Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 3: Can metronomes improve CPR quality?

A short cut review was carried out to establish whether metronomes can improve the quality of cardiopulmonary resuscitation. 38 papers were found using the reported searches, none of which directly addressed the problem but some 21 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are tabulated.

Towards evidence-based emergency medicine: Best BETs from the Manchester Royal Infirmary. BET 2: Is there value in testing troponin levels after ICD discharge?

A short cut review was carried out to establish whether testing for troponin levels is useful after discharge of an Implanted Cardioverter-Defibrillator (ICD). Many papers were found using the reported searches, none of which directly addressed the problem but some 13 presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of those best papers are tabulated.

Scaphoid views: a need for standardisation.

Aims: Several views are needed to visualise the scaphoid. These are routinely called 'scaphoid views'. The authors believe that asking for scaphoid views from the radiology department often leads to a wide variety and number of radiographic views being taken.

Knowledge and attitudes about vaginal birth after Caesarean section in Australian hospitals. VBAC Study Group. Vaginal Birth After Caesarean.

A survey of staff attitudes and knowledge about vaginal birth after Caesarean section (VBAC) was undertaken in Australian hospitals. There was a high response rate (67%), and over 900 responses were analysed. Generally, there was a high level of awareness about outcomes and the relative importance of many issues in considering VBAC.

Vaginal birth after Caesarean section: an Australian multicentre study. VBAC Study Group.

Retrospective analysis of medical records and individual case review was undertaken at 11 major obstetric hospitals for a 5 year period from July 1992 to June 1997 to investigate rates of vaginal birth after Caesarean section (VBAC), the occurrences of uterine rupture, and the outcomes for mother and infant following rupture. Total deliveries were 234,015, of which 21,452 or 9.2% were associated with one or more previous Caesarean sections.

A novel assay for detecting antibodies to cytochrome P4502D6, the molecular target of liver kidney microsomal antibody type 1.

Liver Kidney Microsomal type 1 (LKM1) antibody, the diagnostic marker of autoimmune hepatitis type 2, is also found in a proportion of patients with hepatitis C virus infection (HCV). It is detected conventionally by the subjective immunofluorescence technique. Our aim was to establish a simple and objective enzyme-linked immunosorbent assay (ELISA) that measures antibodies to cytochrome P4502D6 (CYP2D6), the target of LKM1.

Soft tissue lipoleiomyoma.

A primary tumor composed of mature adipose tissue and smooth muscle occurring in the anterior abdominal wall of a 46 yr old Filipino woman is described. The tumor was not attached to the uterus, but had an appearance similar to a uterine lipoleiomyoma. It appeared as a soft, rubbery, encapsulated 11 cm ovoid mass with a uniform, white cut surface.

Caesarean section and trial of scar.

A retrospective study over a 16-year interval at the Mercy Maternity Hospital was made to analyse the contribution made by repeat Caesarean to the overall Caesarean section rate. The practice of trial of scar was examined with reference to the selection of patients, the conduct of labour, and the risks incurred by the mother and infant. The literature has been reviewed.

Assessment of foetal welfare.

While the reduction in maternal and perinatal mortality remains a constant goal, the emphasis in modern obstetrics has shifted towards the assessment of foetal welfare in utero. However, if the clinician is to avoid ultimate confusion, he must temper the information which may be obtained from the numerous tests and techniques available with shrewd clinical judgement. In addition, in the current climate of economic audit, he must consider the cost of the investigations in pure monetary terms.

The effect of fetal and placental weight at birth on weight during early childhood.

A study of children whose birth weights or placental weights were above the 90th or below the 10th percentile for gestational age indicated that bigness at birth tends to be an innate quality, as the majority of those who were large at birth remained oversized. The small at birth are not all destined to remain diminutive, as the children in this category attained a normal distribution curve for weight during the first year of life. Thus smallness at birth may represent intrauterine nutritional deprivation and be overcome with normal access to calories.