Are the “Life‐Support” Courses Updated? An Evaluation of Their Literature Base

Background: As a condition of employment, many physicians practicing in the United States are mandated to remain current in their certification of some or all of the life‐support courses. These courses reputedly set the standard of care by establishing nationally recognized paradigms of resuscitation. These courses' textbooks are revised and re‐released at regular intervals. Objectives: To determine whether the source data for these texts are vigorously updated with each revision and whether there is an obvious literature‐based impetus to release a new version. Methods: A comparison was made of the years of the references contained within the three most recent textbook editions of the advanced cardiac life support (ACLS), advanced trauma life support, basic life support, and pediatric advanced life support courses. The years of the references were tallied for each text, and these tallies were compared both within and between the courses. Data were divided into three groups: group 1, references published before the previous versions' release; group 2, references published after previous versions' release; group 3, references dated within three years of the texts' release. Results: There appears to be a large amount of overlap of group 1 data throughout most of the course texts; the number of references in group 2 and 3 varies greatly between and within these courses. Conclusions: With one exception (ACLS in 2003), the life‐support courses appear to be based on similar reference sets for the last 7 to 11 years. There may be a reason other than an availability of a critical mass of new information that prompts the release of a new edition of these life‐support courses.     

Is parathyroidectomy of benefit in primary hyperparathyroidism?

A retrospective survey was performed on 265 patients with primary hyperparathyroidism who had received three forms of treatment on a non-randomised basis. 'Successful' surgery (normalisation of serum calcium) was carried out in 142 patients, 'unsuccessful' surgery (persistence of hypercalcaemia after neck exploration) in 33 and no surgery in 90. Patients subjected to surgery were significantly younger than patients in the unoperated group and their serum calcium values at the time of decision were approximately 10 per cent higher. The mean follow-up period was significantly longer in the operated groups. The percentages of patients who had died were similar in each group. Clinical events relating to renal stones depended on the presence or absence of calculi at the time of decision rather than on the method of treatment. At the time of follow-up the prevalence of hypertension, renal impairment and vertebral crush fractures were similar in all three groups. Forearm osteo-densitometry showed a higher bone mineral content in the 'successful' group than in the other two groups. In spite of the selection bias inherent in a study of this kind, it is clear that untreated hyperparathyroidism is compatible with long survival and a lack of demonstrable deleterious effects on kidney and bone.     

Sensitivity to penicillin of gonococci in different racial groups

The distribution of the sensitivity to penicillin of gonococci isolated from 631 men and 290 women was analysed in relation to the racial origin of the patients and the type of source contact alleged by the men. No difference in the sensitivity patterns was found between strains from white patients from the United Kingdom and those from immigrants from the Caribbean area. Asian men harboured significantly more insensitive strains than men of other racial groups. Men of Caribbean stock who had been born in this country had significantly more infections due to fully sensitive strains. The reasons for these variations are not known, but one contributory factor may be differences within the racial groups in the proportions of infections contracted from prostitutes.     

Brain slices in radioligand binding assays: Quantification of opiate, benzodiazepines and beta-adrenergic ([H] CGP-12177) receptors

1. We have characterized and quantified specific binding of [³H]-flunitrazepam (FNZ: (benzodiazepine), [³H]-naloxone (NAL: (opiate) and [³h]cgp-12177(CGP: (beta-adrenergic) to thick slices (230–400 μm) of mouse and rat brain.

2. The binding sites are stereospecific, saturable and of high affinity. In all cases, the binding of the ligands is readily reversible and demonstrates the appropriate drug specificity.

3. In mouse brain [³H]-NAL binding is elevated by chronic treatment with naloxone (via capsules).

4. We have been unsuccessful in quantifying beta adrenoreceptors with the archetypal ligand [³H]-dihydroalprenolol (DHA). However, the use of [³H]-CGP 12177 enabled us to detect high-affinity beta adrenoreceptors in brain slices.

5. [³H]-CGP also permits the demonstration of rapid and reversible agonist-induced down-regulation (internalization) of beta binding sites.

6. We have been successful in quantifying beta adrenergic sites in single pineal glands of rat and hamster.     

Partially reversible cerebral atrophy and functional improvement in recently abstinent alcoholics

52 recently abstinent chronic alcoholics were given repeated psychological tests and 20 of these had repeated CT scans. The first scan was done within 5 weeks of the last drink. The degree of measurably reversible cerebral atrophy on CT scan correlated negatively with the interval between the last drink and the first CT scan. Significantly more reversibility of cerebral atrophy was noted in those subjects claiming interscan abstinence. There were positive correlations between functional improvement scores on neurological exam and reversible cerebral atrophy measurements. Significant improvement on psychological test performance was restricted to patients tested initially within 3 weeks of the last drink. Both the CT results and the psychological test results suggest that reversible changes occur soon after the cessation of drinking.     

False-positive DNA probe test for Legionella species associated with a cluster of respiratory illnesses.

Between 11 November 1986 and 28 February 1987, legionellosis was diagnosed in 23 patients at one hospital with a recently marketed Legionella-specific DNA probe for respiratory secretions. Only 10 of the 23 probe-positive patients showed findings typical of Legionella pneumonia, including a temperature of greater than or equal to 100.5 degrees F (approximately 38.1 degrees C) and radiographic evidence of pneumonia. No differences were found in the results of laboratory studies, demographic features, or underlying risk factors for these 10 probe-positive patients when compared with the 13 probe-positive patients with nonpneumonic illnesses. A case-control study comparing probe-positive and -negative patients failed to identify any different features of disease or epidemiologic characteristics. Probes of repeat specimens of sputum were still positive 2 to 13 weeks after the initial test in 5 (50%) of the 10 probe-positive patients. The clinical features in most patients were atypical for legionellosis, and the diagnosis could not be confirmed by traditional laboratory tests performed on duplicate specimens processed at the Centers for Disease Control. This report emphasizes the need for clinical microbiology laboratories to confirm test results from new procedures by accepted diagnostic methods.