Postoperative 12-lead ECG predicts peri-operative myocardial ischaemia associated with myocardial cell damage

Peri-operative myocardial ischaemia is the single most important risk factor for an adverse cardiac outcome after non-cardiac surgery. The present study examines whether intermittent 12-lead ECG recordings can be used as an early warning tool to identify patients suffering from peri-operative myocardial ischaemia and subsequent myocardial cell damage. Fifty-five vascular surgery patients at risk for or with a history of coronary artery disease were monitored for peri-operative myocardial ischaemia using intermittent 12-lead ECG recordings taken pre-operatively and at 15 min, 20 h, 48 h, 72 h and 84 h postoperatively. The effectiveness of the 12-lead ECG was gauged by examining concordance with continuous 3-channel Holter monitoring and capturing peri-operative myocardial ischaemia by serial analyses of creatine kinase myocardial band isoenzyme and cardiac troponin T and I. The incidence of peri-operative myocardial ischaemia detected by 12-lead ECG was 44% and was identifiable in most patients (88%) 15 min after surgery. The incidence of peri-operative myocardial ischaemia detected by continuous monitoring was 53%, with the most severe episodes occurring intra-operatively and during emergence from anaesthesia. The concordance of the 12-lead method with continuous monitoring was 72%. The concordance of creatine kinase myocardial band isoenzyme activity with the 12-lead method was 71% and with Holter monitoring 57%. The concordance of mass concentration of creatine kinase myocardial band with 12-lead ECG recordings was 75%, and the corresponding value for Holter monitoring was 68%. The concordance of cardiac troponin T and I levels with the 12-lead method was 85% and 87%, respectively, and concordance with Holter monitoring was 72% and 66%, respectively. The postoperative 12-lead ECG identified peri-operative myocardial ischaemia associated with subsequent myocardial cell damage in most patients undergoing vascular surgery.     

National Immunization Information Hotline: Calls concerning adverse events, 1998-2000

Data from the National Immunization Information Hotline (NIIH) concerning vaccine adverse event inquiries were analyzed from 1998 to 2000 (total n = 23,841 [public n = 14,330; health care professionals n = 9,511]). Approximately 20% of calls from the public from 1998 to 2000 concerned vaccine adverse events. These calls increased 199.5% from 1998 (n = 422) to 1999 (n = 1,264), then declined 12.4% from 1999 to 2000 (n = 1,107). A Lexus Nexus search showed that the number of news stories mentioning vaccine safety showed a similar pattern. Women were more likely to call the NIIH concerning vaccine adverse events than men, and persons 40-59 years old and persons 60 years old and over were less likely to call about vaccine adverse events than those 20-39 years. The parallel trends in news stories mentioning vaccine safety and calls to the NIIH concerning adverse events suggests that news stories may stimulate questions about vaccine safety. Understanding that news stories may elicit questions about vaccine adverse events and examining the characteristics of persons who ask vaccine adverse event questions may guide future informational interventions toward those most in need.     

Interhemispheric interaction and beliefs on our origin: degree of handedness predicts beliefs in creationism versus evolution

It has been suggested that strongly handed individuals have attenuated systems for updating beliefs compared to mixed handers (Niebauer, Aselage, & Schutte, 2002). The current research extended this theory to individual differences in updating beliefs concerning our origins. Although the theory of evolution has gained overwhelming success in the sciences, a significant percentage of the population believes in biblical creationist accounts of human origins that are inconsistent with accepted, contemporary scientific views. If strongly handed individuals possess attenuated systems for updating beliefs, they might be more likely to believe in creationism. In two studies, strongly handed participants were more likely to believe in creationism while mixed-handed participants were more likely to believe in evolution. A model of how interhemispheric interaction functions in maintaining and updating beliefs is discussed. Specifically, mixed-handedness seems to be associated with a lower threshold for updating beliefs.     

Methodolocical issues of naturalistic observational studies on the economic evaluation of neuroleptic treatment for schizophrenic disease

Methodological problems of prospective natural trials are discussed. The application of adequate methods is demonstrated by analysing the effects of antipsychotic medical treatment on the probability and the costs of inpatient episodes of 307 patients with schizophrenia for 2.5 years. Selection bias is controlled by the propensity score method. Effects of medical treatment on the incidence of inpatient episodes are analysed by means of a random-effect logit model. Effects of medical treatment on the costs of inpatient episodes are analysed by means of a random-effect Tobit model. Results of the study show that antipsychotic medical treatment reduces the probability and the costs of inpatient treatment irrespective of the type of neuroleptic drugs. The hypothesis of a higher effectivity of atypical neuroleptics in comparison to conventional antipsychotics regarding the reduction of the incidence and the costs of inpatient treatment was not supported. Beyond the effects of medical treatment the study results indicate that improving social support and competence for coping with life events as well as providing community mental health services may reduce the risk and the costs of inpatient episodes.     

Ultrastructural examination of cell-mediated degradation of a calcium phosphate ceramic

Up to now little is known about cell-mediated degradation of biomaterial surfaces, especially as methodologically significant studies are not available. Therefore, the present study focused on ultrastructural details of cells involved in degradation of calcium phosphate ceramics. For the experimental procedure six adult sheep were used. At the medial aspect of the left hindlimb a cylindrical defect was created at the level of the proximal epiphysis of the tibia. Subsequently, a calcium phosphate paste was packed into the defect. Six weeks after implantation, specimens from the implants fixed by perfusion were examined histologically and by transmission electron microscopy. The results of light microscopy revealed substitution of the ceramic by newly formed lamellar bone. Electron microscopy indicated multinucleated cells localized at the implantation site and the bone surface, corresponding to osteoclasts. They formed resorption lacunae and revealed typical ultrastructural features such as the ruffled border and the sealing zone. Osteoclast-mediated degradation was performed by simultaneous resorption and phagocytosis. For the first time this degradation mechanism was documented in vivo. It confirms the notion that osteoclasts are members of the monocyte/macrophage family.     

Indicators of empowerment and disempowerment in the subjective evaluation of the psychiatric treatment process by persons with severe and persistent mental illness: a qualitative and quantitative analysis

Empowerment and disempowerment is studied in terms of the way persons with long and persistent schizophrenia evaluate their psychiatric outpatient treatment. One hundred persons with the diagnosis of schizophrenia (ICD-10 F 20.0) were interviewed about their perceptions and evaluation of the treatment process by means of problem-focused interviews. Transcribed interviews were subjected to qualitative content analysis. Relationships among the categories of the qualitative content analysis were analyzed by means of a homogeneity analysis. The latent dimension extracted by the homogeneity analysis could be interpreted as a quantitative measure of an empowered or a disempowered perception of the treatment process. As a result of the qualitative content analysis it was found that a majority of participants tend to describe their treatment as reduced to drug treatment and that they tend to notice only positive medication effects rather than mixed medication effects or positive effects of conversation and that they feel helpless or indifferent rather than actively involved in the treatment process. The impact of socio-demographic, clinical, and treatment characteristics on the participants' location on a latent dimension called "empowerment" was examined by means of multiple regression analysis. General life satisfaction, negative symptoms and getting depot medication were positively associated with a more disempowered perception of the treatment process whereas positive symptoms, getting antidepressant medication and being treated in an outpatient clinic instead of a private practice were associated with a more empowered perception.     

Präoperative Nahrungskarenz

Zusammenfassung Die Anordnung einer strikten Nahrungskarenz nach Mitternacht vor operativen Eingriffen in Narkose ist die geläufige Praxis in chirurgischen Einrichtungen in Deutschland. Das damit verfolgte Ziel ist eine Reduktion des perioperativen Aspirationsrisikos. Seit mehreren Jahren wird die wissenschaftliche Grundlage dieser Verfahrensweise zunehmend kritisch diskutiert. Insbesondere für die präoperative Einnahme von Wasser und klarer Flüssigkeit zeigen experimentelle wie klinische Untersuchungen, dass von einer vollständigen Magenpassage innerhalb von 2 h sicher ausgegangen werden kann und das Risiko nach begrenztem Trinken bis 2 h vor elektiven Operationen in Allgemeinanästhesie nicht erhöht ist. Zudem sind perioperative Aspirationszwischenfälle sehr selten, haben eine gute Prognose und sind eher auf Faktoren wie mangelnde Narkosetiefe oder unzureichende Atemwegsprotektion zurückzuführen als auf den Nüchternheitsstatus des Patienten. Folglich haben zahlreiche nationale anästhesiologische Gesellschaften im Sinne eines verbesserten perioperativen Wohlbefindens der Patienten ihre offiziellen Leitlinien zur präoperativen Nüchternheit geändert und empfehlen unter Berücksichtigung definierter Einschränkungen und Kontraindikationen einen gelockerten Umgang mit der Einnahme flüssiger wie fester Nahrung vor elektiven Eingriffen. Die vorliegende Arbeit gibt eine zusammenfassende Übersicht über die Hintergründe, auf denen diese national erstellten Leitlinien beruhen, mit der Absicht auch für Deutschland eine Empfehlung zur Lockerung der präoperativen Nüchternheit für klare Flüssigkeiten vorzuschlagen.     

Population Dynamics of Streptococcus mitis in Its Natural Habitat

The purpose of this study was to examine the genetic structure of the typical commensal Streptococcus mitis biovar 1 in its natural habitat in the human oral cavity and pharynx and to investigate the role that selected microbial properties and host, spatial, and temporal factors play in determining the structure of the bacterial population. Consecutive samples were collected from buccal and pharyngeal mucosal surfaces of two infants, their four parents, and two elderly individuals over a period of approximately 1 year. A total of 751 isolates identified as S. mitis biovar 1 were typed by restriction endonuclease analysis (REA) and representative clones were typed by multilocus enzyme electrophoresis (MLEE). The genetic diversity of the S. mitis biovar 1 isolates collected from single infant hosts over a period of 9 to 10 months was found to be between 0.69 and 0.76, which is considerably higher than that previously observed for intestinal populations of Escherichia coli. The study provides evidence of the existence of both transient and persistent clones in adult individuals. In the two infants, however, none of 42 demonstrated clones were detected on more than a single occasion. Statistical calculations showed that the ability to persist was not distributed at random in the S. mitis biovar 1 population. However, neither immunoglobulin A1 protease activity nor the ability to bind alpha-amylase from saliva was a preferential characteristic of persistent genotypes. In contrast to current concepts of climax ecosystems, the species niche in the habitat appears to be maintained predominantly by a succession of clones rather than by stable strains. Several lines of evidence suggest that the major origin of "new" clones is the many other habitats in the respiratory tract that are occupied by this species.     

Schizophrenic patients' subjective reasons for compliance and noncompliance with neuroleptic treatment

Although several factors influencing schizophrenic patients' compliance with neuroleptic treatment have been investigated, the subjective reasons that patients are willing or reluctant to take medication have rarely been examined. In a follow-up study of a sample of schizophrenic patients currently undergoing psychiatric treatment in the city of Leipzig, 307 patients were asked about their subjective reasons for medication compliance or noncompliance by administering the Rating of Medication Influences (ROMI) Scale. The perceived benefit from medication proved to be the main reason for patients' compliance with neuroleptic treatment. Respectively, patient-reported noncompliance was mainly explained by negative side effects of medication. However, there were no statistically significant differences in responses between the patients receiving conventional versus second-generation antipsychotics. A positive relationship with the therapist and a positive attitude of significant others toward neuroleptic treatment contributed to patients' medication compliance. Reasons for noncompliance with neuroleptic treatment were lack of acceptance of the necessity of pharmacological treatment and lack of insight into the disease. The results emphasize the importance of psychoeducation in enhancing patient compliance with neuroleptic treatment.