Agreement of clinical measurements of liver size with ultrasound when performed by medical students.

Aim: The accuracy of physical examination techniques in detecting liver disease is unclear. We sought to determine the perceived location of the lower liver border via scratch, percussion, palpation and ballottement with novice medical student examiners, compared with ultrasound localisation.

Method: Five novice medical students learnt four liver examination techniques and measured the lower liver border in 19 healthy volunteers.

Cardiac baroreflex gain is frequency dependent: insights from repeated sit-to-stand maneuvers and the modified Oxford method.

Cardiac baroreflex gain is usually quantified as the reflex alteration in heart rate during changes in blood pressure without considering the effect of the rate of change in blood pressure on the estimated gain. This study sought to (i) characterize baroreflex gain as a function of blood pressure oscillation frequencies using a repeat sit-to-stand method and (ii) compare baroreflex gain values obtained using the sit-to-stand method against the modified Oxford method. Fifteen healthy individuals underwent the repeated sit-to-stand method in which blood pressure oscillations were driven at 0.

Junior doctor skill in the art of physical examination: a retrospective study of the medical admission note over four decades.

Objectives: To investigate the hypothesis that junior doctors' examination skills are deteriorating by assessing the medical admission note examination record.

Design: Retrospective study of the admission record.

Setting: Tertiary care hospital.

Cardioventilatory coupling in preterm and term infants: effect of position and sleep state.

This study documented the effect of position on cardioventilatory coupling (CVC), the triggering of inspiratory onset by a preceding heartbeat, in infants. Cardiorespiratory signals and corresponding oxygen saturation (SpO(2)) were downloaded from Quiet Sleep (QS) and Active Sleep (AS) in prone and supine from preterm (PT) and term (T) infants. Inspiratory onsets (I) and timing of the corresponding ECG R wave were determined and R-R and R-I intervals calculated.

Interactions between heart rate variability and pulmonary gas exchange efficiency in humans.

The respiratory component of heart rate variability (respiratory sinus arrhythmia, RSA) has been associated with improved pulmonary gas exchange efficiency in humans via the apparent clustering and scattering of heart beats in time with the inspiratory and expiratory phases of alveolar ventilation, respectively. However, since human RSA causes only marginal redistribution of heart beats to inspiration, we tested the hypothesis that any association between RSA amplitude and pulmonary gas exchange efficiency may be indirect. In 11 patients with fixed-rate cardiac pacemakers and 10 healthy control subjects, we recorded R-R intervals, respiratory flow, end-tidal gas tension and the ventilatory equivalents for carbon dioxide and oxygen during 'fast' (0.

Peri-operative management of anti-platelet agents.

Background: Increasing numbers of patients treated with anti-platelet agents are presenting for non-cardiac surgery. We examined the peri-operative management of anti-platelet therapy in patients undergoing elective non-cardiac surgery and the process by which patients received instructions.

Methods: We interviewed and collected outcome data on 213 consecutive patients aged > or = 45 years presenting for elective non-cardiac surgery at our institution over a 6-week period regarding the peri-operative management of anti-platelet and warfarin therapy.

Paradoxical respiratory sinus arrhythmia in the anesthetized rat.

This study examines respiratory sinus arrhythmia (RSA) in the isoflurane-anesthetized rat. In fifteen female Sprague-Dawley rats, we recorded continuous ECG and respiratory airflow before and after bilateral vagotomy. RSA was assessed using power spectral analysis and by plotting the normalised changes in heart period as a function of the time during the respiratory cycle.