Caffeine for the prevention of postoperative nausea and vomiting.

Context: Postoperative nausea and vomiting (PONV) is common after ambulatory surgery performed under general anesthesia. Anecdotal evidence suggests that caffeine may be useful in preventing PONV.

Aims: The aim of the study was to determine efficacy of intravenous (IV) caffeine given prior to surgery is effective prophylaxis against PONV.

Practice policies for older anesthesiologists in academic departments: a national survey of academic departmental chairpersons.

Study Objectives: To determine 1) which proportion of academic departments have policies concerning older anesthesiologists, 2) whether departments with such policies, particularly those related to call, had characteristics such as departmental size and proportions of older anesthesiologists that differed from departments without these policies, 3) if departments routinely screened their older members for problem behaviors, and 4) if departments provided nonclinical roles for older anesthesiologists.

Design: Survey instrument.

Setting: Academic medical centers.

Doctors in acute and longitudinal care specialties emphasise different professional attributes: implications for training programmes.

Objectives: Organised medicine mandates that professionalism be taught during specialty training. This study's primary objective was to determine the relative importance that doctors in different specialties place on different attributes of a medical professional.

Methods: Attending staff and resident doctors in acute care (anaesthesia, emergency medicine, surgery) and longitudinal care (internal medicine, psychiatry) specialties at a large academic hospital completed an anonymous, web-based survey.

The effect of eflornithine 13.9% cream on the bother and discomfort due to hirsutism.

Although unwanted facial hair often leads to anxiety and avoidance of social situations, evaluation of treatment outcomes in clinical trials has relied largely on measures external to the patient such as the extent of hair growth or an expert physician's assessment, neglecting to include patient reported outcomes (PRO). To assess the level of bother caused by a dermatological condition (hirsutism) and changes brought on by treatment, the instrument ESTEEM was developed by expanding the Bother Assessment in Skin Conditions (BASC) scale to six questions to cover the discomfort felt in four social situations and bother due to removing facial hair. Each question elicits responses on a visual analog scale.

Postmarketing studies: benefits and risks.

Objective: To consider the benefits and risks of large postmarketing outcomes studies, as demonstrated by studies of the statin drugs.

Methods: Literature review.

Results: The risks were that the statin studies had a strong coat-tail effect.

Assessing the health and economic impact of galantamine treatment in patients with Alzheimer's disease in the health care systems of different countries.

Introduction: Cholinesterase inhibitors have been shown to improve cognitive function and improve or maintain global function.

Objective: To estimate the long-term economic impact of treating patients with Alzheimer's disease with galantamine in seven healthcare systems: Australia, Canada, Finland, New Zealand, Sweden, the Netherlands and the UK.

Methods: The time until patients require full-time care (FTC), defined as the consistent requirement for a significant amount of care giving and supervision each day, and the associated costs were evaluated using the 'Assessment of Health Economics in Alzheimer's Disease (AHEAD)' model.

Assessment of Health Economics in Alzheimer's Disease (AHEAD): treatment with galantamine in Sweden.

Background: Like other developed countries with aging populations, Sweden is expecting large increases in the prevalence of Alzheimer's disease and corresponding escalations in the cost of care for patients with this disease. Galantamine, a new acetylcholinesterase inhibitor and nicotinic modulator, has proved effective in managing patients with Alzheimer's disease in clinical trials.

Objective: To estimate the long-term health and economic impact of galantamine from the perspective of the public health payer in Sweden.

Clinical judgment and clinical practice guidelines.

Clinicians make judgments under conditions of uncertainty. Decision research has shown that in uncertain situations individuals do not always act rationally, coherently, or to maximize their expected utility. Advocates of clinical guidelines believe that these guidelines will eliminate some of the cognitive biases that the practitioner may introduce into the medical decision-making process in an attempt to reduce its uncertainty.

Compliance and hypertension.

Despite decades of attention to noncompliance to treatment for hypertension, the problem remains a significant factor in the inadequate control of blood pressure. Current approaches to enhancing compliance use patient demographics, medication characteristics, clinical factors, health beliefs, and the quality of patient-provider communication. Clinical researchers are just beginning to apply a new approach that views compliance as a behavior change taking place over time.

Stages of change for adherence with medication regimens for chronic disease: development and validation of a measure.

Background: The stages-of-change (SOC) model has been used to explain and predict how behavior change occurs, but it is new as an approach to understanding why patients fail to take their medications as prescribed.

Objective: This study validated a 2-item measure of SOC for adherence with medication regimens in 2 groups of patients prescribed pharmacologic therapy for chronic conditions.

Methods: Two cross-sectional studies of attitudes toward medication adherence included the same measure of SOC for medication adherence.

Planned duration of residential drug abuse treatment: efficacy versus effectiveness.

Aims: Two randomized controlled trials of residential drug abuse treatment programs found the programs to be equally effective, based on outcomes among those assigned to the treatments. This study aimed to compare the relative efficacy of the programs, based on outcomes among those who received the specific treatment program as planned.

Design: Secondary analyses of data from two concurrent randomized controlled trials, with stratification by actual length of stay.

The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior.

Objective: This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors.

Methods: Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.

Strategies for follow-up of drug users: field research guidelines.

The timely follow-up of clients who exited from two residential treatment programs was achieved by the consistent application of the described strategies. The enrollment and treatment phases of the study provided the environment for the use of standard follow-up and enhanced outreach methods. The applicability of the strategies to a variety of settings makes the prioritization of the follow-up methods presented a meaningful one.

Changes in HIV risk behavior following alternative residential programs of drug abuse treatment and AIDS education.

We compared the effectiveness in changing human immunodeficiency virus (HIV) risk behavior of two different approaches to acquired immunodeficiency syndrome (AIDS) education given by residential drug abuse treatment programs differing in their planned duration. Two randomized controlled trials compared (a) a 6-month with a 12-month therapeutic community (TC) program, and (b) a 6-month with a 3-month relapse prevention (RP) program. Three composite variables assessing HIV risk (a) drug injection, (b) sexual partners, and (c) condom use-were measured for the 3 months prior to admission and follow-up.

The effectiveness of alternative planned durations of residential drug abuse treatment.

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates.

The relationship between legal factors and attrition from a residential drug abuse treatment program.

This article examines the legal involvement of 438 clients randomized to three- and six-month versions of a residential drug abuse treatment program with respect to early attrition (before 40 days in treatment) and later attrition (40-79 days in treatment). Concern about legal problems was reported by 21% of subjects in response to an open-ended question about factors that led to admission; 42% had other legal circumstances that were determined either from documented evidence of legal involvement from chart review or from self-report through structured questioning about legal status. For those with "concern about legal problems" the early attrition rate was 16%, compared with 33% for those with no legal factors--odds ratio (OR) .

Radioimmunoassay of hair for determination of cocaine, heroin, and marijuana exposure: comparison with self-report.

Radioimmunoassay of hair (RIAH) was compared with self-report for cocaine, heroin, and marijuana in two populations: 109 persons entering residential drug user treatment and 86 at follow-up posttreatment. Among treatment entrants, 89% of 87 RIAH cocaine-positives and 96% of 45 RIAH heroin-positives were confirmed by self-report. However, among those followed-up posttreatment, only 51% of 43 RIAH cocaine-positives and 67% of 18 RIAH heroin-positives were so confirmed.

A comparison of clinical and psychological effects of fentanyl and nalbuphine in ambulatory gynecologic patients.

Drug dosages, length of stay (LOS), and incidence of psychological side effects of fentanyl and nalbuphine were compared in a randomized, double-blind study using unpremedicated female day-surgery patients undergoing diagnostic laparoscopy. Patients received either fentanyl 1.5 micrograms/kg (F group; n = 142), low-dose nalbuphine 300 micrograms/kg (LN group; N = 103), or high-dose nalbuphine 500 micrograms/kg (HN group; n = 41), intravenously (IV) before anesthesia consisting of thiopental, N2O, O2, and a succinylcholine infusion.

Impact of a cardiology data bank on physicians' prognostic estimates. Evidence that cardiology fellows change their estimates to become as accurate as the faculty.

To determine whether physicians would be influenced by the prognostic information in a large coronary artery disease data bank, cardiology faculty and fellows made initial estimates of the prognoses of their patients and then made revised final estimates after seeing the outcome of matched patients (OMP) from the data bank. The faculty cardiologists' original estimates proved to be as accurate as those of the data bank's OMP, and the faculty revised their estimates minimally in response to the data bank's OMP. Conversely, the cardiology fellows' original estimates were less accurate than the data bank's OMP, and under all observed circumstances the fellows responded more to the data bank's OMP than did the faculty.

Effects of nitrous oxide on decision-strategy and sustained attention.

Effects of 10,20, and 30% N2O on decision-making strategy, reaction-times, sustained attention, the Digit Symbol Subsititution Test (DSST), short-term memory and the Clyde Mood Scale were assessed in 12 test subjects. Decision-making strategy, as measured by 2-choice probability-learning, was unaffected by 30% N2O once a strategy had been formulated, but reaction-times were increased. Sustained attention was significantly affected in 33% of our subjects, whereas performance on the DSST and on the short-term memory task was impaired in virtually all subjects.