Normal chemoreceptor function in obesity before and after heal bypass surgery to force weight reduction

Ventilatory responses to progressive isocapnic hypoxia and rebreathing of carbon dioxide in oxygen were determined in four obese women before and approximately 1 year after ileal bypass surgery to force weight reduction. None of the patients was hypoventilating and all had normal pulmonary function tests. The ventilatory responses to hypoxia were normal before surgery and were not effected by weight reduction. The ventilatory responses to hypercapnia did not change in slope but a shift of the carbon dioxide response line toward a lower arterial carbon dioxide tension occurred in two subjects after weight reduction. We conclude that obesity per se does not necessarily cause loss of hypoxic ventilatory drive.     

The Upper Limb Functional Index: development and determination of reliability, validity, and responsiveness.

PURPOSE: Current upper limb regional self-report outcome measures are criticized for poor clinical utility, including length, ease, and time to complete and score, missing responses, and poor psychometric properties. To address these concerns a new measure, the Upper Limb Functional Index (ULFI), was developed with reliability, validity, and responsiveness being determined in a prospective study. METHODS: Patients from nine Australian outpatient settings completed the ULFI and two established scales, the Disabilities of the Arm, Shoulder, and Hand (DASH) (n=214) and the Upper Extremity Functional Scale (UEFS) (n=64) concurrently to enable construct and criterion validity to be assessed. Two subgroups were used to assess test-retest reliability at 48-hour intervals (n=46) and responsiveness through distribution-based methods (n=29). Internal consistency, change scores, and missing responses were calculated. Practical characteristics of the scale were assessed. RESULTS: The ULFI correlated with the DASH (r=0.85; 95% CI) and UEFS (r=0.78; 95% confidence interval [CI]), demonstrated test-retest reliability (intraclass correlation coefficient=0.96; 95% CI) and internal consistency (Cronbach alpha=0.89). The change scores of the ULFI with standard error of the measurement was 4.5% or 1.13 ULFI-points and minimal detectable change at the 90% CI was 10.4% or 2.6 ULFI-points. Responsiveness indices were standardized response mean at 1.87 and effect size at 1.28. The ULFI demonstrated an impairment range of 0-100%, with no missing responses and a combined patient completion and therapist scoring time of less than 3 minutes. CONCLUSIONS: The ULFI demonstrated sound psychometric properties, practical characteristics, and clinical utility thereby making it a viable clinical outcome tool for the determination of upper limb status and impairment. The ULFI is suggested as the preferred upper limb regional tool due to its superior practical characteristics and clinical utility, and comparable psychometric properties without a tendency toward item redundancy.     

Quality assurance/peer review for recredentialing/relicensure in New York State.

In consultation with the State Health Department, the New York State Society of Anesthesiologists has developed a Model Program of Quality Assurance/Peer Review for Recredentialing/Relicensure. The Model Program was developed to provide a standardized peer review process through which anesthesiologists practicing in New York State can be recredentialed and relicensed when recredentialing becomes a requirement for relicensure of New York State physicians. The program of recredentialing and relicensure is part of the agenda of the Governor's office, the State Health Department, and the State Education Department to improve the quality of healthcare in New York State through (1) identifying physicians whose quality of care is below reasonable thresholds, (2) assuring that these physicians receive appropriate remedial education or training, and (3) generally raising the quality of healthcare provided by all physicians practicing in New York State.