Showing papers by "Royal Adelaide Hospital published in 1993"
TL;DR: Results indicate in normal subjects that gastric emptying accounts for about 34 % of the variance in peak plasma glucose after a 75-g oral glucose load and plasma glucose levels at 120 min are inversely, rather than directly, related to gastric emptied.
Abstract: The relationships between gastric emptying and intragastric distribution of glucose and oral glucose tolerance were evaluated in 16 healthy volunteers. While sitting in front of a gamma camera the subjects drank 350 ml water containing 75 g glucose and 20 MBq 99mTc-sulphur colloid. Venous blood samples for measurement of plasma glucose, insulin and gastric inhibitory polypeptide were obtained at — 2, 2, 5, 10, 15, 30, 45, 60, 75, 90, 105, 120 and 150 min. Gastric emptying approximated a linear pattern after a short lag phase (3.3±0.8 min). The 50% emptying time was inversely related to the proximal stomach 50% emptying time (r=−0.55, p<0.05) and directly related to the retention in the distal stomach at 120 min (r=0.72, p<0.01). Peak plasma glucose was related to the amount emptied at 5 min (r=0.58, p<0.05) and the area under the blood glucose curve between 0 and 30 min was related to the amount emptied at 30 min (r=0.58, p<0.05). In contrast, plasma glucose at 120 min was inversely related to gastric emptying (r=−0.56, p<0.05) and plasma insulin at 30 min (r=−0.53, p<0.05). Plasma insulin at 120 min was inversely related (r=−0.65, p<0.01) to gastric emptying. The increase in plasma gastric inhibitory polypeptide at 5 min was related directly to gastric emptying (r=0.53, p<0.05). These results indicate in normal subjects that (i) gastric emptying accounts for about 34 % of the variance in peak plasma glucose after a 75-g oral glucose load (ii) plasma glucose levels at 120 min are inversely, rather than directly, related to gastric emptying (iii) the distal stomach influences gastric emptying of glucose.
451 citations
TL;DR: The relationship between the toxic effects of metal wear particles and their ability to stimulate the release of inflammatory mediators implicated in bone resorption was investigated and titanium-aluminum-vanadium particles showed little toxicity even at high concentrations, while the cobalt-chromium particles were very toxic.
Abstract: We investigated the relationship between the toxic effects of metal wear particles and their ability to stimulate the release of inflammatory mediators implicated in bone resorption. In vitro studies were carried out with use of rat peritoneal macrophages, which were exposed to either cobalt-chromium-alloy or titanium-aluminum-vanadium particles, milled from the metal components of hip prostheses. The particles were in the size-range of, and at concentrations similar to, those found in the tissues surrounding failed prostheses in humans. The titanium-aluminum-vanadium particles showed little toxicity even at high concentrations, while the cobalt-chromium particles were very toxic. The titanium-aluminum-vanadium particles induced significantly more release of prostaglandin E2 than did the cobalt-chromium particles, and this was true for a wide range of concentrations. Exposure to titanium-aluminum-vanadium increased the release of prostaglandin E2, interleukin-1, tumor necrosis factor, and interleukin-6. In contrast, exposure to cobalt-chromium particles was associated with a decreased release of prostaglandin E2 and interleukin-6, and it had little effect on the release of interleukin-1 and tumor necrosis factor.
436 citations
TL;DR: The pattern and relative frequencies of the various categories of incidents are similar to those in “closed-claims” studies, suggesting that AIMS should provide information of relevance to those wishing to develop strategies to reduce the incidence and/or impact of incidents and accidents.
Abstract: The Australian Patient Safety Foundation was formed in 1987; it was decided to set up and co-ordinate the Australian Incident Monitoring Study as a function of this Foundation; 90 hospitals and practices joined the study. Participating anaesthetists were invited to report, on an anonymous and voluntary basis, any unintended incident which reduced, or could have reduced, the safety margin for a patient. Any incident could be reported, not only those which were deemed "preventable" or were thought to involve human error. The Mark I AIMS form was developed which incorporated features and concepts from several other studies. All the incidents in this symposium were reported using this form, which contains general instructions to the reporter, key words and space for a narrative of the incident, structured sections for what happened (with subsections for circuitry incidents, circuitry involved, equipment involved, pharmacological incidents and airway incidents), why it happened (with subsections for factors contributing to the incident, factors minimising the incident and suggested corrective strategies), the type of anaesthesia and procedure, monitors in use, when and where the incident happened, the experience of the personnel involved, patient age and a classification of patient outcome. Enrollment, reporting and data-handling procedures are described. Data on patient outcome are presented; this is correlated with the stages at which the incident occurred and with the ASA status of the patients. The locations at which the incidents occurred and the types of procedures, the sets of incidents analysed in detail and a breakdown of the incidents due to drugs are also presented.(ABSTRACT TRUNCATED AT 250 WORDS)
389 citations
TL;DR: An approach is provided for the prevention and management of errors, incidents and accidents which allows clinical problems to be categorized, the relative importance of various contributing factors to be established, and appropriate preventative strategies to be devised and implemented on the basis of priorities determined from the AIMS data.
Abstract: Human error is a pervasive and normal part of everyday life and is of interest to the anaesthetist because errors may lead to accidents. Definitions of, and the relationships between, errors, incid...
321 citations
TL;DR: The results suggest that the tendency for serum 25(OH)D to fall with age is due in part to the age-related decline in skin thickness.
308 citations
TL;DR: In this paper, the authors extracted information of relevance to human failure from the first 2,000 incidents reported to the Australian Incident Monitoring Study (AIMS) and searched for human factors amongst the "factors contributing," "factor minimising", and "suggested corrective strategies" categories, and these were classified according to the type of human error with which they were associated.
Abstract: Information of relevance to human failure was extracted from the first 2,000 incidents reported to the Australian Incident Monitoring Study (AIMS). All reports were searched for human factors amongst the "factors contributing," "factors minimising", and "suggested corrective strategies" categories, and these were classified according to the type of human error with which they were associated. In 83% of the reports elements of human error were scored by reporters. "Knowledge-based errors" contributed directly to about one-quarter of incidents; the outcome of one third of incidents was thought to have been minimised by prior experience or awareness of the potential problems, and in one fifth some strategy to improve knowledge was suggested. Correction of "rule-based errors" or provision of protocols or algorithms were thought, together, to have a potential impact on nearly half of all incidents. Failure to check equipment or the patient contributed to nearly one-quarter of all incidents, and inadequate crisis management contributed to a further 1 in 8. "Skill-based errors" (slips and lapses) were directly responsible for 1 in 10 of all incidents, and were thought to make an indirect contribution in up to one quarter. "Technical errors" were responsible for about 1 in 8 incidents. Analysing the relative contribution of each type of error for each type of problem allows the development of rational preventative strategies.(ABSTRACT TRUNCATED AT 250 WORDS)
226 citations
TL;DR: The findings suggest that the anti-reflux effects of fundoplication result from changes in the mechanical behaviour of the gastro-oesophageal junction that result in incomplete abolition of the high pressure zone during lower oesophageaal sphincter relaxation, and reduced triggering of transient lower Oesophagal spHincter relaxations.
Abstract: The effect of fundoplication on patterns of gastro-oesophageal reflux and the underlying motor mechanisms were investigated in 18 patients with symptomatic reflux Oesophageal motility and pH were recorded concurrently after a standard meal Studies were performed preoperatively and from 5 to 27 months after surgery Fundoplication virtually eliminated reflux in all but three patients Control of reflux was associated with a 50% fall in the number of transient lower oesophageal sphincter relaxations, a fall in the proportion of transient lower oesophageal sphincter relaxations accompanied by reflux from 47% to 17%, and an increase in the mean residual pressure at the gastro-oesophageal junction during swallow induced lower oesophageal sphincter relaxation from 07 mm Hg to 60 mm Hg Basal pressure at the gastro-oesophageal junction rose from 109 mm Hg to 145 mm Hg, however, there was no correlation between postoperative reflux and basal gastro-oesophageal junction pressure These findings suggest that the anti-reflux effects of fundoplication result from changes in the mechanical behaviour of the gastro-oesophageal junction that result in incomplete abolition of the high pressure zone during lower oesophageal sphincter relaxation, and reduced triggering of transient lower oesophageal sphincter relaxations
188 citations
TL;DR: The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the incidence and circumstances of problems with endotracheal intubation; 85 (4%) indicated difficulties with intra-nasal inturbation as discussed by the authors.
Abstract: The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the incidence and circumstances of problems with endotracheal intubation; 85 (4%) indicated difficulties with intubation. One third of these were emergency cases, one third involved an initially unassisted trainee and one fifth were outside normal working hours. Failure to predict a difficult intubation was reported in one third of the cases, with another quarter presenting serious difficulty despite preoperative prediction. Difficulties with ventilation were experienced in 1 in 7 of the 85 reports; there was one cardiac arrest, but no death. Endotracheal intubation was not achieved in one fifth of the cases. The commonest complications reported amongst the 85 incidents were oesophageal intubation (18 cases), arterial desaturation (15 cases), and reflux of gastric contents (7 cases). Emergency trans-tracheal airways were required in 5 cases. Obesity, limited neck mobility and mouth opening, and inadequate assistance together accounted for two thirds of all the contributing factors. The most successful intubation aid in this series was a gum elastic bougie. A capnograph contributed to management in 28% and a pulse oximeter in 12% of the cases in which they were used. The most serious desaturations were associated with accidental oesophageal intubation. These data suggest a lack of reliable preoperative assessment techniques and skills for the prediction of difficult intubations. They also suggest the need for a greater emphasis on ensuring that the necessary equipment is available, and on teaching and learning drills for difficult intubation and any associated difficulty with ventilation.
187 citations
TL;DR: The priority sequence of monitor acquisition for those with limited resources should be stethoscope, sphygmomanometer, oxygen analyser if nitrous oxide is to be used, pulse oximeter, capnograph, high pressure alarm, and, if patients are to be mechanically ventilated, a low pressure alarm (or spirometer with alarm).
Abstract: The role of monitors in patients undergoing general anaesthesia was studied by analysing the first 2000 incidents reported to the Australian Incident Monitoring Study; 1256 (63%) were considered ap...
178 citations
TL;DR: Although there was improvement in most of these changes with time, at 1 to 2 years after the completion of irradiation, the frequency of bowel actions was greater, bile acid absorption was less, and small-intestinal transit was more rapid when compared with that of baseline and the normal subjects.
145 citations
TL;DR: A generic crisis management algorithm analogous to the “Phase I” immediate response routine used by airline pilots proved sufficiently robust and safe to recommend its general use as an initial response to any incident or crisis which occurs when a patient is breathing gas from an anaesthetic machine.
Abstract: Anaesthetists are called upon to manage complex life-threatening crises at a moment's notice. As there is evidence that this may require cognitive tasking beyond the information-processing capacity of the human brain, it was decided to try and develop a generic crisis management algorithm analogous to the "Phase I" immediate response routine used by airline pilots. Such an algorithm, based on the mnemonic "COVER ABCD, A SWIFT CHECK", was developed and refined over 3 meetings, each attended by 60-100 anaesthetists and aviation psychologists. It was validated against 1301 relevant incidents among the first 2000 incidents reported to the Australian Incident Monitoring Study. It proved sufficiently robust and safe to recommend its general use as an initial response to any incident or crisis which occurs when a patient is breathing gas from an anesthetic machine. It requires a limited knowledge base and is easily learnt and rehearsed during the anaesthetist's working day. It will provide a functional diagnosis in over 99% of cases and will correct 62% of the problems in 40-60 seconds. In the remaining 37% it will allow the anaesthetist to proceed with a "sub-algorithm", confident in the knowledge that some important step has not been missed. In just over 30% of incidents this will be for a problem familiar to all anaesthetists (e.g. laryngospasm, bradycardia); in just over 6% it will be for a less common, more complex, but finite, set of problems (3% cardiac arrest, 1% air embolism, 1% anaphylaxis, 1% for the remaining desaturations); in less than 1% diagnosis and correction will require a more complex checklist (e.g. for malignant hyperthermia, pneumothorax). The next stage, the development of specific sub-algorithms and a structured team approach for ongoing problems, is in progress.
TL;DR: Future in vivo and in vitro studies of the effects of wear particles should focus on quantitative measurement of the effect of particles and on the use of particles of comparable size and in concentrations similar to those found in the tissues surrounding failed prostheses.
TL;DR: The results indicate that gravity has a major effect on the intragastric distribution and relatively little effect on total stomach emptying of oil, and postprandial hunger is affected by posture and, in the decubitus position, is inversely related to the amount of oil that has entered the small intestine.
TL;DR: Amongst the first 2000 incidents reported to the Australian Incident Monitoring Study, there were 144 incidents in which the "wrong drug" was nearly or actually administered to a patient as discussed by the authors.
Abstract: Amongst the first 2000 incidents reported to the Australian Incident Monitoring Study, there were 144 incidents in which the “wrong drug” was nearly or actually administered to a patient. Thirty-th...
TL;DR: The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed and the capnograph was ranked second and detected 24% of these monitor detected incidents; this figure would have been nearly 30% if a correctly checked, calibrated capnographs had always been used.
Abstract: The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the pulse oximeter. Of these 184 (9%) were first detected by a pulse oximeter and there were a further 177 (9%) in which desaturation was recorded. Of the 1256 incidents which occurred in association with general anaesthesia 48% were "human detected" and 52% "monitor detected". The pulse oximeter was ranked first and detected 27% of these monitor detected incidents; this figure would have been over 40% if an oximeter had always been used and its more informative modulated pulse tone relied upon instead of that of the "bleep" of the ECG. The pulse oximeter is the "front-line" monitor for endobronchial intubation, the fourth most common incident in association with general anaesthesia (it detected 87% of the 76 cases in which it was in use). It also played an invaluable role as a "back-up" monitor in 40 life-threatening situations in which "front-line" monitors (e.g. oxygen analyser, low pressure alarm, capnograph) were either not in use, were being used incorrectly or failed. Other situations detected, in order of frequency of detection, were: circuit disconnection, circuit leak, desaturation (severe shunt), oesophageal intubation, aspiration and/or regurgitation, pulmonary oedema, endotracheal tube obstruction, severe hypotension, failure of oxygen delivery, hypoxic gas mixture, hypoventilation, anaphylaxis, air embolism, bronchospasm, malignant hyperthermia, and tension pneumothorax.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to problems with the endotracheal tube; 189 (9%) were reported as mentioned in this paper and the most common problem was endobronchial intubation which accounted for 42% of these 189 reports.
Abstract: The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to problems with the endotracheal tube; 189 (9%) were reported. The most common problem was endobronchial intubation which accounted for 42% of these 189 reports; endobronchial intubation was the most common cause of arterial desaturation in the 2000 incidents. Obstructions and oesophageal intubation each accounted for 18% of the 189 problems with tubes. The remainder was made up of disconnections and leaks (7% each), misplacements other than endobronchial or oesophageal (4%), inappropriate choice of tube (3%), cuff herniation (1%), failure to deflate the cuff and foreign body in the tube (0.5% each). The pulse oximeter and capnograph first detected 58% of these incidents; a further 25% were detected clinically. The pulse oximeter is the "front-line" monitor for endobronchial intubation, and the capnograph the "front-line" monitor for oesophageal intubation, disconnection and obstruction. Recommendations are made for how to prevent problems and how to determine the nature of those that do occur.
TL;DR: The incidence and nature of significant associated neurosurgical, ocular, spinal, torso and extremity injuries in facial fracture patients treated by the Department of Plastic and Reconstructive Surgery from June 1989 to June 1992 are reported.
TL;DR: Day surgery in a teaching hospital can provide satisfactory outcome, with low complication rates, high patient acceptance and low community support requirements after patient discharge.
Abstract: Outcome has been measured for 6000 consecutive procedures in a major public teaching hospital day surgery unit. The unanticipated hospital admission rate was 1.34% and surgery-related admissions (0...
TL;DR: The only consistent morphological changes present in patients with pain reproduction at discography are the presence of various annular defects involving the outer layers, and discogenic pain may be linked to damage to the outer portion of the annulus fibrosus.
Abstract: Disc degeneration in the human spine is a complex phenomenon characterised by biochemical change in the nucleus pulposus and inner annulus and the formation of clefts and fissures radiating from the central area of the disc towards the periphery. In addition, and probably independent of these phenomena, discrete defects in the outer annular attachement are seen which are likely to be due to mechanical stress and failure. The presence of stress tears in disc tissue and their failure to heal can initiate or accelerate the degeneration of the central component of the intervertebral disc. We postulate that discogenic pain may be linked to damage to the outer portion of the annulus fibrosus. Although it would seem logical to assume that discs with sustained high intradiscal pressure would be more prone to pain referred in the outer annular layers because of higher tensile strain, analysis of prospective studies has failed to confirm a relationship between typical pain reproduction at discography and high pressure values. It is concluded that, at present, the only consistent morphological changes present in patients with pain reproduction at discography are the presence of various annular defects involving the outer layers. Whether nerve ingrowth during attempts at repair of these defects is a consistent feature remains to be established.
TL;DR: AIMS has the potential not only to play a vital practical role in the continued enhancement of the quality of anaesthetic practice, but also to provide a valuable resource for research at the increasingly important interface between human behaviour and complex systems.
Abstract: Although 70–80% of problems have some component of human error, its overall contribution to many problems may be small; studies of complex systems have revealed that up to 85% are primarily due to ...
TL;DR: Meticulous adherence to the equipment checking and monitoring guidelines of the Australian and New Zealand College of Anaesthetists and application of a suitable crisis management algorithm should protect the patient from potentially life-threatening equipment failure in virtually all cases except electric shock, power failure and overheating of warming devices.
Abstract: Of the first 2000 incidents reported to the Australian Incident Monitoring Study, 177 (9%) were due to “pure” equipment failure according to pre-defined criteria. Of these 107 (60%) involved anaesthetic equipment, 42 (24%) involved monitors, 17 (10%) other theatre equipment and 11 (6%) the gas or electricity supply. Ninety-seven (55% of the 177) were potentially life-threatening; of these two-thirds would be detected by the array of monitors recommended by the Australian and New Zealand College of Anaesthetists and all but 9 of the remainder would be handled by application of the crisis management algorithm recommended elsewhere in this symposium. Of the 9 remaining, 2 were electrical shock, 3 overheating of a humidifier or blood warmer, 2 the unavailability of a spare laryngoscope and 1 the consequence of a power failure. Meticulous adherence to the equipment checking and monitoring guidelines of the Australian and New Zealand College of Anaesthetists and application of a suitable crisis management algor...
TL;DR: The incidence of postoperative nausea and vomiting in the recovery room after local anesthesia and sedation (6%) was less than after general anesthesia (14%) (P < .01), and average recovery times to sitting out of bed and being ready for discharge were less after localesthesia and Sedation (38 +/- 15 minutes and 120 +/- 39 minutes, respectively).
TL;DR: D diarrhoea caused by chronic radiation enteritis is associated with more rapid intestinal transit and a high prevalence of bile acid and lactose malabsorption, and loperamide-N-oxide slows small intestinal transit, increases bile Acid absorption, and is effective in the treatment of diarrhoee associated with chronic radiationEnteritis.
Abstract: The effects of loperamide-N-oxide, a new peripheral opiate agonist precursor, on gastrointestinal function were evaluated in 18 patients with diarrhoea caused by chronic radiation enteritis. Each patient was given, in double-blind randomised order, loperamide-N-oxide (3 mg orally twice daily) and placebo for 14 days, separated by a washout period of 14 days. Gastrointestinal symptoms; absorption of bile acid, vitamin B12, lactose, and fat; gastric emptying; small intestinal and whole gut transit; and intestinal permeability were measured during placebo and loperamide-N-oxide phases. Data were compared with those obtained in 18 normal subjects. In the patients, in addition to an increased frequency of bowel actions (p < 0.001), there was reduced bile acid absorption, (p < 0.001) a higher prevalence of lactose malabsorption (p < 0.05) associated with a reduced dietary intake of dairy products (p < 0.02), and faster small intestinal (p < 0.001) and whole gut transit (p < 0.05) when compared with the normal subjects. There was no significant difference in gastric emptying between the two groups. Treatment with loperamide-N-oxide was associated with a reduced frequency of bowel actions (p < 0.001), slower small intestinal (p < 0.001), and total gut transit (p < 0.01), more rapid gastric emptying (p < 0.01), improved absorption of bile acid (p < 0.01), and increased permeability to 51Cr EDTA (p < 0.01). These observations indicate that: (1) diarrhoea caused by chronic radiation enteritis is associated with more rapid intestinal transit and a high prevalence of bile acid and lactose malabsorption, and (2) loperamide-N-oxide slows small intestinal transit, increases bile acid absorption, and is effective in the treatment of diarrhoea associated with chronic radiation enteritis.
TL;DR: It is concluded that stimulation of pyloric contractions and suppression of antral and proximal duodenal motility may contribute to the slowing of gastric emptying produced by cholecystokinin.
Abstract: Stimulation of localised pyloric contractions may be an important mechanism in the slowing of gastric emptying by cholecystokinin infusion. The effect of cholecystokinin octapeptide on fasting pyloric motility was investigated in 14 healthy volunteers. Antral, pyloric, and duodenal pressure responses to normal saline and graded injections of cholecystokinin octapeptide (5, 10, and 20 ng/kg) were measured. Injections were given double blind and in randomised order. All doses of cholecystokinin octapeptide initially stimulated (p < 0.05 cf saline) phasic pressure waves localised to the pylorus--the median number of pyloric pressure waves in the 5 minutes after injection being 0, 3.5, 6, and 7 for the saline and the 5, 10, 20 ng/kg cholecystokinin octapeptide injections respectively. The phasic pyloric motor response to 20 ng/kg cholecystokinin octapeptide injection was greater than that to 5 ng/kg (p < 0.05). Basal pyloric pressure increased after 20 ng/kg (1.0 v 0.2 mm Hg, p < 0.05 cf saline). Antral and duodenal pressure waves were suppressed initially by all doses of cholecystokinin (p < 0.05 cf saline). Subsequently, 20 of the 42 cholecystokinin octapeptide, injections but none of the saline injections, were followed by antropyloric pressure waves. Atropine, 15 micrograms/kg iv as a bolus, and then 4 micrograms/kg/hour iv as an infusion, had no effect on the stimulation of localised phasic pyloric pressure waves by cholecystokinin octapeptide 10 ng/kg. It is concluded that stimulation of pyloric contractions and suppression of antral and proximal duodenal motility may contribute to the slowing of gastric emptying produced by cholecystokinin.
TL;DR: There were 57 reports of possible allergic reactions in the perioperative period in the first 2000 incidents reported to the Australian Incident Monitoring Study and a method of determining an “allergy score” was devised as an indication of which reactions may be most deserving of further investigation.
Abstract: There were 57 reports of possible allergic reactions in the perioperative period in the first 2000 incidents reported to the Australian Incident Monitoring Study. These were examined and classified with respect to presentation, clinical course, agents implicated and management strategies employed. Reactions were graded as to probability of allergic aetiology and severity of systemic disturbance. Two deaths were reported. A method of determining an "allergy score" was devised as an indication of which reactions may be most deserving of further investigation.
TL;DR: The measurement of x-ray beam dose profiles in the penumbral region, using silicon diode, ionization chamber, TLD, and film dosimetry, has been investigated and the width of the point detector penumbra calculated from the diode penumbr is 3.4 mm, indicating that the TLD rods are a good approximation to a point detector.
Abstract: The measurement of x-ray beam dose profiles in the penumbral region, using silicon diode, ionization chamber, TLD, and film dosimetry, has been investigated for a 6-MV beam defined by independent collimators. Penumbral width (80%-20%) at dmax, as measured by diode, film, and TLD was found to be 3.6, 3.6, and 3.4 mm, respectively. These results reflect the relative sensitive widths of each of the measurement systems (2.5, 2.0, and 1.0 mm, respectively). An empirical forming function was used to relate the penumbral shape measured with a finite-sized detector to that which would be measured with a point detector, the width of the point detector penumbra calculated from the diode penumbra is 3.4 mm, indicating that the TLD rods are a good approximation to a point detector. An alternative method of determining the width of a point detector penumbra is to extrapolate the penumbral widths obtained using two or more detectors of sensitive width. With this method, using Farmer and RK ionization chambers, a point detector penumbra width of 3.1 mm is obtained. An EGS4 Monte Carlo simulation, where a point source was assumed, gave a penumbral width of 2.8 mm. Negligible differences between the penumbra of beams defined by symmetric and asymmetric collimators was observed.
TL;DR: There were 35 oesophageal intubations in the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS), with no false positives in the 16 cases in which the instrument was used.
Abstract: There were 35 oesophageal intubations in the first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS). These reports confirm existing impressions that misplacement of the endotracheal tube can occur in trained as well as untrained hands, and that auscultation is an unreliable test. On the other hand, the value of capnography is emphasised, with no false positives in the 16 cases in which the instrument was used. There was one false negative. Over the 4 years of the AIMS study, reports have declined in frequency. It is possible that the early detection of oesophageal intubation by capnography has altered its status to the extent that anaesthetists no longer regard it as a "critical" incident. It is highly recommended that the presence of the expected concentration of carbon dioxide in expired air be confirmed by capnography immediately after any endotracheal intubation.
TL;DR: There is a highly significant difference in the outcome of those cases operated on within 24h of bladder paralysis compared to those operated on after this period, and this is a most important indication for immediate surgery.
Abstract: The syndrome of cauda equina compression due to central disc rupture is uncommon but its importance greatly transcends its rarity. Key symptoms and signs are bilateral leg pain, weakness or numbness (although unilateral symptoms or even absence of leg pain do not exclude the diagnosis), perineal numbness and, in 60% of patients, bladder and bowel incompetence ranging from dysuria to vesical and anal sphincter paralysis. Diagnosis and treatment are often delayed due to lack of recognition of the condition and failure to appreciate the surgical imperative for its treatment. At the present time myelography is the one essential investigation, although this may become supplanted in time by magnetic resonance imaging. Arrangements for myelography should be planned so that immediate operation can be commenced following the procedure. The onset of disc rupture may be acute and massive and result in intradural sequestration of disc fragments in 7.5% of cases. Intradural exploration and/or transdural sequestrectomy avoids traction on already compromised nerve roots and is often safer than extradural sequestrectomy. The onset of bladder paralysis is a most important indication for immediate surgery. The cases presented show that there is a highly significant difference in the outcome of those cases operated on within 24h of bladder paralysis compared to those operated on after this period.
TL;DR: The findings suggest that continuing education is required for GPs and that palliative care should become an integral part of undergraduate education and there is also a need to enhance communication and co-ordination between hospital and community-based services for the terminally ill.
Abstract: A randomly selected sample of 158 South Australian general practitioners (GPs) were sent a questionnaire which assessed opinions and management practices in the palliative care of terminally ill patients. A total of 117 responses (74%) were received. Most GPs were at least moderately satisfied with the care they were able to give their terminally ill patients, although a substantial number reported difficulties in pain and other symptom control, dealing with relatives' emotional distress and attending to patients' psychosocial needs. There was considerable support for continuing education in these aspects of palliative care. More than half were at least somewhat concerned by opioid side effects and impairment of cognitive function, although opioid dependence was not a concern. Considerable dissatisfaction was expressed with public hospital care for the terminally ill and most felt excluded from decision-making once their patients were admitted. The findings suggest that continuing education is required for GPs and that palliative care should become an integral part of undergraduate education. There is also a need to enhance communication and co-ordination between hospital and community-based services for the terminally ill.
TL;DR: Results indicate that cisapride in a dose of 10 mg i.v. has dual effects on gastric emptying and gastric motility, and the stimulation of associated antral pressure waves is a plausible mechanism for the efficacy of cisAPride in the treatment of gastroparesis.
Abstract: There is little information about the effects of cisapride on human antropyloroduodenal motility, despite its documented efficacy for increasing the rate of gastric emptying in patients with gastroparesis. Cisapride has been reported to have little effect on gastric emptying in normal subjects. Antral, pyloric, and duodenal pressures were recorded simultaneously with gastric emptying in 20 healthy volunteers. Thirty minutes after the solid component of the meal had started to empty from the stomach, each subject received either 10 mg cisapride i.v. (11 subjects) or intravenous saline (9 subjects). Intravenous saline had no effect on either motility or gastric emptying. In contrast, cisapride administration was associated with a dual effect on motility, with initial suppression of antral pressure waves (P < 0.05) followed by stimulation of associated antropyloroduodenal pressure waves (P < 0.01). Gastric emptying slowed in the first 30 min after cisapride (P < 0.05), and this was followed by more rapid gas...