Risk-sensitive events during laparoscopic cholecystectomy: the influence of the integrated operating room and a preoperative checklist tool

Background  

Awareness of the relative high rate of adverse events in laparoscopic surgery created a need to safeguard quality and safety of performance better. Technological innovations, such as integrated operating room (OR) systems and checklists, have the potential to improve patient safety, OR efficiency, and surgical outcomes. This study was designed to investigate the influence of the integrated OR system and Pro/cheQ, a digital checklist tool, on the number and type of equipment- and instrument-related risk-sensitive events (RSE) during laparoscopic cholecystectomies.     

Measuring progress in the management of ambient air quality: the case for population health

Although progress has been made in the last few decades at reducing ambient concentrations of air pollutants, scientific evidence suggests that there remains a risk to human health from exposure to these pollutants at current levels in Canada. Much of the motivation for air pollution reduction efforts is to protect population health. This article presents a method of monitoring changes in air pollution-related health outcomes over time in conjunction with temporal changes in ambient pollution concentrations. The progress measure is a function of temporal changes in location-specific ambient concentrations and the potentially time-dependent association between those concentrations and daily deaths. The progress measure can be determined for a single location or at a national level. The measure can also be extended to include several pollutants. The progress measure is illustrated with an example of how changes in nitrogen dioxide levels in 12 Canadian cities from 1981 to 1999 have translated into changes in the percent of nonaccidental mortality burden attributable to this pollutant over time.     

Reliability testing of the Danish version of the Kidney Disease Quality of Life Short Form

OBJECTIVE: The questionnaire Kidney Disease Quality of Life Short Form version 1.3 (KDQOL-SF) is valuable for assessing the health-related quality of life in patients treated with chronic dialysis. The aim of this study was to translate and test the reliability of the KDQOL-SF for use in Denmark. MATERIAL AND METHODS: Translation into Danish and back-translation into English were performed. Pilot, field and internal consistency reliability tests were performed. RESULTS: Cronbach's alpha coefficients for the internal reliability test ranged from 0.77 to 0.93 for the eight generic scales. In a test involving all patients, two of the disease-specific scales had Cronbach's alpha coefficients of <0.70 ("social support" = 0.67; and "quality of social interaction" = 0.43). After removing one item from the scale "quality of social interaction", Cronbach's alpha reached 0.63. A test of the scores of peritoneal dialysis (PD) patients discovered low reliability for three disease-specific scales. The KDQOL-SF manual and the Danish manual for the Short Form 36 (SF36) differed in the scoring of four generic scales: "role limitation-physical", "bodily pain", "general health" and "social function". CONCLUSIONS: With the exception of the scale "quality of social interaction" the Danish translation of the KDQOL-SF achieved values in the internal consistency reliability test of the same level as the original U.S. version. When data were stratified according to dialysis treatment, the reliability of PD patients scores was lower. Generic data from the questionnaire SF36 should be scored according to the Danish SF36 manual.     

Snowboarden

Zusammenfassung Snowboarden hat sich spätestens seit der Olympiade in Nagano 1998 vom Trendsport zum Wintersport der Jugend, aber auch Erwachsener etabliert. Mittlerweile war dieser junge Sport bereits 2-mal bei Olympischen Spielen vertreten. Die häufigste aller erlittenen schweren Verletzungen beim Snowboarden stellt nach wie vor mit mehr als 50% der handgelenknahe Bruch, speziell bei Anfängern dar. Der Einsatz von im Snowboardhandschuh integrierten Handgelenkschienen könnte die Häufigkeit dieser Verletzung auf ein 1/4 reduzieren. Die Anwendung von Schutzausrüstungen und Helmen sollte dringend empfohlen werden und macht in Wettkämpfen, aber auch speziell beim Freizeitfahren und v. a. bei Kindern und jugendlichen Snowboardern Sinn. Die Schulung ungeübter Anfänger hat nach wie vor große Bedeutung.     

Maternal fish oil supplementation in lactation and growth during the first 2.5 years of life

Fish oil addition to infant formulas has raised concern on whether increased intake of n-3 long-chain polyunsaturated fatty acid (n-3LCPUFA) affects infant growth. The objective of this study was to determine whether maternal fish oil supplementation during 0-4 mo of lactation influences growth in infancy and early childhood. In a randomized, blinded intervention trial, lactating Danish mothers with a fish intake below the population median were randomized to 4.5 g/d fish oil or olive oil. A reference group of 53 mothers with a fish intake in the highest quartile of the population and their infants were included in the study. Head circumference, weight, length, skinfold thickness, and waist circumference of children were measured at 2, 4, and 9 mo and at 2.5 y. One hundred children completed the intervention trial, and 72 were followed up at 2.5 y together with 29 from the reference group. Growth in weight, length, and head circumference did not differ between the randomized groups up to 9 mo, but at 2.5 y, body composition differed significantly. Children in the fish oil group had larger waist circumference body mass index (BMI; 0.6 kg/m(2); p = 0.022), and head circumference compared with those in the olive oil group. Adjusted for sex, ponderal index at birth and current energy intake, BMI at 2.5 y was associated with docosahexaenoic acid in maternal erythrocytes after the intervention. In conclusion, the n-3LCPUFA intake of lactating mothers may be important for growth of young children. The long-term effect on weight and BMI remains to be investigated.     

Effects of ingestion of bicarbonate, citrate, lactate, and chloride on sprint running

PURPOSE: Ingestion of sodium bicarbonate is known to enhance sprint performance, probably via increased buffering of intracellular acidity. The goal was to compare the effect of ingestion of sodium bicarbonate with that of other potential buffering agents (sodium citrate and sodium lactate) and of a placebo (sodium chloride) on sprinting. METHODS: In a double-blind randomized crossover trial, 15 competitive male endurance runners performed a run to exhaustion 90 min after ingestion of each of the agents in the same osmolar dose relative to body mass (3.6 mosmol x kg) on separate days. The agents were packed in gelatin capsules and ingested with 750 mL of water over 90 min. During each treatment we assayed serial finger-prick blood samples for lactate and bicarbonate. A familiarization trial was used to set a treadmill speed for each runner's set of runs. We converted changes in run time between treatments into changes in a time trial of similar duration using the critical-power model, and we estimated likelihood of practical benefit using 0.5% as the smallest worthwhile change in time-trial performance. RESULTS: The mean run times to exhaustion for each treatment were: bicarbonate 82.3 s, lactate 80.2 s, citrate 78.2 s, and chloride 77.4 s. Relative to bicarbonate, the effects on equivalent time-trial time were lactate 1.0%, citrate 2.2%, and chloride 2.7% (90% likely limits +/- 2.1%). Ingested lactate and citrate both appeared to be converted to bicarbonate before the run. There were no substantial differences in gut discomfort between the buffer treatments. CONCLUSION: Bicarbonate is possibly more beneficial to sprint performance than lactate and probably more beneficial than citrate or chloride. We recommend ingestion of sodium bicarbonate to enhance sprint performance.     

Carbamoylcholine homologs: synthesis and pharmacology at nicotinic acetylcholine receptors

In a recent study, racemic 3-(N,N-dimethylamino)butyl-N,N-dimethylcarbamate (1) was shown to be a potent agonist at neuronal nicotinic acetylcholine receptors with a high selectivity for nicotinic over muscarinic acetylcholine receptors [Mol. Pharmacol. 64 (2003) 865-875]. Here we present the synthesis and pharmacological characterization of a series of analogs of, where the methyl group at C-3 has been replaced by different alkyl substituents. Ring systems have been incorporated into the carbon backbone of some of the molecules, or the amino group has been build into ring systems. Furthermore, the (+)- and (-)-enantiomers of have been separated, and X-ray crystallography has revealed that (-)-1 possesses (S)-configuration. The compounds have been characterized pharmacologically at recombinant nicotinic receptor subtypes. The structure-activity relationship study has provided valuable insight into the mode of interactions of and its analogs with neuronal nicotinic acetylcholine receptors.