reduce surgical mortality?
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Sep 1999, 81(5) p343-7
AUTHOR(S): Davies J; Tamhane R; Scholefield C; Curley P
AUTHOR'S ADDRESS: Department of Surgery, Pinderfields Hospital, Wakefield, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The aim of this study was to assess the change in workload in a general surgery department over 2 consecutive 1-year periods and document the impact on hospital mortality. Data were collected on all admissions, the number and type of operations performed for a 1-year period before and after a purpose-built HDU was opened. During the study period, the total number of admissions increased by 15%, with a disproportionately large increase (27%) in the number of emergency admissions. This was reflected by increases in the emergency out-of-hours operating by 12%. During the study period, the overall in-patient mortality rose from 2.16% to 3.2%. Introduction of HDU facilities alone does not lead to a reduction in hospital mortality. Alterations in emergency workload and changes in case-mix are important in determining outcome. League tables of hospital mortality are likely to be difficult to interpret without adequate information about facilities and case-mix.
MB. What a silly study if they thought it would have to show that the mortality would be reduced.

ARTICLE TITLE: Deterioration of theatre discipline during total joint replacement--have theatre protocols been abandoned?
ARTICLE SOURCE: Ann R Coll Surg Engl (England), Jul 1999, 81(4) p262-5
AUTHOR(S): Madhavan P; Blom A; Karagkevrakis B; Pradeep M; Huma H; Newman JH
AUTHOR'S ADDRESS: Department of Orthopaedics, Musgrove Park Hospital, Taunton, UK.
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: The results of the Medical Research Council trial by Lidwell et al. in 1982 [Lidwell OM, Lowbury EJ, Whyte W et al. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. BMJ 1982; 285: 10-4] showed a decrease in infection rates following joint replacements carried out in ultraclean air theatres. Since then, the orthopaedic community in the UK has relied to a large extent on laminar airflow theatres to control infection following arthroplasty. At the same time, there has been a decline in the emphasis on basic principles and practices of antisepsis based on scientific evidence. We undertook this audit to establish whether published recommendations on theatre discipline were being followed in operating theatres where joint replacements are carried out, in England, Scotland and Wales. Our results show that with improvement in technology involved in clean air theatres, and availability in practice, slackness has crept into theatre protocol. In view of the fact that infection following arthroplasty has not been eliminated or indeed in some cases, maintained at the levels of the Medical Research Council study, we feel that traditional practices should be reintroduced. This study shows that there is pressing need for a set of recommendations on theatre practice for all staff in operating theatres that carry out joint replacements.
MB. What a surprise. Why would the need not apply to all operating theatres?