To determine which preoperative factors might affect the development of cardiac complications after major noncardiac operations, we prospectively studied 1001 patients over 40 years of age. By multivariate discriminant analysis, we identified nine independent significant correlates of life-threatening and fatal cardiac complications: preoperative third heart sound or jugular venous distention; myocardial infarction in the preceding six months; more than five premature ventricular contractions per minute documented at any time before operation; rhythm other than sinus or presence of premature atrial contractions on preoperative electrocardiogram; age over 70 years; intraperitoneal, intrathoracic or aortic operation; emergency operation; important valvular aortic stenosis; and poor general medical condition. Patients could be separated into four classes of significantly different risk. Ten of the 19 postoperative cardiac fatalities occurred in the 18 patients at highest risk. If validated by prospective application, the multifactorial index may allow preoperative estimation of cardiac risk independent of direct surgical risk.

Multifactorial Index of Cardiac Risk in Noncardiac Surgical Procedures

This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in the development of health interventions. The study identified 23 papers. Few were comparable as different studies use different measures, of different things, at different time points. We concluded that the current state of knowledge of time lags is of limited use to those responsible for R&D and knowledge transfer who face difficulties in knowing what they should or can do to reduce time lags. This effectively ‘blindfolds’ investment decisions and risks wasting effort. The study concludes that understanding lags first requires agreeing models, definitions and measures, which can be applied in practice. A second task would be to develop a process by which to gather these data.

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The answer is 17 years, what is the question: understanding time lags in translational research:

The Answer Is 17 Years, What Is the Question

National High Blood Pressure Education Program.

We examine the interface between for-profit and publicly funded research in pharmaceuticals. Firms access upstream basic research through investments in absorptive capacity in the form of in-house basic research and ‘pro-publication’ internal incentives. Some firms also maintain extensive connections to the wider scientific community, which we measure using data on coauthorship of scientific papers between pharmaceutical company scientists and publicly funded researchers. ‘Connectedness’ is significantly correlated with firms’ internal organization, as well as their performance in drug discovery. The estimated impact of ‘connectedness’ on private research productivity implies a substantial return to public investments in basic research.

Absorptive Capacity, Coauthoring Behavior, and the Organization of Research in Drug Discovery

The role of anesthesia in contributing to surgical mortality has been studied in 33,224 patients given either spinal anesthesia or a general anesthetic to which muscle relaxants were added. There were no deaths atributable to anesthesia in the 16,000 physically fit patients anesthetized by either technique. As the patients' physical condition worsened, deaths related to anesthesia increased in incidence; in the moribund patients, 1 in 16 patients given spinal anesthesia died of causes related to the anesthetic, and in 1 in 10 patients, general anesthesia could not be excluded as contributing to death. Of 6,000 physically fit patients who received a muscle relaxant, none died. No evidence of an inherent toxicity of muscle relaxants could be found. When deaths were related to the use of muscle relaxants, errors of omission or commission were always apparent.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=331895&pdfFileName=jama_178_3_001.pdf

The Role of Anesthesia in Surgical Mortality

Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia

• The headache that frequently follows spinal anesthesia is sometimes associated with visual and auditory difficulties and dizziness. This syndrome was studied in connection with 9,277 anesthetizations by the spinal technique, and the data were compared with those from 1,000 other patients who were given general anesthesia over the same period of time. The over-all incidence of the headache, which occurred in 9,277 anesthetizations, was 1,011, or 11%. The oldest patients were least susceptible to it, and men were less susceptible than women. Its incidence when needles of small diameter were used was much less than that with needles of large diameter; the 22-gauge needle was found best for routine use. Headache could be virtually eliminated by the employment of a 24-gauge needle. The data on duration and time of onset of the headache, on the effects of postural changes, and on the visual and auditory phenomena indicate that this syndrome results from a decrease in cerebrospinal fluid pressure and that the decrease is caused by leakage of the fluid.

Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties).

Our project had only one goal: to demonstrate that objective, scientific techniques—instead of the present anecdotal approach—can be used to design and justify a national biomedical research policy.

https://science.sciencemag.org/content/sci/192/4235/105.full.pdf

Scientific basis for the support of biomedical science

In anesthesiology there is a continuing healthy criticism of the agents and techniques used to achieve practical and safe conditions for surgical operations. This criticism arises both from within the ranks of the specialty and from outside. Hardly a drug or method is free of major disadvantages. Recent reports have described what seems to be an increasing incidence of cardiac arrest under anesthesia.1General anesthesia and particularly the employment of multiple agents have been blamed in part for this increased mortality. We hear that ether is not the safe agent it once was thought to be2and that curare may possess an inherent toxicity.3Spinal anesthesia, an anesthetic technique with great advantages for the patient, surgeon, and anesthetist, is relatively free from the criticism of toxicity and the mortality associated with general anesthesia; on the other hand, the great hazard of spinal anesthesia in the minds of

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=jama&articleId=298523&pdfFileName=jama_156_16_005.pdf

Robert D. Dripps

Papers

The Role of Anesthesia in Surgical Mortality

Reflex circulatory responses to direct laryngoscopy and tracheal intubation performed during general anesthesia

Long-term follow-up of patients who received 10,098 spinal anesthetics; syndrome of decreased intracranial pressure (headache and ocular and auditory difficulties).

Scientific basis for the support of biomedical science

Long-term follow-up of patients who received 10,098 spinal anesthetics: failure to discover major neurological sequelae.