bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone scintigraph of rheumatoid or osteoarthritic knees after total arthroplasty
Authors: Koshino Tomihisa , Saito Tomoyuki
Published: May 2003

Aim: This investigation was carried out to observe mineral metabolism around the implanted prosthesis in the knee.

Method: Follow‐up with technetium‐99m methylene‐di‐phosphate bone scintigraphy was performed on 69 knees of 57 patients (41 rheumatoid and 28 osteoarthritic knees) from 10 days to 91 months after total knee replacement results.

Results: Uptake of injected isotope was seen only around the artificial joint in the scintigram, at 10 days’ post‐operatively and became denser with wider distribution thereafter. Maximum uptake was noted at 3 months. Post‐operatively, mineral metabolism began to decrease from 6 months on, and uptake was seen only in the bone near the prostheses, especially at the proximal end of the tibia, in scintigrams performed after more than 2 years. Uptake counts on the medial side of the tibial proximal end were higher than those on the lateral side in nine out of 11 knees in scintimetry performed more than 1 year after surgery. Persistent high uptake was observed in three knees, with subsequent loosening. Local high uptake was seen in the femoral shaft of three knees before the appearance of heterotopic ossification in X‐rays, and in an area of fracture in two knees.

Conclusion: Loosing, heterotopic ossification and stress fracture can be detected by bone scintigraphy earlier than by roentgenogram.
Spirituality and Psychosis
Authors: Keks Nicholas , D'Souza Russell
Published: May 2003

Objective: To examine a few links between spirituality and psychosis through illustrative cases.

Conclusions: Psychoses exact a terrible toll on people. In approximately half the patients there is an enduring loss of richness of personality - the so-called deficit syndrome. Many people with psychoses attempt and complete suicide. Spirituality may be critical for dealing with the assault that psychoses effects on identity and personality. It may also help in coping with devastating loss. Religion and spirituality may replace some of the loss, and may also play a key role in psychotherapeutic support and recovery. However, religion can also be a source of pain, guilt and exclusion, and religious themes may also play a negative role in psychopathology.
Spiritual History of Parents of Children Attending a Child and Adolescent Mental Health Service
Authors: Mathai John , North Amanda
Published: May 2003

Objective: To conduct a survey of the importance of spirituality in parents of children referred to a child and adolescent mental health service.

Method: A questionnaire consisting of five questions was completed by 70 parents.

Results: The vast majority of parents reported spirituality to be of some importance and more than half believed that therapists should consider their spiritual beliefs in the management of their child's problems.

Conclusion: Professional Colleges need to actively address this area and educate their members on the importance of including a spiritual history in assessment and treatment protocols.
Summary Australian and New Zealand Clinical Practice Guideline for the Treatment of Schizophrenia 2003
Authors: McGorry Patrick , Killackey Eoin , Elkins Kathryn , Lambert Martin , Lambert Tim ,   RANZCP Clinical Practice Guideline Team for the Treatment of Schizophrenia
Published: May 2003

Objective: To provide a summary of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) Clinical Practice Guideline for the Management of Schizophrenia.

Conclusions: Schizophrenia is a complex and misunderstood illness with a poor public image, but it is more treatable than ever before. A new generation of medication and psychosocial therapies, combined with a first generation of service reform, have created an evidence-based climate of realistic optimism. However, the potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality. The gap between efficacy and effectiveness is wider for schizophrenia than for any other serious medical disorder. These guidelines distil the current evidence and make recommendations based on the best available knowledge. They are based on systematic meta-analyses and comprehensive reviews of the evidence, and their validity is supported by their congruence with several recent rigorous and independent guideline statements from the UK and North America.
Nicotine Withdrawal: Pathway to Aggression and Assault in the Locked Psychiatric Ward?
Authors: Lawn Sharon , Pols Rene
Published: May 2003

Objective: The aims of the present paper are to describe the experiences of patients and staff regarding smoking and violence in locked inpatient settings, and to stimulate debate about the role of nicotine withdrawal in contributing to those experiences.

Method: Interviews were performed with 24 patients and 26 staff attached to a stand-alone psychiatric hospital. Participant observation of the inpatient setting was performed over a 6-month period. Data were triangulated and thematically analysed using the grounded theory method, ethnographic method, and descriptive and inferential statistics.

Results: Staff used cigarettes to clinically manage patients’ symptoms and behaviour. A combative environment existed between patients and staff, fuelled by staff controlling the supply of cigarettes to patients. Physical structures separating staff and patients heightened this problem. Nicotine withdrawal appeared to be misattributed for signs of impending violence or illness relapse. No nicotine replacement therapy was given to patients and no staff acknowledged patients’ nicotine withdrawal other than to ensure the continued supply of cigarettes to patients.

Conclusions: In locked psychiatric settings, staff appear to use cigarettes to clinically manage patients and to avoid violence by patients. No clear clinical strategies for addressing nicotine withdrawal within psychiatric locked settings appear to exist.
Are scratchcards addictive? The prevalence of pathological scratchcard gambling among adult scratchcard buyers in the Netherlands
Authors: DeFuentes‐Merillas Laura , Koeter Maarten W. J. , Bethlehem Jelke , Schippers Gerard M. , VanDenBrink Wim
Published: May 2003

Aims  To determine the prevalence of regular, potential problematic and pathological scratchcard gambling (PSG) 5 years after the introduction of scratchcards in the Netherlands.

Design and participants  A non‐proportional stratified random sample of 12 222 scratchcard buyers was approached. Regular scratchcard buyers (n = 3342) were asked to fill out the South Oaks Gambling Screen (SOGS). Those with a SOGS score of 3 or more (n = 340) were interviewed with the gambling section of the DSM‐IV Diagnostic Interview Schedule (DIS‐T). Weighted data were used to obtain unbiased prevalence estimates.

Findings  The estimated prevalence of regular and potential problematic scratchcard gambling were 28.4% and 2.68%, respectively. Only 0.24% met DSM‐IV criteria for PSG. Of those, only 0.09% were addicted uniquely to scratchcards. The remaining 0.15% were also addicted to other games of chance. Demographic and gambling characteristics of these ‘combined’ PSG (young men, mainly slot‐machine players) resembled characteristics of pathological gamblers in general. In contrast to these ‘combined’ PSG, ‘unique’ PSG were mainly women between 25 and 34 years who spent relatively small amounts of money on scratchcards (equivalent to one scratchcard a day).

Conclusion  Scratchcards have a very low addiction potential among adults in the Netherlands. Given the specific characteristics of the unique PSG and the relatively small amount of money they spent, the appropriateness of DSM criteria for this particular form of gambling can be questioned.
Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990–98
Authors: Coffin Phillip O. , Galea Sandro , Ahern Jennifer , Leon Andrew C. , Vlahov David , Tardiff Kenneth
Published: May 2003

Aims  Accidental drug overdose contributes substantially to mortality among drug users. Multi‐drug use has been documented as a key risk factor in overdose and overdose mortality in several studies. This study investigated the contribution of multiple drug combinations to overdose mortality trends.

Design  We collected data on all overdose deaths in New York City between 1990 and 1998 using records from the Office of the Chief Medical Examiner (OCME). We standardized yearly overdose death rates by age, sex and race to the 1990 census population for NYC to enable comparability between years relevant to this analysis.

Findings  Opiates, cocaine and alcohol were the three drugs most commonly attributed as the cause of accidental overdose death by the OCME, accounting for 97.6% of all deaths; 57.8% of those deaths were attributed to two or more of these three drugs in combination. Accidental overdose deaths increased in 1990–93 and subsequently declined slightly in 1993–98. Changes in the rate of multi‐drug combination deaths accounted for most of the change in overdose death rates, whereas single drug overdose death rates remained relatively stable. Trends in accidental overdose death rates within gender and racial/ethnic strata varied by drug combination suggesting different patterns of multi‐drug use among different subpopulations.

Conclusions  These data suggest that interventions to prevent accidental overdose mortality should address the use of drugs such as heroin, cocaine and alcohol in combination.
Probabilities of alcohol high‐risk drinking, abuse or dependence estimated on grounds of tobacco smoking and nicotine dependence
Authors: John Ulrich , Meyer Christian , Rumpf Hans‐Jürgen , Hapke Ulfert
Published: May 2003

Aims To estimate probabilities of alcohol high‐risk drinking, alcohol abuse and alcohol dependence on grounds of smoking‐behaviour related variables and single nicotine dependence criteria.

Design Cross‐sectional population‐based study.

Setting Adult population of a region in north Germany.

Participants Cigarette smokers (n = 2437) among a random sample of 4075 females and males aged 18–64, drawn in 1996.

Measurement Smoking, nicotine dependence according to theDiagnostic and Statistical Manual of Psychiatric Disorders(DSM‐IV) and the Fagerström Test for Nicotine Dependence (FTND); increasing alcohol‐related harm (ARH): high‐risk drinking, DSM‐IV alcohol abuse, remitted and current alcohol dependence diagnosed by the Composite International Diagnostic Interview (CIDI).

Findings Having smoked 30 cigarettes or more per day, onset of smoking at the age of 17 or younger, nicotine dependence and single nicotine dependence criteria revealed odds ratios higher than 4.0 for alcohol dependence. For alcohol dependence, a logistic regression model showed an increased odds ratios for male gender, smoking for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems, craving for nicotine, withdrawal experience 1 day or longer, smoking first cigarette in the morning 5 minutes or less after waking. The probability of increasing ARH was more likely in males, smokers for 25 years or more, no attempt to quit or cut down, continuation of smoking despite problems and smoking first cigarette in the morning 5 minutes or less after waking.

Conclusions Gender and single nicotine dependence criteria show particularly high probabilities of alcohol dependence and increasing ARH. Interventions need to take these connections into account.
Reasons for selecting an initial route of heroin administration and for subsequent transitions during a severe HIV epidemic
Authors: Bravo María J. , Barrio Gregorio , De La Fuente Luis , Royuela Luis , Domingo Laura , Silva Teresa
Published: May 2003

Aim  To identify the most important reasons for selecting a particular route of heroin administration and for subsequent transitions during a period of epidemic HIV transmission. To study temporal trends in these reasons.

Design  Cross‐sectional survey.

Participants  Nine hundred heroin users in three Spanish cities: 305 in Seville, 297 in Madrid and 298 in Barcelona.

Measurements  A separate analysis was made of the reasons for five types of behaviour: (a) selecting injection as the initial usual route of heroin administration (URHA); (b) changing the URHA to injection; (c) never having injected drugs; (d) selecting the smoked or sniffed route as the initial URHA; and (e) changing the URHA to a non‐injected route. Subjects were invited to evaluate the importance of each reason included in a closed list. Spontaneously self‐perceived reasons were also explored in an open‐ended question for each of the five types of behaviour studied.

Findings  The primary reason selected for each type of behaviour was: (a) pressure of the social environment; (b) belief that injection is a more efficient route than smoking or sniffing heroin; (c) concern about health consequences (especially fears of HIV and overdose), and fear of blood or of sticking a needle into one's veins; (d), pressure of the social environment and (e) concern about health consequences and vein problems. For women, having a sexual partner who injected heroin played a decisive role in initiating or changing to injection. Few people spontaneously mentioned market conditions for purchasing heroin as an important reason for any behaviour, nor did many mention risk of overdose as reasons for (c) or (d).

Conclusions  These findings should be considered when designing interventions aimed at preventing initiation of injecting or facilitating the transition to non‐injected routes.
Family structure and adolescent cigarette smoking in eleven European countries
Authors: Bjarnason Thoroddur , Davidaviciene Aleksandra G. , Miller Patrick , Nociar Alojz , Pavlakis Andreas , Stergar Eva
Published: May 2003

Aims  This study seeks to establish (1) if different types of non‐traditional family structures are related equally to adolescent cigarette smoking; (2) if each type of family structure is related equally to adolescent smoking in different countries and (3) if differences in such patterns can be explained by the prevalence of such family structures in each country.

Design  Self‐reported cigarette smoking among 33 978 students in Cyprus, France, Hungary, Iceland, Ireland, Lithuania, Malta, Slovak Republic, Slovenia, Sweden and the United Kingdom is analysed with multi‐level hierarchical regression models.

Findings  Adolescents living with both biological parents smoke less than those living with single mothers, who in turn smoke less than those living with single fathers, mothers‐stepfathers, or with neither biological parent. Living with fathers‐stepmothers is associated with less smoking than living with single fathers, mother‐stepfathers, or with neither biological parent, but does not differ from living with both biological parents or single mothers. The effects of living with single mothers, single fathers, or with neither biological parent are stronger in countries where such family types are less common. Differences in the strength of effects between countries become non‐significant once the prevalence of each family type has been taken into account.

Conclusions  Adolescents living with both biological parents smoke less than their counterparts in most other family types, and adolescents living with single mothers or fathers‐stepmothers smoke less than those living in other non‐traditional family structures. The strength of this pattern varies inversely with the prevalence of such households in each country.
Video lottery: winning expectancies and arousal
Authors: Ladouceur Robert , Sévigny Serge , Blaszczynski Alexander , O'Connor Kieron , Lavoie Marc E.
Published: May 2003

Aims  This study investigates the effects of video lottery players’ expectancies of winning on physiological and subjective arousal.

Design  Participants were assigned randomly to one of two experimental conditions: high and low winning expectancies.

Setting  Participants played 100 video lottery games in a laboratory setting while physiological measures were recorded. Level of risk‐taking was controlled.

Participants  Participants were 34 occasional or regular video lottery players. They were assigned randomly into two groups of 17, with nine men and eight women in each group.

Intervention  The low‐expectancy group played for fun, therefore expecting to win worthless credits, while the high‐expectancy group played for real money.

Measurements  Players’ experience, demographic variables and subjective arousal were assessed. Severity of problem gambling was measured with the South Oaks Gambling Screen. In order to measure arousal, the average heart rate was recorded across eight periods.

Findings  Participants exposed to high as compared to low expectations experienced faster heart rate prior to and during the gambling session. According to self‐reports, it is the expectancy of winning money that is exciting, not playing the game.

Conclusions  Regardless of the level of risk‐taking, expectancy of winning is a cognitive factor influencing levels of arousal. When playing for fun, gambling becomes significantly less stimulating than when playing for money.
The effect of sleep disruption on performance of anaesthetists – A pilot study*
Authors: Murray D. , Dodds C.
Published: May 2003

Summary Fatigue has been implicated in the occurrence of critical incidents. Using a driving simulator to assess vigilance, we investigated the effect of sleep disruption on the ability of anaesthetists to maintain vigilance after a night on‐call. Following an undisturbed night of sleep, subjects demonstrated a significant improvement in their vigilance scores. Subjects failed to demonstrate this following a disturbed night. The timing of disturbance had a bearing on performance. Subjects' performance was worse if their sleep had been disturbed in the first third of the night. The effect of sleep disruption on vigilance has implications for patient safety during anaesthesia.
Severe myocardial ischaemia during mask induction of anaesthesia in an infant with unknown critical supravalvular aortic stenosis
Authors: Driessen J. J. , Van Oort A. M. , Booij L. H. D. J.
Published: May 2003

Congenital supravalvular aortic stenosis is an uncommon type of aortic obstruction. When critical, it represents an extreme variant of outflow tract obstruction with increased risk of cardiovascular instability during exercise or anaesthesia. We present a case of severe myocardial ischaemia during induction of anaesthesia with sevoflurane in a 3‐month baby with a presumed diagnosis of valvular aortic stenosis for which a percutaneous balloon dilatation of the aortic valve was scheduled.
Sexual hallucinations during and after sedation and anaesthesia
Authors: Balasubramaniam B. , Park G. R.
Published: May 2003

Sexual hallucinations have been reported since the introduction of chloroform. Newer agents such as midazolam and propofol appear particularly prone to producing them. Some practitioners have been the victims of allegations resulting from the hallucinogenic effects of these drugs. Other individuals, including doctors, have used the amnesic effects of midazolam and other drugs to sexually assault victims. Clinicians should be aware of the risks to which they may inadvertently expose themselves if these drugs are not used carefully.
Survey of anaesthetic support staff in obstetric units in England and Wales
Authors: Qureshi A. M. , Stevens M. , Plaat F.
Published: May 2003

In order to determine the current level of support provided to anaesthetists on the labour suite, a postal questionnaire was sent to the lead consultants of the 257 obstetric units in England and Wales. One hundred and ninety‐five replied, a response rate of 76%. Of those who replied, only 1% of units experienced frequent delays to elective obstetric lists due to lack of an anaesthetic assistant and 141 units (72%) had a designated assistant for the labour ward. However, 58 units experienced delays waiting for an anaesthetic assistance in emergency situations (29%). One hundred and sixty‐eight units (86%) had an operating department practitioner/nurse (ODP/N) resident on call for the hospital, but not exclusively for the maternity unit. In 76% of units, midwives assisted the anaesthetist when inserting regional blocks in labour. More than one‐third of respondents thought that it would be appropriate to have a dedicated ODP/N resident on call for the labour ward who would also assist with labour analgesia blocks.
A comparison of the effect of two anaesthetic techniques on surgical conditions during gynaecological laparoscopy
Authors: Williams M. T. , Rice I. , Ewen S. P. , Elliott S. M.
Published: May 2003

In a prospective, randomised, controlled trial, we compared the effects of two anaesthetic techniques on surgical conditions during day‐case, gynaecological laparoscopic procedures in 40 female patients. Patients were allocated randomly to two groups, either to breathe spontaneously through a laryngeal mask airway or to receive a neuromuscular‐blocking agent (NMB) and have the lungs ventilated via a tracheal tube. We then measured the number of attempts of Verres' needle insertion, initial intra‐abdominal pressure, time to reach a steady 15 mmHg (1.97 kPa) of intra‐abdominal pressure, adequacy of the pneumoperitoneum, operative view and duration of operation. We found that the initial intra‐abdominal pressure was higher and the operation time shorter in the laryngeal mask group. The adequacy of the pneumoperitoneum for trocar placement was better in the NMB group. We conclude that the anaesthetic technique of spontaneously breathing through a laryngeal mask airway reduces total operation time. However surgeons should be aware of the different abdominal pressure patterns produced by each anaesthetic technique, and anaesthetists must consider the implications of the anaesthetic technique on surgical safety.
Low‐dose bupivacaine‐fentanyl spinal anaesthesia for transurethral prostatectomy
Authors: Kararmaz A. , Kaya S. , Turhanoglu S. , Ozyilmaz M. A.
Published: May 2003

Summary  We evaluated the effect of low‐dose bupivacaine plus fentanyl administered intrathecally in elderly patients undergoing transurethral prostatectomy. Patients were randomly assigned to one of two groups. Group F received plain bupivacaine 4 mg with 25 µg of fentanyl and sterile water to a total of 1.5 ml, and Group B received only 0.5% plain bupivacaine 7.5 mg for spinal anaesthesia. Sensory block was adequate for surgery in all patients. The mean level of motor block was higher and the duration of motor block was longer in Group B (p < 0.0001). Hypotension and shivering were significantly more common in Group B (p < 0.05). The addition of fentanyl 25 µg to plain bupivacaine 4 mg provides adequate analgesia for transurethral prostatectomy with fewer side‐effects in elderly patients when compared with the conventional dose of bupivacaine.
Prevalence of a training module for difficult airway management: a comparison between Japan and the United Kingdom
Authors: Kiyama S. , Muthuswamy D. , Latto I. P. , Asai T.
Published: May 2003

Summary To examine the education of trainees with regard to difficult airway management, we sent a questionnaire to all 89 Japanese University Departments of Anaesthesia (to be answered by a person who was responsible for teaching trainees) and all 280 Royal College of Anaesthetists' Tutors in the UK. The presence or absence of a formal training module for difficult airway management, timing and methods of training, types of airway devices that should be taught, and tutors' expertise with various techniques and devices were surveyed. Sixty‐seven of the 89 Japanese tutors (75%) and 167 of 280 UK tutors (60%) replied to the questionnaire. Only 19 of 67 (28%) Japanese anaesthetists and 33 of 167 (20%) UK anaesthetists who replied, indicated that they had a difficult airway training module. In six Japanese departments (9%) and 115 (69%) UK departments, equipment for percutaneous transtracheal ventilation was readily available. Airway devices and techniques that tutors considered necessary to be mastered in the first 2 years of training, differed considerably between Japan and the UK, with notable differences in the use of gum elastic bougies and awake intubation. A training module for difficult airway management is often not provided and equipment for emergency transtracheal ventilation is often unavailable in both countries.
Re‐use of equipment between patients receiving total intravenous anaesthesia: a postal survey of current practice*
Authors: Halkes M. J. , Snow D.
Published: May 2003

Summary In order to establish current practice with regard to the reuse of infusion equipment between patients receiving total intravenous anaesthesia (TIVA), a postal survey of 393 consultants was carried out. Additionally, consultants' awareness of relevant guidelines was assessed. Overall, 46% of consultants change all equipment between cases, 37% change one‐way valves and 17% change distal lengths of the infusion tubing. Only 13% of consultants reported knowledge of any guidelines. In the absence of any data relevant to the current techniques of administering TIVA, the level of risk associated with the reuse of infusion components is impossible to quantify. Disposal of all equipment between cases incurs a 26% greater cost when compared to changing one‐way valves alone. Variation in practice between consultants creates the potential for system errors. Practice should be standardised and, to comply with the published guidelines, should involve disposal of all equipment between cases.
The AAITM index, the BIS index and end‐tidal concentration during wash in and wash out of sevoflurane
Authors: Anderson R. E. , Barr G. , Assareh H. , Jakobsson J.
Published: May 2003

Summary The bispectral index (BIS), auditory evoked potential index (AAITM) and the end‐tidal sevoflurane concentration were studied during induction and emergence in 10 ASA I‐II patients. Both during ‘wash‐in’ and ‘wash‐out’ of sevoflurane, the AAITM and BIS indices show huge variability and an overlap of indices between awake and not responding to command. This was the most pronounced during induction and the range of values was larger for the AAITM index as compared with the BIS index. Mean (range) BIS was 85 (73–98) and 48 (10–83) awake and unconscious, respectively, and mean AAITM index was 71 (43–99) and 21 (4–85), respectively. This study demonstrates the difficulties of using processed EEG variables in real time in a clinical situation of non‐steady state pharmacodynamics.
Adrenal axis testing and corticosteroid replacement therapy in septic shock patients – local and national perspectives*
Authors: Bourne R. S. , Webber S. J. , Hutchinson S. P.
Published: May 2003

Summary Recently, there has been renewed interest in corticosteroid therapy for patients with septic shock. The cortisol response to a tetracosactide stimulation test, otherwise known as a short synacthen test, may identify which patients are most likely to benefit from corticosteroid replacement. Controversy over interpretation of the cortisol response and the correct tetracosactide dose remains. We retrospectively analysed all septic shock patients who had full cortisol results following a 1‐µg short synacthen test. All cortisol results were re‐evaluated by three common ways of interpreting the cortisol response to a short synacthen test. The thresholds were a cortisol rise ≥ 250 nmol.l−1, a peak cortisol ≥ 550 nmol.l−1 and a peak cortisol ≥ 700 nmol.l−1. We found a significant relationship between the peak cortisol results and haemodynamic improvement in patients given corticosteroids. There was no association between a cortisol rise ≥ 250 nmol.l−1 and haemodynamic improvement after corticosteroids. A postal questionnaire was sent to adult intensive care units in the United Kingdom to assess national practice. Sixty per cent of intensive care units use corticosteroids in septic shock patients, but only 22% use a short synacthen test to guide therapy.
Evaluation of an insulated Tuohy needle system for the placement of interscalene brachial plexus catheters
Authors: Denny N. M. , Barber N. , Sildown D. J.
Published: May 2003

Summary Major shoulder surgery can be extremely painful. Interscalene brachial plexus catheters provide excellent postoperative analgesia but are technically difficult to place. A new insulated Tuohy needle system for plexus catheterisation is now available. This prospective study examined its ease of use and the postoperative analgesia produced by patient‐controlled interscalene analgesia with ropivacaine 0.2%. Nineteen patients undergoing major shoulder surgery were studied. Interscalene brachial plexus blocks were performed using a modified Winnie technique with the insulated Tuohy needle and a nerve stimulator. After injection of ropivacaine 0.75% 30–40 ml into the plexus, a catheter was inserted. Block and catheter insertion times were recorded. All 19 patients had successful blocks and had catheters successfully threaded. Catheter infusions provided successful analgesia (visual analogue pain score < 5/10) in 18 patients, with one failure, giving a 95% success rate. Mean [range] catheter insertion time was 3.6 [1–10] min. Decreased block and catheter insertion times were associated with experience with the equipment when comparing the mean (SD) times for the first seven catheters and the last seven catheters inserted (12.1 (4.2) min vs. 7.9 (2.4) min), p < 0.05). It is concluded that the insulated Tuohy needle system for interscalene catheterisation proved easy to use in the hands of someone who had not used it before, and can be recommended.
An evaluation of the modified Airway Management Device
Authors: Sivasankar R. , Bahlmann U. B. , Stacey M. R. , Sehgal A. , Hughes R. C. , Hall J. E.
Published: May 2003

We evaluated the modified Airway Management Device (AMDTM) in 60 spontaneously breathing anaesthetised patients. The insertion and removal of the device was very easy and atraumatic. The airway was secured on the first attempt in 41 patients (70%; 95% CI 57–80%). The most important problem was loss of airway, which occurred in 11 patients (19%; 11–30%) during maintenance of anaesthesia. The AMD was dislodged during maintenance in one patient. There was a loss of the airway in 12 patients (20%; 12–31%); in 10, it was maintained with simple airway manoeuvres or a laryngeal mask airway and tracheal intubation was required in two patients. Ten of these patients were male and two were female; the failure rate was 33% (12–31%) among the male patients and 6% (2–22%) among the female patients. The cuff volumes ranged from 4 ml to 80 ml and cuff pressures from 6 cm H2O to 92 cm H2O. Blood was seen on removal in three patients (6%; 2–16%) and nine patients (18%; 10–30%) experienced sore throat after removal of the device.
Quality in paediatric anaesthesia: a pilot study of interdepartmental peer review
Authors: Crean P. M. , Stokes M. A. , Williamson C. , Hatch D. J.
Published: May 2003

Summary A pilot to assess a process of interdepartmental peer review of paediatric anaesthetic departments in the United Kingdom was undertaken. Departments were assessed in relation to the standards which should characterise anaesthetic departments throughout the country. Examples of good practice and areas for further development were identified. Peer review visits were conducted by teams which included medical and non‐medical members. The importance of the inclusion of lay people in such visits is being increasingly recognised. All of those who participated in the process felt their time had been usefully spent, and they were enthusiastic for the process to continue.
A pilot study of the effect of the Queen's Square external bladder stimulator on urinary retention after knee replacement surgery
Authors: Butwick A. , Carter P. , Dolin S. J.
Published: May 2003

Summary Postoperative urinary retention remains an important problem after major orthopaedic surgery and can increase morbidity. External vibration applied to the suprapubic region has improved bladder emptying and urinary symptoms in patients with neurogenic bladders. Forty‐three patients undergoing elective major knee surgery were randomly assigned to receive either a Queen's Square bladder stimulator or placebo device for 24 h postoperatively. No statistically significant differences in rates of urinary retention could be demonstrated in the bladder stimulator group compared to the placebo group (41% and 33%, respectively). There were no differences between the two groups when analysed for prostatic symptoms, type and effectiveness of analgesia and fluid balance. We conclude that, while the Queen's Square external bladder stimulator may be effective in treating chronic urinary retention associated with a neurogenic bladder, it does not appear to be effective in preventing postoperative urinary retention.
The effect of loading on the filtration performance of breathing system filters
Authors: Wilkes A. R.
Published: May 2003

The filtration performance of breathing system filters can be measured by challenging the filter with sodium chloride particles. However, the challenge itself may alter the filtration performance. This effect was determined by repeating a standard challenge test five times on one sample each of 18 different electrostatic filters and seven pleated hydrophobic filters. The penetration of sodium chloride particles through all 18 electrostatic filters increased as the load on the filter increased. In contrast, there was a decrease in penetration through six of the seven pleated hydrophobic filters (p < 0.0001). However, the changes in penetration values were small compared to the large range of penetration values of the filters, and the effect of loading on penetration values using the challenge specified in the European standard is small.
Effect of intra‐operative end‐tidal carbon dioxide partial pressure on tissue oxygenation
Authors: Akça O. , Liem E. , Suleman M.–I. , Doufas A. G. , Galandiuk S. , Sessler D. I.
Published: May 2003

Postsurgical infection risk is correlated with subcutaneous tissue oxygenation. Mild hypercapnia augments cutaneous perfusion. We tested the hypothesis that peripheral tissue oxygenation increases as a function of arterial PCO2 in surgical patients. Twenty patients were randomly assigned to intra‐operative end tidal PCO2 of 3.99 (control) or 5.99 kPa (hypercapnia). All other anaesthetic management was per protocol. Tissue oxygen partial pressure, transcutaneous oxygen tension, cerebral oxygen saturation, and cardiac output were measured. Mean (SD) subcutaneous tissue oxygen tension was 8.39 (1.86) kPa in control and 11.84 (2.53) kPa hypercapnia patients (p = 0.014). Cerebral oxygen saturation was 55 (4)% for control vs. 68 (9)% for hypercapnia (p = 0.004). Neither cardiac index nor transcutaneous tissue oxygen tension differed significantly between the groups. Mild intra‐operative hypercapnia increased subcutaneous and cerebral oxygenation. Increases in subcutaneous tissue oxygen partial pressure similar to those observed in patients assigned to hypercapnia are associated with substantial reductions in wound infection risk.
The contribution of clinical pharmacology to antimalarial drug discovery and development
Authors: Winstanley Peter
Published: May 2003

Unlike human immunodeficiency virus (HIV) disease or tuberculosis, both of which are also major threats to public health throughout the tropics, uncomplicated falciparum malaria is relatively cheaply and rapidly cured, usually in Outpatients. However, in common with both HIV and TB (but to varying degrees), control of malaria is threatened by inadequate resources and drug resistance. Worldwide, it is Africa that carries the greatest burden of falciparum malaria mortality and morbidity; by no coincidence, it is also Africa that is most resource‐limited. The drugs for severe disease (quinine and the artemisinins) are largely unaffected by resistance so far, but the ‘first‐line’ drugs, mostly used by outpatients (mainly chloroquine and sulfadoxine‐pyrimethamine) are a major cause for concern. Although effective drugs are available, they are largely too expensive for routine use. The present article reviews the ways in which clinical pharmacology has contributed to the identification of new drugs and strategies for malaria.
Clear‐cut?: facilitating health librarians to use information research in practice
Authors: Booth Andrew , Brice Anne
Published: May 2003

In 1999, staff at the universities of Sheffield and Oxford commenced an unfunded project to examine whether it is feasible to apply critical appraisal to daily library practice. This aimed to establish whether barriers experienced when appraising medical literature (such as lack of clinical knowledge, poor knowledge of research methodology and little familiarity with statistical terms) might be reduced when appraising research within a librarian's own discipline. Innovative workshops were devised to equip health librarians with skills in interpreting and applying research. Critical Skills Training in Appraisal for Librarians (CRISTAL) used purpose‐specific checklists based on the Users’ Guides to the Medical Literature. Delivery was via half‐day workshops, based on a format used by the Critical Appraisal Skills Programme. Two pilot workshops in Sheffield and Oxford were evaluated using a brief post‐workshop form. Participants recorded objectives in attending, their general understanding of research, and whether they had read the paper before the workshop. They were asked about the length, content and presentation of the workshop, the general format, organization and learning environment, whether it had been a good use of their time and whether they had enjoyed it. Findings must be interpreted with caution. The workshops were enjoyable and a good use of time. Although the scenario selected required no clinical knowledge, barriers remain regarding statistics and research methodology. Future workshops for librarians should include sessions on research design and statistics. Further developments will take forward these findings.
Clinical librarianship: a systematic review of the literature
Authors: Winning M. A. , Beverley C. A.
Published: May 2003

Clinical librarianship (CL), currently receiving renewed interest world‐wide, seeks to provide quality‐filtered information to health professionals at the point of need to support clinical decision‐making. This review builds upon the work of Cimpl (Bulletin of the Medical Library Association 1985, 73, 21–8) and attempts to establish the evidence base for CL. The objectives were to determine, from the literature, whether CL services are used by clinicians, have an effect on patient care, and/or clinicians’ use of literature in practice and/or are cost‐effective. The methodology used was a systematic review of the literature, following, where possible, the NHS Centre for Reviews and Dissemination (CRD) framework. Modifications to this methodology included the resources searched, and the critical appraisal checklist (CriSTAL) used. Two hundred and eighty‐four unique references were retrieved. Seventeen (16 unique) evaluative and a further 33 descriptive studies met the inclusion criteria. The quality of reporting of the literature was generally poor. CL programmes appear to be well‐used and received by clinicians. However, there is insufficient evidence available on their effect on patient care, clinicians’ use of literature in practice, and their cost‐effectiveness, thus highlighting the need for further high‐quality research.
Information skills training: a systematic review of the literature*
Authors: Brettle Alison
Published: May 2003

The objectives of this study were to undertake a systematic review to determine the effectiveness of information skills training, to identify effective methods of training and to determine whether information skills training affects patient care. A systematic review, using an iterative approach to searching, was employed. Studies selected for inclusion in the review were critically appraised using a tool used in previous reviews. A tabular approach was used to provide a summary of each paper allowing synthesis of results. One thousand, three hundred and fifty‐seven potentially relevant papers were located. On the basis of titles and abstracts, 41 potentially relevant studies were identified for potential inclusion. Further reading and application of the inclusion criteria left 24 studies for critical appraisal and inclusion in the review. Study designs included randomised controlled trials, cohort designs and qualitative studies. The majority of studies took place in US medical schools. Wide variations were found in course content and training methods. Eight studies used objective methods to test skills, two compared training methods and two examined the effects on patient care. There was limited evidence to show that training improves skills, insufficient evidence to determine the most effective methods of training and limited evidence to show that training improves patient care. Further research is needed in a number of areas.
A Delphi study to determine nursing research priorities in the North Glasgow University Hospitals NHS Trust and the corresponding evidence base
Authors: Kirkwood Michelle , Wales Ann , Wilson Anne
Published: May 2003

The aims of the study are to identify and prioritize research questions of importance to nurses in North Glasgow University Hospitals NHS Trust and to investigate and describe the existing evidence base for the highest priority questions identified. The consensus method known as the Delphi technique was used. Systematic searching of the literature for each question identified from the research priorities enabled the existing evidence base to be characterized. The following priorities were identified as the most important (in descending order of importance): Recruitment and Retention of Nursing Staff; Staff Stress & Morale; Training & Education of Nursing Staff; Infection Control; and Pain Management. The Delphi technique proved a useful method to determine and prioritize research areas in nursing.
Educational workshop improved information‐seeking skills, knowledge, attitudes and the search outcome of hospital clinicians: a randomised controlled trial
Authors: Cheng Grace Y. T.
Published: May 2003

Abstract A double‐blind randomised controlled trial was conducted on a group of Hong Kong hospital clinicians. The objective was to test if a three‐hour educational workshop (with supervised hands‐on practice) is more effective (than no training) to improve clinical question formulation, information‐seeking skills, knowledge, attitudes, and search outcomes. The design was a post‐test‐only control group; recruitment by stratified randomization (by profession), blocked at 800. End‐user training was more effective than no training in improving clinical question formulation, in raising awareness, knowledge, confidence and use of databases, but had made no impact on preference for secondary databases. It changed the attitude of clinicians to become more positive towards the use of electronic information services (EIS). Participants had higher search performance and outcomes (satisfaction with information obtained (NNT = 3), EIS satisfaction (NNT = 3) and success in problem solving (NNT = 4)). The workshop improved knowledge and skills in evidence‐based searching, but this effect gradually eroded with time. Search logs confirmed that follow‐up is required if effects are to be sustained. Longer effects on search behaviours appear to be positive. A randomised controlled trial is valuable in identifying cause‐and‐effect relations and to quantify the magnitude of the effects for management decision‐making.
LISTENing to healthcare students: the impact of new library facilities on the quality of services
Authors: Haldane Graham C.
Published: May 2003

Following a low assessment of ‘Learning resources’ provision by the Quality Assurance Agency, the librarian of Homerton College, School of Health Studies commenced the LISTEN Project, a long‐term study to monitor the effects of planned interventions on the quality of library provision. Surveys of entry‐to‐register student nurses & midwives were conducted in 1999 and 2001 by extensive questionnaires, inviting Likert‐scaled and free text responses. Following a college relocation, students made greater than expected use of a new health studies library in Cambridge, and significantly less use of the local teaching hospital library. Using both a satisfaction index and a non‐parametric test of mean scores, student evaluation of library services in Cambridge significantly improved following relocation. The physical accommodation and location of library services remain important to healthcare students. Identifiable improvements to the quality of services, however, will overcome initial resistance to change. Education providers must ensure the best mix of physical and electronic services for students who spend much of their time on clinical placement.
The Randomised Controlled Trial design: unrecognized opportunities for health sciences librarianship
Authors: Eldredge Jonathan D.
Published: May 2003

Objectives: to describe the essential components of the Randomised Controlled Trial (RCT) and its major variations; to describe less conventional applications of the RCT design found in the health sciences literature with potential relevance to health sciences librarianship; to discuss the limited number of RCTs within health sciences librarianship.

Methods: narrative review supported to a limited extent with PubMed and Library Literature database searches consistent with specific search parameters. In addition, more systematic methods, including handsearching of specific journals, to identify health sciences librarianship RCTs.

Results: While many RCTs within the health sciences follow more conventional patterns, some RCTs assume certain unique features. Selected examples illustrate the adaptations of this experimental design to answering questions of possible relevance to health sciences librarians. The author offers several strategies for controlling bias in library and informatics applications of the RCT and acknowledges the potential of the electronic era in providing many opportunities to utilize the blinding aspects of RCTs. RCTs within health sciences librarianship inhabit a limited number of subject domains such as education. This limited scope offers both advantages and disadvantages for making Evidence‐Based Librarianship (EBL) a reality.

Conclusion: The RCT design offers the potential to answer far more EBL questions than have been addressed by the design to date. Librarians need only extend their horizons through use of the versatile RCT design into new subject domains to facilitate making EBL a reality.