bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum neurologic symptoms following single‐shot spinal block for labour analgesia
Authors: Viitanen H. , Porthan L. , Viitanen M. , Heula A‐L. , Heikkilä M. 
Published: July 2005

Background:  As part of a quality assurance program, we investigated the incidence of postpartum neurologic symptoms in multiparous parturients receiving spinal block for labour analgesia, now in routine use in our labour ward.Methods:  Two hundred and twenty‐nine consecutive multiparous parturients presenting for vaginal delivery and requesting spinal analgesia were asked to participate in this prospective study. All parturients received our standard intrathecal analgesia (ITA): 2.5 mg bupivacaine (1 ml) + 25 µg fentanyl (0.5 ml) using a 27‐gauge Quincke‐type needle. The patients filled in a questionnaire on the first day after delivery and again upon discharge. Complaints typical of neurologic sequelae were noted and a neurologic examination was performed, if necessary. All patients with postdural puncture headache (PDPH) and transient neurologic symptoms (TNSs) were interviewed by telephone 2 weeks after discharge to determine the course of the symptoms.Results:  Two hundred and twelve parturients were included in the study. Eighteen (8.5%) parturients complained of PDPH, the severity of which was mild in eight (4%), moderate in seven (3%), and severe in three (1%) patients, respectively. Fifteen (7%) mothers were treated with analgesics or bedrest only. Three (1%) patients were given an epidural blood patch. The paramedian approach was associated with the development of PDPH (P = 0.04). Transient neurologic symptoms were experienced by nine (4.2%) mothers, lasting 1–3 days, mostly presenting as bilateral pain in the buttocks or thighs. One parturient suffered from paraesthesia of the left foot lasting for 3 days. Forty (19%) mothers complained of non‐postural headache and 28 (13%) of new‐onset backpain. Three mothers (1%) would not want to receive a further spinal block.Conclusion:  Transient neurologic symptoms (TNSs) after spinal block occurred infrequently. The incidence of PDPH was higher than in the obstetric population in general and calls for re‐evaluation of our spinal block methods. Despite the occurrence of neurologic sequelae, patient acceptability was high.
Identification and characterization of errors and incidents in a medical intensive care unit
Authors: Graf J. , Von Den Driesch A. , Koch K.‐C. , Janssens U. 
Published: July 2005

Background:  To assess the frequency, type, consequences, and associations of errors and incidents in a medical intensive care unit (ICU).Methods:  Two‐hundred and sixteen consecutive patients with predominantly cardiovascular and pulmonary disorders admitted between December 2002 and February 2003 were enrolled. Demographic data, SAPS II, and TISS‐28 were obtained for all patients. Prior to patient enrolment all staff members (physicians, nurses, physiotherapists) were repeatedly encouraged to make use of the Incident Report Form (IRF) and detailed descriptions on how, why and when to use the IRF were provided.Results:  During the observation period of 64 days, 50 errors involving 32 patients (15%) were reported. Patients subjected to errors were more severely ill (SAPS II 42 ± 25 vs. 32 ± 18, P < 0.05), had a higher hospital mortality (38% vs. 9%), and a longer ICU stay (11 ± 18 vs. 3 ± 5 days, P < 0.05). Gender, age and TISS‐28 were equally distributed. Each day of ICU stay increased the risk by 8% (odds ratio 1.078, 95% confidence interval 1.034–1.125, P < 0.001), and by 2.3% per SAPS II point (odds ratio 1.023, 95% confidence interval 1.006–1.040, P < 0.001). The majority of errors and incidents were judged as ‘human failures’ (73%), and 46 errors and incidents (92%) as ‘avoidable’.Conclusions:  The identification and characterization of errors and incidents combined with contextual information is feasible and may provide sufficient background information for areas of quality improvement. Areas with a high frequency of errors and incidents need to undergo process evaluation to avoid future occurrence.
Dopamine or norepinephrine infusion during thoracic epidural anesthesia? Differences in hemodynamic effects and plasma catecholamine levels
Authors: Lundberg J. F. , Martner J. , Raner C. , Winsö O. , Biber B. 
Published: July 2005

Background:  During thoracic epidural anesthesia, an intravenous dopamine infusion augments the systemic pressure response and modifies plasma catecholamine levels. If such an altered response occurs when norepinephrine is infused is not clear. Therefore, dopamine and norepinephrine induced circulatory and catecholamine responses were studied before and during thoracic epidural anesthesia.Methods:  Nine chloralose‐anesthetized dogs were equipped with thoracic epidural catheters. Dopamine (5, 10, and 20 µg kg−1 min−1), and norepinephrine (0.1, 0.25, and 0.5 µg kg−1 min−1) were infused before and during epidural anesthesia, while cardiovascular performance and plasma catecholamine changes were studied.Results:  Thoracic epidural anesthesia decreased arterial pressure, and cardiac contractility. The systemic pressure response induced by dopamine was augmented during epidural anesthesia. Norepinephrine did not increase arterial pressure and myocardial contractility as markedly as dopamine, and cardiac output was not altered. Thoracic epidural anesthesia attenuated the plasma norepinephrine level. Plasma dopamine levels were augmented by the dopamine infusion during epidural anesthesia, while plasma norepinephrine levels were attenuated. In contrast, norepinephrine augmented the plasma norepinephrine levels during epidural anesthesia. In general, plasma norepinephrine levels were three to six times higher during a norepinephrine infusion compared to a dopamine infusion.Conclusion:  The cardiovascular response to a graded dopamine infusion is augmented during thoracic epidural anesthesia, while norepinephrine‐induced effects are unaltered. The modified plasma catecholamine levels may contribute to the hemodynamic differences between dopamine and norepinephrine infusions during thoracic epidural anesthesia.
Training trauma teams in the Nordic countries: An overview and present status
Authors: Wisborg T. , Castren M. , Lippert A. , Valsson F. , Wallin C. J. ,   on behalf of the Working Scandinavian Group (WISE)
Published: July 2005

Background:  During the last decade there has been an increased interest in the organisation and quality of trauma care in the Nordic countries. Still, most patients are initially cared for at hospitals with low caseloads of severe trauma. More than 200 hospitals offer initial care to trauma patients. Training of trauma teams using simulators or simulated patients has evolved in the same period, as one important factor to overcome lack of practical training. This overview describes the present state of trauma team training in the Nordic countries.Methods:  Members of a Nordic working group on the use of simulation in medicine reviewed present literature on training with simulation and described the present use of team training in their own countries during winter 2004.Results:  There is an increasing amount of evidence indicating that training of teams with simulation reduces treatment errors and improves performance. The training activities do not need to be complex, but skilled debriefing seems necessary. Few Nordic hospitals train their trauma teams. The training activities vary considerably between and within countries.Conclusion:  There is considerable evidence supporting an increased use of experience gained in other high‐risk domains where training in communication, leadership and decision‐making is the focus for safety and improvement efforts. There is a need for more widespread training of trauma teams. The different training activities actually undertaken should be scientifically evaluated.
Comparison of perioperative spirometric data following spinal or general anaesthesia in normal‐weight and overweight gynaecological patients
Authors: Von Ungern‐Sternberg B. S. , Regli A. , Reber A. , Schneider M. C. 
Published: July 2005

Background:  There is limited data comparing the impact of spinal anaesthesia (SA) and general anaesthesia (GA) on perioperative lung function. Here we assessed the differences of these two anaesthetic techniques on perioperative lung volumes in normal‐weight (BMI < 25) and overweight (BMI 25–30) patients using spirometry.Methods:  We prospectively studied 84 consenting patients having operations in the vaginal region receiving either GA (n = 41) or SA (n = 43). Both groups (GA and SA) were further divided into two subgroups each (normal‐weight vs. overweight). We measured vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), midexpiratory (MEF25‐75) and peak expiratory flow rates (PEFR) at the preoperative assessment (baseline), after premedication, after effective SA, and 20 min, 1 h, 2 h and 3 h after the operation (last measurement after patient mobilization).Results:  Premedication was associated with a small but significant decrease in lung volumes in direct correlation with BMI (−5%). Spinal anaesthesia resulted in a significant reduction in lung volumes in overweight as opposed to normal‐weight patients. Postoperatively, lung volumes were significantly more reduced following GA than SA as indicated by differences in mean VC (SD) of −12 (6)% vs. −6 (5)% 20 min after the end of the operation in the normal‐weight and −18 (5)% vs. −10 (5)% in the overweight patients. There was a significant impact of BMI on postoperative respiratory function, which was significantly more important in the GA group than in the SA group, and recovery of lung volumes was more rapid in the normal‐weight patients than in the overweight patients, particularly in the SA group.Conclusion:  In gynaecological patients undergoing vaginal surgery, the impact of anaesthesia on postoperative lung function as assessed by spirometry was significantly less after SA than GA, particularly in overweight patients.
Impact of gender on treatment and outcome of ICU patients
Authors: Reinikainen M. , Niskanen M. , Uusaro A. , Ruokonen E. 
Published: July 2005

Background:  Gender modifies immunologic responses caused by severe trauma or critical illness. The aim of this study was to investigate the impact of gender on hospital mortality, length of intensive care unit (ICU) stay, and intensity of care of patients treated in ICUs.Methods:  Data on 24,341 ICU patients were collected from a national database. We measured severity of illness with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores and intensity of care with Therapeutic Intervention Scoring System (TISS) scores. We used logistic regression analysis to test the independent effect of gender on hospital mortality. We compared the lengths of ICU stay and the intensity of care of men and women.Results:  Male gender was associated with increased hospital mortality among postoperative ICU patients [adjusted odds ratio 1.33 (95% confidence interval 1.12–1.58, P = 0.001)] but not among medical patients [adjusted odds ratio 1.02 (95% confidence interval 0.92–1.13, P = 0.74)]. Male gender was associated with an increased risk of death particularly in the oldest age group (75 years or older) and among the patients with relatively low APACHE II scores (<16). Mean length of ICU stay was 3.2 days for men and 2.6 days for women (P < 0.001). Male patients comprised 61.7% of the study population but consumed 66.0% of days in intensive care.Conclusion:  Male gender contributes to poor outcome in postoperative ICU patients. Approximately two‐thirds of ICU resources are consumed by male patients.
Is ECG‐guidance a helpful method to correctly position a central venous catheter during prehospital emergency care?
Authors: David J. S. , Tazarourte K. , Perfus J. P. , Savary D. 
Published: July 2005

Background:  Insertion of a central venous catheter (CVC) in an emergency situation is challenging and may be potentially associated with more complications. Because CVC positioning by ECG‐guidance may help to decrease the frequency of a malpositioned catheter, we decided to prospectively evaluate the usefulness of positioning a CVC by ECG‐guidance during prehospital emergency care.Methods:  Prospective observational study during which all patients requiring CVC placement during prehospital care were included. We compared two periods of 1 year during which CVCs were inserted without and then with the help of ECG‐guidance.Results:  Eighty successive patients were included. We observed a significant reduction of incorrectly positioned CVCs with ECG‐guidance (13% vs. 38%, P < 0.05) and a decreased number of chest X‐rays needed to verify the position of the CVC (40 vs. 54, P < 0.05).Conclusion:  ECG‐guidance is a safe and feasible technique which significantly improved the rate of CVCs correctly positioned during prehospital emergency care.
The future role of the anaesthesiologist in pain management
Authors: Breivik H. 
Published: July 2005

Background:  Relieving pain during and after surgery and trauma has always been a basic duty of anaesthesiologists. With their skills and expertise in regional analgesia and pharmacological analgesia, anaesthesiologists have improved management of severe cancer pain. Will there be a place for anaesthesiologists in multidisciplinary pain clinics managing chronic non‐cancer pain patients in the future?Methods:  This is a personal review of the development of pain management as a growing part of the responsibilities of anaesthesiologists during the past three decades and the importance of continued involvement of anaesthesiologists in this interesting and challenging aspect of clinical medicine.Results and conclusions:  Optimal management of pain during and after surgery is a prerequisite for successful short‐ and long‐term rehabilitation after surgery. After surgery, reducing dynamic pain with prolonged optimal epidural analgesia and regional blocks facilitates mobilization and reduces chronic pain. The expertise of well‐trained anaesthesiologists in skilfully using regional analgesia and pharmacological pain relief continues to be in demand in palliative care. Some interventional techniques are useful in relieving chronic non‐cancer pain in selected patients. Well‐trained anaesthesiologist‐pain clinicians can perform interventional treatments safely. No doubt, anaesthesiologists will continue to have important roles in pain management in the future.
Single‐shot spinal block for labour analgesia in multiparous parturients*
Authors: Viitanen H. , Viitanen M. , Heikkilä M. 
Published: July 2005

Background:  Intrathecal analgesia (ITA) is effective in late, rapidly progressing labour. In 1998, our hospital implemented the use of single‐shot spinal block for pain relief in multiparous parturients. As part of a quality assurance programme, we assessed the analgesic efficacy, obstetric and neonatal outcomes and maternal satisfaction after this form of analgesia now in routine use in our labour ward.Methods:  Two hundred and twenty‐nine consecutive multiparous parturients presenting for vaginal delivery and requesting analgesia were asked to participate in this prospective study. All parturients received our standard ITA: 2.5 mg bupivacaine (1 ml) + 25 µg fentanyl (0.5 ml) inserted via the L2−3 or L3−4 interspace. Routine monitoring included maternal vital signs, uterine contraction and fetal heart rate tracing. Pain scores (visual analogue scale (VAS) 0–10), sensory levels, motor block, side‐effects and maternal satisfaction were recorded. Satisfactory analgesia was defined as a decrease in pain scores to three or less within 20 min after injection. The number of parturients requesting additional analgesia and the duration of spinal block (time from injection until request for additional medication after satisfactory analgesia had worn off) were recorded.Results:  Two hundred and nine parturients were included in the study. Satisfactory analgesia was achieved in 153 (73%) parturients. Fifty‐five (26%) women requested additional analgesia: 38 (18%) because of unsatisfactory analgesia and 17 (8%) because analgesia ended before delivery. The duration of spinal block was 101 ± 34 min. Pruritus occurred in 64%, fetal bradycardia in 7% and hypotension in 2% of deliveries. Pain relief was rated excellent by 65%, moderate by 20% and inadequate by 14% of the parturients. One hundred and sixty‐nine (81%) women stated that they would like to have spinal analgesia again for pain relief during delivery.Conclusion:  The majority of multiparous parturients found ITA adequate for pain relief during delivery. However, modifications are required in terms of improved timing, reliability and duration of analgesia.
Update on anti‐emetics for chemotherapy‐induced emesis
Authors: Olver I. N. 
Published: July 2005

Abstract The need to control chemotherapy‐induced emesis has stimulated research into anti‐emetics. Emesis is not only unpleasant, but negatively impacts on global quality of life. The development of two new classes of drugs has been responsible for the major advances in anti‐emesis. The 5 hydroxytryptamine3 (5HT3) antagonists in combination with dexamethasone significantly improved the control of acute post chemotherapy emesis, but delayed emesis which can last for several days was still problematic, yet its incidence was underestimated by clinicians. Both the control of acute and delayed emesis was improved when the neurokinin1 (NK1) receptor antagonists were added to 5HT3 antagonists and steroids. The complete control of delayed emesis was improved by 21% with little toxicity. The triple drug combination has become the standard of care for preventing the emesis associated with cytotoxic drugs of high emetic potential. (Intern Med J 2005; 35: 478−481)
Asthma 3+ Visit Plan: a qualitative evaluation
Authors: Douglass J. A. , Goeman D. P. , Yu E. A. , Abramson M. J. 
Published: July 2005

Abstract Introduction:  The Asthma 3+ Visit Plan is a Commonwealth primary care initiative to improve care for patients with moderate or severe asthma through visits to general practitioners (GP).Aims:  To assess the use of, and barriers to, completing the Asthma 3+ Visit Plan in recurrent emergency department attendees; asthma knowledge, symptoms and quality of life were assessed before and after undertaking the plan.Methods:  The design was a predominantly qualitative study. Consenting individuals who presented for emergency treatment for asthma were interviewed before and after completing the Asthma 3+ Visit Plan with their GP. Asthma knowledge, symptom control, quality of life and demographic information were collected and participants underwent in‐depth interviews for qualitative analysis. The setting was a tertiary teaching hospital and two suburban hospitals. The participants were 20 recurrent emergency attendees with asthma.Results:  Individuals who completed the Asthma 3+ Visit Plan had significant improvements in asthma‐related quality of life and asthma knowledge. Qualitative interviews revealed that recurrent emergency attendees for asthma viewed the Asthma 3+ Visit Plan favourably. A good relationship with the GP appeared integral to the success of the Asthma 3+ Visit Plan and patient recall was an important factor in plan completion. Cost was also a barrier to patients completing the plan.Conclusion:  Our findings support the Asthma 3+ Visit Plan as a discharge strategy for recurrent emergency attendees with asthma. (Intern Med J 2005; 35: 457–462)
Part II. General practitioner–specialist referral process
Authors: Piterman L. , Koritsas S. 
Published: July 2005

Abstract This is the second of two articles that explore the general practitioner (GP)–specialist relationship. In this article, we explore the nature of the referral process, beginning with referrals frequently made by GPs in Australia and reasons for referral to specialists. In Australia, GPs commonly refer patients to specialists, particularly orthopaedic surgeons, ophthalmologists, surgeons and gynaecologists for a variety of reasons, including diagnosis or investigation, treatment and reassurance (reassurance for themselves as well as reassurance for the patient). GPs will choose a specialist after considering a variety of factors, such as the specialist's medical skill, their previous experience with the specialist, the quality of communication between them, office location and patient preferences. The referral is generally made by telephone or by letter, the latter of which is known to vary significantly in content and quality. The specialist, GP and patient expectations of the referral and the consultation process are also described. Specialists expect the GP to provide information about the problem to be addressed and adequate patient history, GPs expect a clear response regarding diagnosis and management as well as justification for the course of action, and patients expect clear communication and explanation of the diagnosis, treatment and follow‐up requirements. When these expectations remain unmet, GPs, specialists and patients end up dissatisfied with the referral process. (Intern Med J 2005; 35: 491–496)
Recombinant factor VIIa as an adjunctive therapy for patients requiring large volume transfusion: a pharmacoeconomic evaluation
Authors: Loudon B. , Smith M. P. 
Published: July 2005

Abstract Background:  Acute haemorrhage requiring large volume transfusion presents a costly and unpredictable risk to transfusion services. Recombinant factor VIIa (rFVIIa) (NovoSeven, Novo Nordisk, Bagsvaard, Denmark) may provide an important adjunctive haemostatic strategy for the management of patients requiring large volume blood transfusions.Aims:  To review blood transfusion over a 12‐month period and assess the major costs associated with haemorrhage management. A pharmoeconomic evaluation of rFVIIa intervention for large volume transfusion was conducted to identify the most cost‐effective strategy for using this haemostatic product.Methods:  Audit and analysis of all patients admitted to Christchurch Public Hospital requiring >5 units of red blood cells (RBC) during a single transfusion episode. Patients were stratified into groups dependent on RBC units received and further stratified with regard to ward category. Cumulative costs were derived to compare standard treatment with an hypothesized rFVIIa intervention for each transfusion group. Sensitivity analyses were performed by varying parameters and comparing to original outcomes.Results:  Comparison of costs between the standard and hypothetical model indicated no statistically significant differences between groups (P < 0.05). Univariate and multivariate sensitivity analyses indicate that intervention with rFVIIa after transfusion of 14 RBC units may be cost‐effective due to conservation of blood components and reduction in duration of intensive area stay.Conclusion:  Intervention with rFVIIa for haemorrhage control is most cost‐effective relatively early in the RBC transfusion period. Our hypothetical model indicates the optimal time point is when 14 RBC units have been transfused. (Intern Med J 2005; 35: 463–467)