Is there still a place for dopamine in the modern intensive care unit?

For many years, dopamine was considered an essential drug in the intensive care unit (ICU) for its cardiovascular effects and, even more, for its supposedly protective effects on renal function and splanchnic mucosal perfusion. There is now ample scientific evidence that low dose dopamine is ineffective for prevention and treatment of acute renal failure and for protection of the gut. Until recently, low-dose dopamine was considered to be relatively free of side effects. However, it is now clear that low-dose dopamine, besides not achieving the preset goal of organ protection, may also be deleterious because it can induce renal failure in normo- and hypovolemic patients. Furthermore, dopamine may cause harm by impairing mucosal blood flow and by aggravating reduced gastric motility. Dopamine also suppresses the secretion and function of anterior pituitary hormones, thereby aggravating catabolism and cellular immune dysfunction and inducing central hypothyroidism. In addition, dopamine blunts the ventilatory drive, increasing the risk of respiratory failure in patients who are being weaned from mechanical ventilation. We conclude that there is no longer a place for low-dose dopamine in the ICU and that, in view of its side effects, its extended use as a vasopressor may also be questioned.     

Measuring the immeasurable? Assessing the quality of anaesthetic care

Quality can be viewed from three perspectives: the requirements of the healthcare system; issues related to delivery of care, such as access; and methods used to measure quality, such as outcome analysis. These viewpoints can be applied to the anaesthetic literature to analyse the assessment of quality of care.     

Osteoporosis management and the utilization of FRAX?: a survey amongst health care professionals of the Asia-Pacific

Summary

This survey investigated osteoporosis management practices in the Asia-Pacific region. While access to anti-osteoporotic medication is reasonable, screening for secondary contributors is performed insufficiently. FRAX? is well-known, but not used by many physicians. High costs of medication and unawareness about the disease are the biggest barriers to osteoporosis care.

Purpose

Osteoporosis is an increasing burden amongst countries of the Asia-Pacific. The fracture risk assessment tool FRAX? has recently been introduced in some Asian countries. This study aimed to identify attitudes about osteoporosis management in general and the utilization of FRAX? in particular amongst physicians in the Asia-Pacific region.

Methods

A 26-item questionnaire was distributed to the participants of the first Asian regional osteoporosis meeting of the IOF in 2010. In total, 247 valid questionnaires representing 17 countries from the Asia-Pacific region were analyzed.

Results

Most physicians make use of bone densitometry devices (94?%) and have access to at least one type of anti-osteoporotic medication (100?%). Central dual-energy X-ray absorptiometry was the most accessible device (87?%). Oral bisphosphonates were the only medication that was available to health care professionals in all surveyed Asia-Pacific countries. Seventy-six percent were aware of FRAX?; however, among these only 62?% used it. The main reason for not using FRAX? was the lack of country-specific models (46?%). Screening for secondary osteoporosis was performed by 36?% of the respondents. The high costs of medication and lack of awareness amongst physicians and patients about the disease were perceived as the most important barriers to osteoporosis care.

Conclusion

More FRAX? models should be established and implemented into the local guidelines. The necessity of screening for secondary contributors to osteoporosis should be emphasized, as easily treatable causes might be identified. To further improve osteoporosis diagnosis and treatment, the awareness of osteoporosis among doctors as well as patients needs to be raised.     

Analysis of the s2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine?

Background Context

Arthrodesis of the lumbosacral junction continues to be a challenge in pediatric and adult spinal deformity surgery.

Minimally Invasive Biopsy Methods – Diagnostics or Therapy? Personal Opinion and Review of the Literature

SUMMARY: This article provides an overview of different minimally invasive biopsy (MIB) methods for preoperative assessment of suspicious and indeterminate breast lesions. Accuracy depends on the choice of method and on lesion characteristics. An additional aspect deals with the question whether or not MIB is a suitable therapeutic approach in selected lesions.