bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic prescription practices, consumption and bacterial resistance in a cross section of Swedish intensive care units
Authors: Walther S. M. , Erlandsson M. , Burman L. G. , Cars O. , Gill H. , Hoffman M. , Isaksson B. , Kahlmeter G. , Lindgren S. , Nilsson L. , Olsson‐Liljequist B. , Hanberger H. , Icustrama Study Group The 
Published: March 2003

Background: The purpose of this work was to study usage of antibiotics, its possible determinants, and patterns of bacterial resistance in Swedish intensive care units (ICUs).Methods: Prospectively collected data on species and antibiotic resistance of clinical isolates and antibiotic consumption specific to each ICU in 1999 were analyzed together with answers to a questionnaire. Antibiotic usage was measured as defined daily doses per 1000 occupied bed days (DDD1000).Results: Data were obtained for 38 ICUs providing services to a population of approximately 6 million. The median antibiotic consumption was 1257 DDD1000 (range 584–2415) and correlated with the length of stay but not with the illness severity score or the ICU category. Antibiotic consumption was higher in the ICUs lacking bedside devices for hand disinfection (2193 vs. 1214 DDD1000, p=0.05). In the ICUs with a specialist in infectious diseases responsible for antibiotic treatment the consumption pattern was different only for use of glycopeptides (58% lower usage than in other ICUs: 26 vs. 11 DDD1000,P=0.02). Only 21% of the ICUs had a written guideline on the use of antibiotics, 57% received information on antibiotic usage at least every 3 months and 22% received aggregated resistance data annually. Clinically significant antimicrobial resistance was found among Enterbacter spp. to cephalosporins and among Enterococcus spp. to ampicillin.Conclusions: Availability of hand disinfection equipment at each bed and a specialist in infectious diseases responsible for antibiotic treatment were factors that correlated with lower antibiotic consumption in Swedish ICUs, whereas patient‐related factors were not associated with antibiotic usage.
Alveolar integrity and ultrastructure in pigs remain undamaged after exposure to sevoflurane
Authors: Takala R. S. K. , Soukka H. R. , Kirvelä O. A. , Kujari H. P. , Pelliniemi L. J. , Kääpä P. O. , Aantaa R. E. 
Published: March 2003

Previous studies have shown that both halothane and isoflurane have adverse but reversible effects on alveolar physiology. The present study was designed to test the hypothesis that also sevoflurane may affect alveolar integrity.Fifteen pigs were randomly selected to receive either thiopentone infusion (control group, n=8) or sevoflurane (n=7) at 4.0% inspiratory concentration (1.5 MAC) in air for 6 h. Tissue samples from the lungs were obtained at the end of the experiment. Both histopathological light microscopy and electron microscopy were used to assess the structural integrity of the alveoli.Pulmonary hemodynamics were comparable in both groups. Light microscopy showed no difference between the groups in the amount of alveolar macrophages, red blood cells or edema. Electron microscopy showed minor changes such as moderate local swelling of alveolar epithelium in both study groups. Alveolar type II cells were ultrastructurally unaltered in both study groups.We conclude that long‐term, high concentration exposure to sevoflurane has no detrimental effect on the alveolar integrity in pigs.
Teaching hospital physicians' skills and knowledge of resuscitation algorithms are deficient
Authors: Iirola T. , Lund V. E. , Katila A. J. , Mattila‐Vuori A. , Pälve H. 
Published: March 2003

Background:  The resuscitation skills of 78 on‐call physicians in a tertiary referral center were evaluated in a simulated sudden cardiac arrest (SCA).Methods:  The study subjects consisted of physicians whose on‐call duty included handling emergency situations. First they were drawn without warning to a simulated witnessed cardiac arrest (ventricular fibrillation (VF)). They were provided with two nurses and all the equipment and medicine needed to treat SCA. Second, they were asked to write the current treatment protocols for basic life support (BLS) and VF.Results: The median time to defibrillation was 2.38 min, and only 31% of the physicians were able to use the defibrillator correctly. Thirty per cent treated asystole according to the guidelines of the time. Twenty‐four per cent were able to return the spontaneous circulation and the median time to ROSC (return of spontaneous circulation) was 5.75 min Only 25% of the physicians wrote the guideline for treatment of VF and basic life support correctly or nearly correctly.Conclusion:  Regular resuscitation education should be compulsory to all physicians responsible for on‐call duties in hospitals. Hospitals should have at least one employee part‐time responsible for this duty.
Thoracic epidural anesthesia and epidural hematoma
Authors: Persson J. , Flisberg P. , Lundberg J. 
Published: March 2003

This report involves a 74‐year‐old‐male who developed a thoracic epidural hematoma with paraparesis on the second postoperative day in conjunction with thoracic epidural anesthesia established before surgery for acute abdominal aortic dissection.The finding indicates that laminectomy can be performed successfully as late as three days after diagnosis of the hematoma, with a complete restitution of neurological function. High‐dose steroid treatment may have been a contributing factor for the positive outcome.
Mortality rates among Swedish physicians:  a population‐based nationwide study with special reference to anesthesiologists
Authors: Svärdsudd K. , Wedel H. , Gordh T. 
Published: March 2003

Background: Recent studies both in the UK and in the USA have indicated a higher mortality rate among anesthesiologists than among other physicians. We therefore decided to investigate the situation in Sweden during the years 1993–99.Methods: All 26 086 doctors in Sweden with a specialist licence in 1993, including those who were retired or who received one until 1999, were identified in official records and followed up regarding survival until 1999; generating approximately 179 300 person‐years.Results: Overall, 893 deaths occurred during the 7‐year follow up. Mean age at death was 72.9 years in the whole population, the lowest being 64.1 years among the anesthesiologists and the highest 77.0 among the pediatricians. However, there were large differences in the age and sex distribution among the specialities. For this reason a series of proportional hazard regression analyses (Cox's) of the mortality rates in the various speciality groups were performed, taking into account the influence of age and gender differences. After this procedure anesthesiologists had a 46% higher mortality rate and pediatricians a 24% lower mortality rate than other specialist groups; both deviations being statistically significant. All other specialities had a mortality risk within the expected range. Anesthesiologists tended to have higher rates than other specialists for most underlying causes of death.Conclusion: Anesthesiologists have a higher mortality rate than other specialities. The cause is so far unknown. However, it is unlikely to be caused by obvious confounders such as age, gender, or smoking habits. Other factors linked to occupational exposure should be investigated.
Mortality among Finnish anesthesiologists from 1984–2000
Authors: Ohtonen P. , Alahuhta S. 
Published: March 2003

Background: Previous studies have suggested increased mortality among anesthesiologists. We report age‐standardized mortality rates and causes of death among Finnish anesthesiologists.Methods:  Data covering the deaths of all medical specialists during 1984–2000 were obtained and analyzed. There were 799 deaths, of which 18 involved anesthesiologists. The causes of deaths of these anesthesiologists were obtained from the database of Statistics Finland.Results:  The age‐standardized mortality rate (SR) for the male anesthesiologists was 33.9 years (per 1000), and that for the other male specialists was 84.6 years. The SR for the female anesthesiologists was 45.4 years, and that for the other female specialists was 77.3 years. The mean age at death among the anesthesiologists was 63.0 years (SD 11.0), while the mean age at death among the other specialists was 68.6 years (SD 14.7). The age structures of the anesthesiologists and other specialists were different, with the anesthesiologists being younger.Conclusion: The different age distributions of the anesthesiologists and other specialists caused the difference in age at death. The SR values for the anesthesiologists are clearly lower than those for other specialists. Thus, the present findings do not show increased mortality among Finnish anesthesiologists.
Mortality of anesthesiologists, pediatricians, and other specialists in Norway
Authors: Aasland O. G. 
Published: March 2003

Background: Following sensational media reports, particularly from Sweden, there has been discussion in Scandinavia during the last couple of years about whether anesthesiologists have shorter life spans than other medical specialists.Methods: Survival analysis (Cox regression) from the master file of the Norwegian Medical Association was used to compare anesthesiologists with pediatricians and other specialists. Data was taken from 10 367 specialists, 533 anesthesiologists, 488 pediatricians, and 9325 other specialists, with Norwegian citizenship. These comprised 574 065 man‐years, of which 171 190 were lived after achieving specialty.Conclusion: No differences in mortality were found between the three groups.
Mortality among anesthesiologists in Denmark, 1973–95
Authors: Juel K. , Husum B. , Viby‐Mogensen J. , Viskum S. 
Published: March 2003

Background: Preliminary data from Sweden indicating that anesthesiologists have a high mortality risk has caused a lot of concern in Denmark. The aim of this study therefore was to compare mortality between consultant anesthesiologists and other consultants in Denmark.Methods: A historical prospective cohort study based on the membership register of the Danish Medical Association from 1973 to 1992. The study population consisted of 6854 consultants who were members of the Association of Medical Specialists, 406 of whom were anesthesiologists. The all‐cause mortality between the two groups was compared during the period 1972–95 using Cox's proportional hazard regression model.Results: The study covered approximately 86 000 person‐years. A total of 1205 deaths occurred within the period studied, 41 of whom were anesthesiologists. The relative risk for all‐cause mortality among the anesthesiologists compared with all the other consultants was 1.0 (95% confidence limit: 0.7–1.4).Conclusion: In Denmark there is no evidence of a high mortality risk in consultant anesthesiologists compared with other consultants.
Sigmoid colonic reflectance pulse oximetry and tonometry in a porcine experimental hypoperfusion shock model
Authors: Koga I. , Stiernström H. , Wiklund L. 
Published: March 2003

Background: The objective of the present study was to determine if colonic endoluminal mucosal oxygen saturation, as determined by reflectance pulse oximetry, is an appropriate method to monitor colonic ischemia produced by a gradual partial constriction of the aorta in a porcine experimental model.Methods: Piglets were anesthetized and mechanically ventilated. A Nellcor RS‐10 reflectance pulse oximeter probe was attached to a Foley balloon catheter and passed transanally to record the oxygen saturation of the sigmoid colonic mucosa. For comparison, a tonometry catheter was introduced into the sigmoid colon. Hypoperfusion shock was induced by partial gradual constriction of the aorta. The same measurements but no intervention was performed in the control group.Results: During one‐third reduction of the aortic blood flow, the plethysmographic signal disappeared suddenly and the sigmoid colonic mucosa oxygen saturation (ScO2) measurements showed zero in seven out of the eight pigs. During two‐thirds flow reduction, no plethysmographic signals were observed in any of the piglets. During the reperfusion period, ScO2 measurements with a good plethysmographic signal were obtained immediately after complete release of the aortic constriction in all pigs. Significantly decreased intramucosal pH and increased difference between the arterial and regional PCO2 (PCO2 gap) were observed during two‐thirds blood flow reduction.Conclusion: In contrast to the results of previous investigations, the sigmoid colonic pulse oximetry was not useful because the method proved to be overly sensitive and non‐linear in relation to regional blood flow.
Prospective, randomized cost analysis of anesthesia with remifentanil combined with propofol, desflurane or sevoflurane for otorhinolaryngeal surgery
Authors: Loop T. , Priebe H.‐J. 
Published: March 2003

Background: In the era of cost containment, cost analysis should demonstrate the cost‐effectiveness of new anesthetic drugs.Methods: This single‐blind, prospective, randomized study compared the costs of three remifentanil (REM)‐based anesthetic techniques with a conventional one in 120 patients undergoing otorhinolaryngeal surgery. The patients were randomized (n=30 each group) to either receive a combination of REM with propofol, desflurane or sevoflurane, or a conventional anesthetic with thiopentone, alfentanil, isoflurane and N2O.Results: The costs for anesthetic and nonanesthetic drugs and for disposables were twice as high in the three REM‐based groups as in the conventional group (REM/PRO 0.51 €/min, REM/DES 0.42 €/min, and REM/SEVO 0.41 €/min vs. 0.18 €/min in the ALF/ISO/N2O group; P<0.05). Wastage of intravenous drugs accounted for up to 40% of total costs. In all REM groups, early recovery was predictably faster and more complete (P<0.05). Patient satisfaction was equally high (90–97%) in all groups, with less nausea in the REM/PRO group.Conclusion: This study demonstrates that REM‐based anesthetic techniques are more expensive than a conventional technique using alfentanil, isoflurane and N2O. This is the result of higher costs of anesthetic and nonanesthetic drugs and of disposables. The wastage of intravenous drugs contributes considerably to these costs.
Lamotrigine monotherapy for control of neuralgia after nerve section
Authors: Sandner‐Kiesling A. , Rumpold Seitlinger G. , Dorn C. , Koch H. , Schwarz G. 
Published: March 2003

Background: We present six patients treated only with the new‐generation anticonvulsant lamotrigine to define its sole effect on neuralgia after nerve section.Methods: Previous surgical or pharmacological attempts failed to relieve this neuropathic pain in our patients. Before initiation of lamotrigine therapy, patients reported spontaneous and touch‐evoked shooting pain followed by periods of burning pain. No breakthrough medication was needed during the maintenance phase of 1–23 months. Data were acquired by a pain diary on a weekly basis.Results: With 75–300 mg of lamotrigine per day, the burning and shooting pain intensity was relieved by 33–100%. Most obviously, the attack frequency of the shooting pain was reduced by 80–100%. No adverse effects were observed.Conclusion: We conclude that lamotrigine may be beneficial in the treatment of neuralgia after nerve section following the failure of previous pharmacological or surgical attempts.
Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta‐analysis of randomized controlled trials
Authors: Kranke P. , Morin A. M. , Roewer N. , Eberhart L. H. J. 
Published: March 2003

Background: Diphenhydramine and its theoclate salt dimenhydrinate are traditional antiemetics still in use. However, so far the quantitative effect of dimenhydrinate in the prophylaxis of postoperative nausea and vomiting (PONV) has not been evaluated systematically.Methods : Results from randomized controlled trials investigating the efficacy of dimenhydrinate vs. a control to prevent PONV were included in a meta‐analysis. Studies were systematically searched through MEDLINE, EMBASE, the Cochrane‐Library, manually screening of reference lists of matching review articles and current issues of locally available peer‐reviewed anesthesia journals, up to June 2001. The numbers of patients with complete absence of PONV within 6 h and within 48 h after surgery were extracted as the main end point. Pooled relative benefits (RB) and numbers‐needed‐to‐treat (NNT) with their corresponding 95% confidence intervals (CI) were calculated using a random effects model. This quantitative systematic review was performed following the recommendations of the QUORUM statement.In all, 18 trials with 3045 patients were included in the analysis: 1658 patients received a placebo (control) and 1387 patients received dimenhydrinate.Results: The RB to stay completely free of PONV was 1.2 (95% CI: 1.1–1.4) for the early period (NNT = 8; 95% CI: 5–25) and 1.5 (1.3–1.8) for the overall investigated period (NNT = 5; 95% CI: 3–9).Conclusion : Dimenhydrinate is a traditional and inexpensive antiemetic with an efficacy that might be considered as clinically relevant. Although in use for a long time, the dose–response, precise estimation of side‐effects, optimal time of administration and the benefit of repetitive doses still remain unclear.
Myocardial ischemia induces coronary t‐PA release in the pig
Authors: Österlund B. , Andersson B. , Häggmark S. , Jern C. , Johansson G. , Seeman‐Lodding H. , Biber B. 
Published: March 2003

Background:  Tissue‐type plasminogen activator (t‐PA) is the key factor in initiating endogenous fibrinolysis in the vascular compartment. Regulated release of t‐PA from endothelial stores is rapidly induced by several humoral factors as well as coagulation activation products. The aim of the present study was to test the hypothesis that regional myocardial ischemia induces regulated release of t‐PA in the coronary vasculature in vivo.Methods:  Healthy anesthetized (pentobarbital) pigs (n=8) were studied before and after a 10‐min left anterior descending region coronary artery occlusion (LAD). Coronary fluxes of lactate, total t‐PA antigen (ELISA, detecting both complex bound and free fraction) and active t‐PA (functional assay detecting biological free fraction) were determined at 1, 3, 5 and 10 min of reflow.Results:  Coronary occlusion induced myocardial lactate production in all animals. Net coronary release of total t‐PA, which was 21 ng/min during control, increased rapidly during reflow with a peak after only 1 min (136 ng/min), and returned to baseline within 3 min. Net release of active t‐PA mirrored the overall net release response, but fell short of statistical significance.Conclusion:  Data indicate a local myocardial profibrinolytic response following regional ischemia, which may serve as a prompt defence against coronary thromboembolic events.
Detecting postoperative urinary retention with an ultrasound scanner
Authors: Rosseland L. A. , Stubhaug A. , Breivik H. 
Published: March 2003

Background: Retention of urine is a common postoperative problem associated with risk of overdistention and permanent detrusor damage. Prevention of urinary retention by insertion of indwelling catheter may increase the risk of urinary infection. We have performed a reliability test of an ultrasound scanner, implemented in the postoperative monitoring equipment.Methods: Patients were monitored after different types of surgery under spinal anesthesia with an ultrasound scanner in the postanesthesia care unit (PACU).Patients: Patients who according to current guidelines required a urinary bladder catheter, were scanned before a catheter was inserted and urine volume was measured. These two urine volumes were compared and analyzed for agreement.Results: Nineteen female and 17 male patients were included. The mean difference between ultrasound estimates and catheter urine volume measurements was − 21.5 mL, and limits of agreement, calculated as a 95% confidence interval, were − 147 and + 104 mL. This means that the urine volume estimated by ultrasound was on average 21.5 mL smaller than the urine volume when the bladder was emptied.Conclusion: This study confirms a good agreement between the ultrasound scanner estimates of urinary bladder volume and urine volume measured after emptying the bladder. Nurses in the PACU could operate the ultrasound scanner after a brief instruction and training period. Considering the potentially serious long‐term consequences of undiagnosed postoperative urinary retention, introducing this equipment for routine monitoring of urinary bladder volume should be considered.
Spasmolytic effects of colforsin daropate on serotonin‐induced pulmonary hypertension and bronchoconstriction in dogs
Authors: Hirota K. , Yoshioka H. , Kabara S. , Koizumi Y. , Abe H. , Sato T. , Matsuki A. 
Published: March 2003

Background: We have previously found that agents increasing intracellular cAMP levels of smooth muscles, such as PDE3 inhibitors, aminophylline and prostaglandin E1, produce both bronchodilation and pulmonary vasodilation in serotonin‐induced pulmonary hypertension and bronchoconstriction models. In the present study we have simultaneously evaluated the spasmolytic effects of colforsin daropate, a novel forskolin derivative, on serotonin‐induced pulmonary hypertension and bronchoconstriction.Methods: Ten mongrel dogs were anesthetized with pentobarbital. The pulmonary hypertension and bronchoconstriction were elicited with serotonin (10 µg/kg + 1 mg·kg−1·h−1) and assessed as percentage changes in pulmonary vascular resistance (PVR) and bronchial cross‐sectional area (BCA) (basal = 100%). Initially, the relaxant effects of colforsin daropate (0–300 µg/kg) were determined. The PVR and BCA were assessed before and 30 min after serotonin infusion began and 5 min after each dose of colforsin daropate. To determine whether colforsin daropate‐induced relaxation is independent of plasma catecholamine, propranolol 0.4 mg/kg was given following colforsin daropate 300 µg/kg i.v.Results:  Colforsin daropate reversed both pulmonary hypertension and bronchoconstriction dose‐dependently: ‐logED50 (95% confidence intervals, mean ED50) for pulmonary hypertension and bronchoconstriction 5.44 (5.08–5.80, 3.6 µg/kg) and 4.90 (4.06–5.20, 12.5 µg/kg), respectively. However, colforsin daropate (≥ 30 µg/kg) produced a more pronounced systemic than pulmonary vasodilation. Although colforsin daropate (≥ 30 µg/kg) significantly increased plasma catecholamines, propranolol did not reverse the relaxant effects.Conclusions:  Colforsin daropate may attenuate bronchoconstriction and pulmonary hypertension. In addition, as β‐blockade did not change the attenuation, the relaxant effects may be independent of plasma catecholamines.