bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dantrolene – A review of its pharmacology, therapeutic use and new developments
Authors: Krause T. , Gerbershagen M. U. , Fiege M. , Weißhorn R. , Wappler F. 
Published: March 2004

SummaryHuman malignant hyperthermia is a life‐threatening genetic sensitivity of skeletal muscles to volatile anaesthetics and depolarizing neuromuscular blocking drugs occurring during or after anaesthesia. The skeletal muscle relaxant dantrolene is the only currently available drug for specific and effective therapy of this syndrome in man. After its introduction, the mortality of malignant hyperthermia decreased from 80% in the 1960s to < 10% today. It was soon discovered that dantrolene depresses the intrinsic mechanisms of excitation–contraction coupling in skeletal muscle. However, its precise mechanism of action and its molecular targets are still incompletely known. Recent studies have identified the ryanodine receptor as a dantrolene‐binding site. A direct or indirect inhibition of the ryanodine receptor, the major calcium release channel of the skeletal muscle sarcoplasmic reticulum, is thought to be fundamental in the molecular action of dantrolene in decreasing intracellular calcium concentration. Dantrolene is not only used for the treatment of malignant hyperthermia, but also in the management of neuroleptic malignant syndrome, spasticity and Ecstasy intoxication. The main disadvantage of dantrolene is its poor water solubility, and hence difficulties are experienced in rapidly preparing intravenous solutions in emergency situations. Due to economic considerations, no other similar drugs have been introduced into routine clinical practice.
Haemodynamic effects of a milrinone infusion without a bolus in patients undergoing off‐pump coronary artery bypass graft surgery
Authors: Kwak Y. L. , Oh Y. J. , Shinn H. K. , Yoo K. J. , Kim S. H. , Hong Y. W. 
Published: March 2004

SummaryThe haemodynamic effects of a continuous infusion of milrinone without an initial bolus dose were evaluated in patients undergoing off‐pump coronary artery bypass graft surgery. After internal mammary artery harvest, milrinone 0.5 μg.min−1.kg−1 (29 patients) or a normal saline infusion (33 patients) was started and continued until all graft anastomoses were completed. Haemodynamic variables were recorded before application of the tissue stabiliser, at 1, 3, 5 and 10 min after the application of the stabiliser, and after its removal. The administration of a milrinone infusion was associated with a smaller decrease in cardiac output and mixed venous oxygen saturation during all the coronary artery anastomoses, with no severe complications and a decreased dose of norepinephrine infused to maintain systemic arterial pressure.
Peri‐operative troponin I concentration as a marker of long‐term postoperative adverse cardiac outcomes – A study in high‐risk surgical patients
Authors: Higham H. , Sear J. W. , Sear Y. M. , Kemp M. , Hooper R. J. L. , Foex P. 
Published: March 2004

SummaryWe have previously demonstrated that the peri‐operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase‐MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients undergoing major vascular surgery or major joint arthroplasty to 1 year using a patient questionnaire, general practitioner follow‐up and case‐notes review. Increased postoperative marker concentrations were defined as values greater than the upper reference limit. Increases in troponin I and troponin T concentrations, as well as a single elevated creatine kinase‐MB and two successively elevated creatine kinase‐MB concentrations were measured in 12, 13, 33 and 15 patients respectively. Thirty‐nine major adverse cardiac outcomes were recorded (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina, cerebrovascular accident and major arrhythmias needing active treatment). There was no association between increases in any of these cardiac markers and cardiac death to 1 year. However, increases in troponin I and both a single elevated creatine kinase‐MB and two successively elevated creatine kinase‐MB concentrations were associated with an increased incidence of major cardiac outcomes, including cardiac death, to 1 year (odds ratio [95% confidence intervals] = 4.19 [1.16–14.87], 3.97 [1.65–9.44] and 5.19 [1.60–16.22], respectively).
Pre‐operative information and patient‐controlled analgesia: much ado about nothing
Authors: Chumbley G. M. , Ward L. , Hall G. M. , Salmon P. 
Published: March 2004

SummaryWe examined whether pre‐operative information benefited patients receiving patient‐controlled analgesia (PCA) after major surgery. We investigated whether patients felt better informed about PCA and also whether pre‐operative information altered the use of PCA, the adequacy of pain relief, worries about addiction and safety, and knowledge of side‐effects. We investigated the effectiveness of information provided in two ways, namely by a patient‐determined leaflet or an interview by a trained nurse from the pain team, compared with routine pre‐operative information. We studied 225 patients, 75 in each group. Patients in the leaflet group were better informed about PCA, became familiar with using PCA more quickly and were less confused about PCA than the control group. However, there were no effects on pain relief, worries about addiction and safety, and knowledge of side effects. The pre‐operative interview resulted in no benefits. Our findings indicate that the detailed provision of pre‐operative information failed to improve patients' experiences of PCA.
Disruption of cleft palate repair following the use of the laryngeal mask airway
Authors: Somerville N. S. , Fenlon S. , Boorman J. , Abbot M. 
Published: March 2004

SummaryA 55‐year‐old man was admitted for routine examination of ears with insertion of grommets under general anaesthesia. At 2 years of age he had undergone successful repair of cleft lip and palate. A reinforced laryngeal mask airway was employed to maintain the airway. Postoperatively, it was evident he had suffered complete disruption of the soft palate repair, leading to velopharyngeal insufficiency with nasal regurgitation of fluids. We discuss the possible aetiology, having found no such reported injury pattern documented in the literature.
Cerebral and extracerebral release of protein S100B in cardiac surgical patients
Authors: Snyder‐Ramos S. A. , Gruhlke T. , Bauer H. , Bauer M. , Luntz A. P. , Motsch J. , Martin E. , Vahl C. F. , Missler U. , Wiesmann M. , Böttiger B. W. 
Published: March 2004

SummaryAlthough several clinical studies have shown that increased serum concentrations of protein S100B predict ischaemic brain damage after cardiac surgery, S100B may also be released from the heart or other injured tissue. We therefore investigated the correlation between serum S100B levels and those of the specific cardiac marker troponin I in order to assess the cerebral vs. extracerebral origin of S100B. In 64 cardiac surgical patients, serial blood samples were drawn for the measurement of S100B and troponin I before surgery and for seven days after surgery. Neurological function was assessed before with the National Institutes of Health Stroke Scale and the Folstein Mini Mental Test. The data show that a sustained increase in serum S100B levels is associated with neurological dysfunction, as witnessed by a positive correlation between S100B values and the results of the neuropsychological tests. In contrast, the early postoperative increased levels of protein S100B derive from cardiac tissue, as shown by the positive correlation between S100B and cardiac troponin I levels.
Sleep disruption in critically ill patients – pharmacological considerations
Authors: Bourne R. S. , Mills G. H. 
Published: March 2004

SummarySleep disturbances are common in critically ill patients and contribute to morbidity. Environmental factors, patient care activities and acute illness are all potential causes of disrupted sleep. Additionally, it is important to consider drug therapy as a contributing factor to this adverse experience, which patients perceive as particularly stressful. Sedative and analgesic combinations used to facilitate mechanical ventilation are among the most sleep disruptive drugs. Cardiovascular, gastric protection, anti‐asthma, anti‐infective, antidepressant and anticonvulsant drugs have also been reported to cause a variety of sleep disorders. Withdrawal reactions to prescribed and occasionally recreational drugs should also be considered as possible triggers for sleep disruption. Tricyclic antidepressants and benzodiazepines are commonly prescribed in the treatment of sleep disorders, but have problems with decreasing slow wave and rapid eye movement sleep phases. Newer non‐benzodiazepine hypnotics offer little practical advantage. Melatonin and atypical antipsychotics require further investigation before their routine use can be recommended.
The effect of epidural analgesia in labour on maternal respiratory function*
Authors: Von Ungern‐Sternberg B. S. , Regli A. , Bucher E. , Reber A. , Schneider M. C. 
Published: March 2004

SummaryLumbar epidural analgesia during labour has gained widespread acceptance. The impact of epidural analgesia based on mixtures of low‐dose local anaesthetic solutions and lipophilic opioids on most clinically relevant obstetric outcomes is minimal. Since the pregnant state per se is associated with important alterations in respiration, we assessed whether a subtle degree of motor blockade brought about by epidural analgesia might compromise respiratory function as assessed by spirometry. Sixty consenting parturients receiving epidural analgesia were consecutively included in this prospective study. We performed spirometry during the antepartum visit and in labour after effective epidural analgesia was established; at both assessments the women were pain‐free. Values were within normal ranges but increased significantly after effective epidural analgesia; median (IQR [range]) increase for vital capacity 7.4 (3.0–13 [−12–27])% (p < 0.001); forced vital capacity 4.4 (1.7–9.8 [−13–26])% (p < 0.001); forced expiratory volume in 1 s 5.5 (1.7–8.6 [−14–28])% (p < 0.001); and peak expiratory flow rate 2.3 (−1.6–5.8 [−18–16])% (p = 0.01)). We conclude that epidural analgesia for labour significantly improved respiratory function.
Evaluation of a new continuous cardiac output monitor in off‐pump coronary artery surgery
Authors: Leather H. A. , Vuylsteke A. , Bert C. , M'Fam W. , Segers P. , Sergeant P. , Vandermeersch E. , Wouters P. F. 
Published: March 2004

SummaryWe evaluated a new, ultra‐fast response continuous cardiac output monitor in 34 adult patients undergoing off‐pump coronary artery bypass graft surgery. Cardiac output was measured with the TruCCOMS® continuous cardiac output monitor (Aortech International plc, Lanarkshire, UK), using triplicate cold bolus thermodilution as the criterion standard, at fixed time points during surgery and during dobutamine infusion. The two techniques were compared using linear regression and Bland‐Altman analysis. Overall, the study device displayed a bias of 0.4 l.min−1 with limits of agreement of +2.5 l.min−1 and −1.7 l.min−1. The study device failed to detect the change in cardiac output caused by dobutamine accurately (y = 0.18x + 0.45; r2 = 0.13), with an error linearly related to the magnitude of the change measured. We conclude that the device's failure to detect changes in cardiac output could be a major limitation in its clinical use in its current form.
The short, tragic life of Robert M. Glover
Authors: Defalque R. J. , Wright A. J. 
Published: March 2004

SummaryRobert Mortimer Glover (1815–1859) was a contemporary of John Snow and James Young Simpson. Although he did not reach the standing of those two giants, his researches, writings and lectures were important contributions to the early development of British anaesthesia. Glover was the first to explore the physiological action of chloroform in the laboratory and to discover its anaesthetic effect in 1842. He helped Sir John Fife in Hannah Greener's autopsy in January 1848 and influenced Fife's conclusions on the cause of the young girl's death. His numerous and extensive articles reviewing the history, chemistry, pharmacology and clinical applications of various anaesthetics were widely read and quoted by his colleagues, including John Snow. While in Edinburgh and Newcastle, Glover was recognised as a remarkably astute physician, original researcher, prolific writer and enthusiastic lecturer with an enormous knowledge of medicine, the physical sciences, mathematics and philosophy. His brilliant career deteriorated after his arrival in London and, especially, after his return from the Crimea, although he continued to publish until the week before his death. The causes of his decline remain obscure. The last year of his life was ruined by his addiction to chloroform, to whose development he had contributed so much, and which killed him at the early age of 43.
Forehead SpO2 monitoring compared to finger SpO2 recording in emergency transport
Authors: Nuhr M. , Hoerauf K. , Joldzo A. , Frickey N. , Barker R. , Gorove L. , Puskas T. , Kober A. 
Published: March 2004

SummaryContinuous peripheral oxygen saturation monitoring using a finger pulse oximeter is standard in prehospital emergency medicine. Forehead peripheral oxygen saturation monitoring has been enhanced for better performance during movement and in cold ambient temperatures, both of which are common during emergency transport. We compared a new forehead monitor with standard finger pulse oximeter. The forehead technique had significantly fewer mean (SD) alarms per patient (3.0 (2.2)) than the finger pulse oximeter (7.8 (4.0)) and shorter durations of malfunction (76 (60) s compared to 333 (170) s) when using the finger pulse oximeter. We conclude that measuring peripheral oxygen saturation monitoring with a forehead sensor provides better monitoring quality in emergency care.
Second and subsequent surgical operations within 12 months of a first operation
Authors: Haden R. M. , Scott P. V. 
Published: March 2004

SummaryIn a retrospective study, all patients having anaesthetic procedures within a 3‐month period were identified and followed up to establish if they had further procedures within a calendar year. The procedures undertaken on these patients were then identified to establish if a relationship existed between the procedures and what that relationship was. 11% of all patients returned for further procedures, 80% of which were within the same surgery speciality. In the overwhelming majority, the subsequent procedures were related to the first either as planned courses of treatment or by complications of the surgery or the disease process. The relationship between the procedures and their time intervals is discussed.
Odour identification as a marker for postoperative cognitive dysfunction: A pilot study*
Authors: Rentowl P. , Hanning C. D. 
Published: March 2004

SummaryThe onset of postoperative cognitive dysfunction is delayed in some elderly surgical patients and the condition may persist. Increasing age is a risk factor for both postoperative cognitive dysfunction and dementia. Major surgery may unmask an underlying dementia; we report findings of a pilot study designed to inform this hypothesis. Impaired odour identification ability is a characteristic of the preclinical phase of some neuro‐degenerative diseases. This pilot study was designed to establish whether odour identification deficit is a marker for postoperative cognitive dysfunction, particularly in elderly patients genetically predisposed to develop late‐onset Alzheimer's disease. We found no association between odour identification ability and postoperative cognitive dysfunction in 53 patients aged 62–86, undergoing major non‐cardiac surgery under general anaesthesia. Our pilot study showed that a high number of patients genetically predisposed to develop Alzheimer's disease is required to test the utility of odour identification as a marker for postoperative cognitive dysfunction.
Are caregivers’ reports of motivation valid? Reliability and validity of the Reiss Profile MR/DD
Authors: Lecavalier L. , Havercamp S. M. 
Published: March 2004

AbstractBackground  Sensitivity theory proposes that there are wide individual differences in what motivates people with intellectual disability. The Reiss Profile MR/DD is a rating scale that measures 15 fundamental motives. This study examined the internal consistency and interrater reliability of the 15 subscales as well as the validity of motivational profiles.Method  The study consisted of two distinct but related steps. First, the interrater reliability of the rating scale was established by having pairs of raters evaluate 48 individuals. Second, raters were presented with three different motivational profiles and asked to identify which one corresponded to the individual they had rated 4 weeks earlier.Results  Results indicated good internal consistency (average alpha = 0.84), significant variability in the interrater reliability (average intraclass correlation coefficient = 0.52), and excellent validity (95% of the correct profiles were chosen). Average discrepancies between pairs of raters are presented.Conclusions  Interrater reliability is an important topic for professionals working in the field of intellectual disability and results are discussed in terms of the factors that affect it. This is the first published study to report on the interrater reliability of the Reiss Profile MR/DD.
Burnout in direct care staff in intellectual disability services: a factor analytic study of the Maslach Burnout Inventory
Authors: Hastings R. P. , Horne S. , Mitchell G. 
Published: March 2004

AbstractBackground  There is gathering research interest in the well‐being of staff working in services for people with intellectual disability (ID), including the assessment of burnout and its correlates. However, no previous studies have considered the applicability of the main three dimensions of burnout to staff in ID services.Methods  Data were analysed from two samples of staff (total n = 184) who participated in research studies that included completion of the Maslach Burnout Inventory (MBI).Results  Nineteen of the MBI items loaded clearly onto factors closely resembling the three original subscales: emotional exhaustion, depersonalization and personal accomplishment. Internal consistency for the three MBI subscales was fair to good (range 0.68–0.87).Conclusions  The original three MBI dimensions were found to be highly relevant to the present sample of staff. The analyses support the construct validity and reliability of the MBI for staff in ID services.
Smoking prevalence and knowledge of associated risks in adult attenders at day centres for people with learning disabilities
Authors: Taylor N. S. , Standen P. J. , Cutajar P. , Fox D. , Wilson D. N. 
Published: March 2004

AbstractBackground  Increased longevity among people with learning disabilities is accompanied by an increase in morbidity. A possible explanation is that living in the community and a move to greater independence may bring higher health risks through obesity and smoking. The study aimed to see if rates of smoking have increased from earlier published rates and to ascertain the awareness of the risks of smoking among people with learning disabilities.Methods  A total of 435 people attending four social services day centres in a large urban area were assisted to complete a questionnaire.Results  Twenty‐seven (6.2%) reported that they currently smoked. Those with mild disabilities were much more likely to smoke than those with more severe disabilities and they also reported smoking more heavily. For those with mild levels of learning disability, a higher than expected proportion living in hospital and staffed housing smoked, a lower proportion living with parents smoked but for those living independently the proportion who smoked was no higher than expected. Smokers were more knowledgeable about the risks than non‐smokers even if the level of learning disability was controlled for. Only a third of smokers were concerned about the risks.Conclusions  The study provides no evidence that rates of smoking are increasing among people with learning disabilities nor that those living independently were more likely to smoke. Knowledge of health risks is poor across the group, but higher among the smokers who were unlikely to express concern about the risks. This may indicate that more support may be needed along with health education in this group.
Effectiveness of immediate verbal feedback on trainer behaviour during communication training with individuals with intellectual disability
Authors: Van Vonderen A. 
Published: March 2004

AbstractThe effect of immediate verbal feedback on trainer behaviour during communication training sessions with individuals with intellectual disability (ID) was assessed. Trainers were six undergraduate university students majoring in psychology. The procedure consisted of interrupting the sequence of trials of training by the supervisor and then giving brief corrective feedback. Feedback was focused on the accuracy of the following procedural aspects: (1) entry behaviour; (2) prompt level and order of presenting response prompts; (3) use of reinforcement; (4) pace of presenting trials; and (5) if this occurred, handling trainee's disruptive behaviour during training. Data were collected in a nonconcurrent multiple baseline design. Results indicated a statistically significant increase of the percentage correct trainer behaviour as compared to the baseline phase. Maintenance of effect of feedback was recorded during post‐training and follow‐up.
An exploratory study into health care policy for persons with intellectual disabilities in Taiwan
Authors: Lin J. D. , Wu J. L. , Yen C. F. 
Published: March 2004

AbstractBackground  Although Taiwan has already had a higher quality of health care compared with other countries, there still is a need to review the quality and effectiveness of services provided. The lack of health care policy for persons with disabilities is a reflection of health care provision in Taiwan. Health care provision problems will limit persons with disabilities in their access to the health care system. The purpose of the present study was to examine the general beliefs about the current health care policies for persons with intellectual disabilities (ID) in Taiwan.Methods  Data were obtained from two sources, namely government policies analysis and interviews with representatives for key stakeholders in the field of ID.Results  The results illustrate that health care service problems for persons with ID include: how to enforce the discovery system and early intervention service, disability evaluation system, National Health Insurance medical payment and medical care resource development are still confining their quality of care. Furthermore, the links between social welfare, education and health care have been lost because the different roles and perspectives of people in these fields are fundamentally at odds with one another. Health care professionals have become less reform‐minded as a consequence of the conditions of their work. Consequently, a complete and coordinated health care policy for persons with ID has become unattainable in society. The present paper draws on evidence from research and policies to explore the problems and potential of service development for persons with ID, and to identify review and action points for managing its implementation.